Responding and Transporting Code 3

[chaz90]

Its not about the time but not doing anything when something can be done. The bottom line is that it come down to a risk reward situation where people have to decide to take the risk.

You admit you haven't been doing this long. In this case, take the advice of those who have been doing this longer than you. We're not trying to tear you down, but instead attempting to teach you how to be a better provider. "Taking the risk" in this case is risking additional harm to your patient with no possible benefit. The vast majority of hot returns save a trivial amount of time that has been statistically proven to be non-beneficial in mortality benefits to patients. Even the "Golden Hour" is an obsolete concept that no longer holds water. As a disclaimer, the studies I cite here are just the first one I found on a quick Google search, and I am certain there are better ones out there.

Fact 1: Driving emergently does increase the risk of being involved in an accident.

http://www.purdue.edu/discoverypark/nextrans/assets/pdfs/completedprojects/Final Report 015.pdf

Fact 2: Lights and sirens responses and returns save a trivial amount of time in the vast majority of transport environments.

http://www.ncbi.nlm.nih.gov/pubmed/10634288

An honest risk reward assessment that you suggested should lead us to transport significantly fewer to no patients using lights and sirens. One common statistical analysis used in medicine is number needed to treat vs. number needed to harm. In the case of emergent transport, the number needed to treat and potentially benefit one patient with a time sensitive emergency that can be affected by our 90 second transport reduction is much higher than the number needed to harm. This means I am statistically more likely to cause further harm to my patient by being involved in an ambulance collision than to help them by getting them to the hospital more quickly.

As far as the specific situation of transporting patients while performing CPR, please see the thread regarding moving CPR vs. no CPR for further information. No need to beat a dead horse on that subject here.

 

[chaz90]

I apologize for the length of the previous rant. This subject happened to hit home after a course I had to attend tonight. I'm just really not a fan of the worship at the almighty altar of emergent transport that so many people I meet seem to adhere to...

 

[Bullets]

Code 3 driving saves 60-90 seconds, nothing is that time sensitive. Nothing is worth killing yourself or others over. The days of traveling code 3 while doing CPR are numbered and shouldn't even occur.

What changed my mind about a lot of things was a conversation I had with my uncle, a USMC Drill Sergent. When they are teaching new Marines how to operate under fire they teach one concept "Slow Is Smooth, Smooth Is Fast "

 

[Handsome Robb]

I'd argue and say the swaying and hard braking seen with emergent transports would cause an increase in anxiety in the patient and family.

And personally, I love the red lights. Perfect time to get up and reach for something if need be. IVs? BPs? It's nice having a stagnant environment at times. If you're comfortable in knowing you can provide the care for your patient that they need, you won't feel rushed or "Get to the hospital ASAP!" at all.

Agreed

Took my old partner a minute to get used to me asking him to pull over so I could start an IV. "Hey if you've got a good spot can I get a stop for an IV? If not, no worries."

No reason to blow a line when you can take the time to pull over and stop everything from moving.

 

[katgrl2003]

This past month, I lost 2 very close friends in an ambulance crash. They DIED. I really don't think you understand the risk of driving emergent. I am not willing to risk anyone else in a crash for needless speed. My job is to go home at the end of the night, if I happen to save someone, that's extra. I and my coworkers are not going to die for your 'fun'.

 

[Clare]

Driving with lights and siren is a huge risk; we recently changed our entire dispatch system to only go on a 1 to those calls that are immediately life threatening i.e. cardiac or respiratory arrest, patients who are still fitting, major bleeding, severe shortness of breath, cardiac chest pain, stroke with altered level of consciousness etc.

The time you save is not worth the risk unless the patient is status 1 i.e. immediately life threatening problem.

 

[Bullets]

Agreed

Took my old partner a minute to get used to me asking him to pull over so I could start an IV. "Hey if you've got a good spot can I get a stop for an IV? If not, no worries."

No reason to blow a line when you can take the time to pull over and stop everything from moving.

This aggravates me. IV access isn't predicted on the responding type of an ambulance. What does the M in MICU stand for. Get in the truck and let's go or stay on scene and start your interventions, but don't tell me you can't start the line half way to the ER because the roads are bumpy

 

[usalsfyre]

This aggravates me. IV access isn't predicted on the responding type of an ambulance. What does the M in MICU stand for. Get in the truck and let's go or stay on scene and start your interventions, but don't tell me you can't start the line half way to the ER because the roads are bumpy

You speak of what you do not know.

What difference does 15-30 seconds make?

 

[RocketMedic]

This aggravates me. IV access isn't predicted on the responding type of an ambulance. What does the M in MICU stand for. Get in the truck and let's go or stay on scene and start your interventions, but don't tell me you can't start the line half way to the ER because the roads are bumpy

Why not? What's the harm in pulling over to get a patent line vs a blown moving line? Same concept as the 20 that works beats the 16 that doesn't.

 

[Achilles]

Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.

Actually, the lights and sirens cause more anxiety in the pt.

 

[Achilles]

Why not? What's the harm in pulling over to get a patent line vs a blown moving line? Same concept as the 20 that works beats the 16 that doesn't.

Not just a line, AED, and hopefully it never happens in the truck but delivery as well.

 

[74restore]

Like the other's have said, lights and sirens can be dangerous. Does every vehicle always move for you and listen for lights and sirens? No.

Sometime people have their radio or a/c turned up, and don't hear the sirens or see the lights coming until it's too late.

Here: unless you want this to be you and your "critical patient", maybe code 3 is not the way to go in many situations. Just a glimpse of the back of the rig during a crash. Notice the flying sharps container too

http://www.youtube.com/watch?v=myZZtmpvB7g

I'm also not saying we should NEVER drive emergent, because in can be helpful in some cases.

 

[Bullets]

You speak of what you do not know.

What difference does 15-30 seconds make?

Why not? What's the harm in pulling over to get a patent line vs a blown moving line? Same concept as the 20 that works beats the 16 that doesn't.

I'm not saying don't start the line and take the time to get a good access. If we have a 2:1 or 4:1 provider to patient ratio then the patient gets better attention being with EMS. Let's do the treatments on scene while the patient has multiple providers working on him.

If the condition is so severe that we cant stay then we need to get you to an advanced care facility and IV access won't be beneficial.

Add to that our local hospitals consider field starts "dirty" and like to pull them once the patient is in their care, it isn't beneficial to pull over for a stick

 

[cruiseforever]

Does your service use Opticoms? If they do what is your experience?

 

[DesertMedic66]

Does your service use Opticoms? If they do what is your experience?

My service does use them. Generally it makes the ride more smooth and quicker due to every traffic light being green.

 

[chaz90]

Both services I've worked with use Opticom. They've been pretty hit or miss as far as I can see. The problem seems to be many of the intersections don't have sensors or just aren't calibrated correctly.

 

[Mariemt]

Small town, we have ema. Emergency management guys who will block traffic for us to go through intersections as needed... we rarely run lights and sirens.

 

[SSwain]

Having been in the back and in the driver's seat running L/S...I understand both mindsets.
Our rigs ride like lumbertrucks. Every turn and braking is magnifies due to being elevated in the box.
In the box, a simple sweeping 35 MPH curve will easily set you off balance when driven at 35 MPH. In the driver's seat it isn't as noticeable.
The adrenaline "rush" from responding L/S can get the driver subconsciously driving faster and faster w/o realizing it. I find myself listening to the engine rpm more to guage my speed w/o having to look away from the road and other traffic.
Plus, after a 15 minute L/S run, by the time I got the the ED, my hearing was noticeably impaired. A night run will also play with your eyes with the strobe reflections off anything nearby.


Just my humble observations.

 

[Veneficus]

Having been in the back and in the driver's seat running L/S...I understand both mindsets.
Our rigs ride like lumbertrucks. Every turn and braking is magnifies due to being elevated in the box.
In the box, a simple sweeping 35 MPH curve will easily set you off balance when driven at 35 MPH. In the driver's seat it isn't as noticeable.
The adrenaline "rush" from responding L/S can get the driver subconsciously driving faster and faster w/o realizing it. I find myself listening to the engine rpm more to guage my speed w/o having to look away from the road and other traffic.
Plus, after a 15 minute L/S run, by the time I got the the ED, my hearing was noticeably impaired. A night run will also play with your eyes with the strobe reflections off anything nearby.


Just my humble observations.

Just to point out, the fire service has done extensive research on the various configurations and intensity of warning lights, both in the day and at night.

Any agency managers ordering trucks should probably be well versed with that body of literature.

 

[slewy]

Driving lights and sirens is extremely dangerous. We normally don't transport people with CPR in progress. The fun aspect goes away when you realize it's dangerous.

It's also shown to not have much of an impact as far as time goes. Some studies say only a couple of seconds to a minute or 2.

Are you serious? 1 or 2 MINUTES is huge.