Light or No Lights?

[Tigger]

Unless a firefighter or a cop is in the back of an ambulance or some tactical vehicle (think SWAT APC) there is no reason they should be exempt from seatbelt laws. I'm not totally sure how it works for FFs being belted while they're getting their SCBA on and what not in the truck mounted ones so I could see n exemption there for the little bit of time it takes to get envy thing squared away without the seatbelt in the way but that's about it.

Meh even with the in-seat SCBA there is still no excuse. I recall Denver Fire distributing a video showing how to get in the truck and put your seatbelt on so it wasn't tangled in anything and that one could dismount on scene and be good to go.

The department whose station I run out of got rid of the option entirely due in part to poor seatbelt compliance from what I heard.

We run L&S on nearly all responses, particularly since our dispatches are known to be wrong. I've been called to a "teen not feeling well" only to roll up on him in full cardiac arrest! Of course, I've also responded to "pregnant, full-term female hemorrhaging" only to determine, on-scene, epistaxis. The only time we wouldn't go L&S to the scene is if the dispatcher, PD or first responder says, over the air or a recorded line, "precautionary" or "mental hygiene."

There are few truly time sensitive emergencies where a couple minutes make any difference at all. The fact that you have occasionally showed up to a call and found a critical patient when you were not expecting one does not justify responding emergent all the time. I'd bet that the vast majority of the time that dispatch gets it right, or at least close in terms of priority. Some errors will be made, it's inevitable. A miniscule decrease in the error rate while putting my, my partner's, and the general public's lives in danger is not worth this change.

From a legal perspective, they called 911 because (they believed) they were having an "emergency". If I were called to the witness stand, I would have to answer why I took it upon myself to determine it wasn't an emergency.

I don't care if the patient thinks they are having a true medical emergency, because odds are they are not. Needing an ambulance to go to the hospital and having a true, time sensitive medical emergency are not the same things. If, for the sake of argument, the patient has stubbed his toe and it hurts rull bad, the patient might think he is having an emergency. As medical professionals (or something like that), we know in fact that he is not having an emergency! At some point we have to call it like it is. In the days of EMD if it sounds like something that is not time sensitive, it probably isn't.

From the scene to the hospital, it just depends on the condition of the Pt. We don't employ hard rules. The notion you wouldn't go L&S with BLS is crazy. In NYC, as in many places, all trauma is BLS. If I have a guy who fell 15-ft off a ladder and is unstable or potentially unstable, you won't find me stopping at red lights under the false notion that BLS is never emergent.

Most BLS calls should be non-emergent. If you have a patient in back that would be better served by ALS then that's one thing, but systems that routinely do that are broken. If I fall off a 15 foot latter and am still conscious you can bet that I will be whining aggressively until someone comes to give me pain meds. This will be done before I am moved. That is what the standard of care is. Throwing me in back and driving emergent is about the opposite of what good care is.

 

[lightsandsirens5]

Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.

Not the best system.

Exactly the same here minus the fire response.

Every. Freaking. Call. Is dispatched P1. I hate it, despite what my username is....

 

[EMDispatch]

Unfortunately we don't advise priority in my area... They tried a pilot test, and it failed miserably. So they mostly run hot to all calls, but we try to give them a good idea of the priority in our dispatches. Still, most just run hot. We also have automatic mutual aid in some areas, which also ignores priority. I'm never a big fan of sending two different county ALS agencies plus volly units to a low priority sick person.

 

[Tigger]

Unfortunately we don't advise priority in my area... They tried a pilot test, and it failed miserably. So they mostly run hot to all calls, but we try to give them a good idea of the priority in our dispatches. Still, most just run hot. We also have automatic mutual aid in some areas, which also ignores priority. I'm never a big fan of sending two different county ALS agencies plus volly units to a low priority sick person.

Why did it fail?

 

[EMDispatch]

Why did it fail?

Apparently field units didn't follow the Alpha-Echo system. They just didn't want to deal with it, and they felt it wasn't benificial, or at least that's what we were told. I'd imagine we'd try to input it again, it's been at least 2 years since they've tried it

 

[Tigger]

Apparently field units didn't follow the Alpha-Echo system. They just didn't want to deal with it, and they felt it wasn't benificial, or at least that's what we were told. I'd imagine we'd try to input it again, it's been at least 2 years since they've tried it

So they system didn't fail, the crew's just failed to implement it.

That's too bad, sorry about that.

 

[JMorin95]

My service makes it 100% the crews choice on l and s response. Up to the person whether not we transport l and s. We tend to not use l and s unless the patient is unstable/critical.

 

[highglyder]

Response priority is determined by the algorithm that our dispatchers follow. Return priority is determined by us based on the patient's current and anticipated condition.

 

[wigwag]

There are few truly time sensitive emergencies where a couple minutes make any difference at all. The fact that you have occasionally showed up to a call and found a critical patient when you were not expecting one does not justify responding emergent all the time. I'd bet that the vast majority of the time that dispatch gets it right, or at least close in terms of priority.

We are dispatched by PD and they do not give a priority. So saying they get the "priority right" most of the time is simply not factual. You are making the assumption that I'm given a priority and ignore it.

If, for the sake of argument, the patient has stubbed his toe and it hurts rull bad, the patient might think he is having an emergency. As medical professionals (or something like that), we know in fact that he is not having an emergency! At some point we have to call it like it is. In the days of EMD if it sounds like something that is not time sensitive, it probably isn't.

We are not EMD'd. Again, you are making a lot of assumptions about my service and about me. You have now made the assumption that we are being given a priority by an EMD. The 911 call-taker is a patrol cop, working a rotation, who only asks one question if the Pt isn't the caller, and that's "is he breathing?" If they say "yes, the person is breathing," then the cop tells us "the patient is conscious and alert." !! You heard me right.

This is why many dispatches have been wrong in terms of chief complaints. There is no EMD and the dispatcher asks no questions as they aren't trained to ask them. Our agency is not immune from being sued like the dispatcher (police) is. I wish this wasn't the case, but it answers why we respond hot to most calls.

Now, proceed with telling us all why we are so wrong.

 

[Tigger]

We are dispatched by PD and they do not give a priority. So saying they get the "priority right" most of the time is simply not factual. You are making the assumption that I'm given a priority and ignore it.

I did assume you had EMD, my bad. The place where I work also does not have EMD for 60% of our calls. They city we cover has it, the county we cover does not.

We are not EMD'd. Again, you are making a lot of assumptions about my service and about me. You have now made the assumption that we are being given a priority by an EMD. The 911 call-taker is a patrol cop, working a rotation, who only asks one question if the Pt isn't the caller, and that's "is he breathing?" If they say "yes, the person is breathing," then the cop tells us "the patient is conscious and alert." !! You heard me right.

This is why many dispatches have been wrong in terms of chief complaints. There is no EMD and the dispatcher asks no questions as they aren't trained to ask them. Our agency is not immune from being sued like the dispatcher (police) is. I wish this wasn't the case, but it answers why we respond hot to most calls.

Now, proceed with telling us all why we are so wrong.

I'm not really making any assumptions about you there bud...

Where I work we get the same thing. Chief complaint and is the patient conscious/breathing. We still respond non-emergent to 80% of our calls. Sometimes the dispatcher messes up and forgets to provide important information and we show up non-emergent to a somewhat unstable patient. Oh well, even if we saved five minutes running hot, it is unlikely to have made any difference in outcomes.

So yeah, not having EMD is not an excuse to run hot to every call. Period. You gain so little from doing it and risk quite a bit more.

 

[BasicBek]

Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.

Not the best system.

Same here, however AMR is coming here to take over and apparently is changing out priority 2 patients to running cold. I disagree with this greatly, unless they plan to rectify how dispatch codes calls. Almost every critical patient I've had has come in as a 2.

 

[PaulEMT]

We light 'em up code 3 lights/sirens every call.

 

[ZombieEMT]

I love the feedback that this thread has created, as I feel this is an important issue in EMS. I am happy to see that many areas are pushing towards no lights/sirens on most transport. I believe it is safer for the providers, patients and other drivers.

On a positive note, I have been told that New Jersey had put out new guidlines (not protocols) that state patients should not be transported lights/sirens unless ALS is indicated. They also state lights/sirens are not indicated for patient's in cardiac arrest due to the high risks of lights/sirens compared to probability of positive outcome from cardiac arrest. However, I feel that this is something many people are not onboard with.

 

[TransportJockey]

We light 'em up code 3 lights/sirens every call.

What's the thought process, if there is one, behind an outdated and dangerous practice like that?

 

[DesertMedic66]

What's the thought process, if there is one, behind an outdated and dangerous practice like that?

Could be what the public wants. That's how it is for us right now, when 911 is called you get a lights/siren response from fire and ambulance. In order for us to keep our contract we have to keep the public happy :glare:

 

[Scott33]

We light 'em up code 3 lights/sirens every call.

1976 just called...

 

[PaulEMT]

What's the thought process, if there is one, behind an outdated and dangerous practice like that?

I don't know waht you mean? If you call 911 then you get lights/sirens, code 3. Always. It's the protocol we follow.

 

[TransportJockey]

I don't know waht you mean? If you call 911 then you get lights/sirens, code 3. Always. It's the protocol we follow.

Just what I said. It's an outdated and dangerous practice.

 

[PaulEMT]

It's more dangerous to wait for red lights when the PT is bleeding out.

 

[TransportJockey]

It's more dangerous to wait for red lights when the PT is bleeding out.

Lol thanks I needed that. Studies show you're gonna save very little time. I take it that you are probably in favor of transporting cardiac arrests too?