Speed and Time in Prehospital Trauma Care

For some reason or another we loose common sense and this is one of the areas that "that's they way we do it" mentality is ingrained in providers and the public.

Face it it is a PR thing to maintain L & S on any vehicle. In reality L & S has been proven over & over never to really save any significant amount of time to really change an outcome vs. the endangerment it places the public and provider.

Truthfully, we only ask for the right away, we should be either maintain safe speed and observe laws so in reality, how much time really could be saved, if one is doing it right? Do the math.. it's not that hard..

If we were really to do things right we would increase the number of responding units to reduce the time factor alike fire apparatus. Of course, it will never happen in the real world.

Is there really time sensitive injuries? Yes, but again in comparison those are very, very few and in-between. Again, if we were to do things right we would have proper dispatching and many of those responses would never be considered time sensitive.

So yes, we will continue with L & S for many reasons. Partly the image that we want to portray to the public and making ourselves feel better. Second, we realize it is much easier to do something half arse than to do it right to begin with.

R/r 911
 
So, Rid, should they get rid of l&s on police cruisers and fire vehicles as well? I mean, you put the argument out there yourself. If EMS truly cared, we'd have more vehicles on the road, elimanating the necessity of l&s.
 
Linuss said:
So, Rid, should they get rid of l&s on police cruisers and fire vehicles as well? I mean, you put the argument out there yourself. If EMS truly cared, we'd have more vehicles on the road, elimanating the necessity of l&s.
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100% agreement on both counts!

but it's not if EMS truly care, it's "if those who funded EMS truly cared." Some systems can only staff as many units as the municipality is willing to pay for.
 
EMTinNEPA said:
The Golden Hour is a myth. Some patients have days, some patients have hours, some patients have minutes, and some patients will be dead before you get there. Base your transport mode on patient condition.

As for cardiac arrests, if their condition hasn't improved in 25-30 minutes, just call it on scene. By that point they'll be vegetables anyway.
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For traumatic arrests the golden hour is definitely a myth - you have ten minutes, tops. The golden hour applies to a very specific set of major trauma patients.
 
Linuss said:
So, Rid, should they get rid of l&s on police cruisers and fire vehicles as well? I mean, you put the argument out there yourself. If EMS truly cared, we'd have more vehicles on the road, elimanating the necessity of l&s.
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Well, yes! Why not? Look at how many times LEO actually utilize L & S? Majority of the times it is not for responding rather they are utilized for warning signals while being parked. How many "silent" responses occur in lieu of using l & s? As a former officer majority of true emergency responses were at this level as not to forewarn and potentially cause a problem.

Fire responses.. again, really how much time does emergency status really save? Sure the stop at the signal light, where if one truly slows and comes to a complete stop and then proceed and then uses extreme caution; I again ask how much time is saved?

I routinely respond without l & s and many times actually arrive before the responding units that are using warning signals. Knowledge of the area is essential as well as well as utilizing proper routes again, back to a full understanding of your job.

Do we need to eliminate all l & s .. probably not but usage should be very limited and very rare occurrence. Operators/driving should be fully educated and trained with constant monitoring and revue. Each driver should have bi-annual training and review with a good QI to ensure safety.

R/r 911
 
R/r good posts, +2, thank you.

Generally, if you do want to run emergency TO scene, at least use MPDS or another tiered/protocol-based call taking system. There's a lot of evidence that says these systems are effective. Running emergency TO scene on every call is ridiculous. A tiered system can decrease your emergency responses immensely.

The above journal review looks at a study that is good in that it specifically talks about the trauma patient. These were the patients that we thought should be *rushed* to the hospital l/s because only a surgeon could save their life. Well, turns out that mortality isn't effected by scene or transport time intervals! So, even more reason to stop our rampant use of l/s. I would note, however, that the study doesn't look at morbidity, just mortality.

I wish we could banish most emergency response, especially TO hospital. I agree that the option should remain, however, for rare circumstances - e.g. can't establish an airway, etc. Otherwise, aren't we doing the same things the hospital is in our initial treatment of our patients? If not, perhaps we should lobby for the additional education and skills/medications to do so...
 
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DrParasite said:
I am a firm believer in L&S to EVERY emergency call.
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Then I never want to work with you, period.

DrParasite said:
I
...the justification becomes "the sooner you arrive at the hospital, the sooner you become available for the next one. This can be important for agencies that stack or hold BLS jobs because they have no units available (and mutual aid is not used for BLS jobs)... for slower rural and suburban services, going L&S might make sense on minor calls. longer transport times means longer time their primary area is unprotected for the next one, so L&S means quicker times to the hospital and quicker times out of the hospital and back to their primary area.
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Get more ambulances then.
 
I'm OK with using lights because calls are pending ONCE IN A BLUE MOON because everyone in the area is getting their butts kicked, and you need to clear up to cover another call. It happens really rarely out in my nice suburban area... but it does happen.

Still... 15 months ago, we rushed to clear a call so my medic partner could do a BLS intercept when the sky was falling like that... due to circumstances beyond my control, I crashed our MICU. Not only was our ambulance and the medic not making it to our call... but we needed 3 additional transport units to "our" scene. That made an already bad day for the north end of the county even worse. Sitting here... I think that if the day wasn't going crazy, we wouldn't have ever dreamed of taking the call we did... but we took the call... and in the end, we didn't help matters, but made them worse.
 
I have always served in rural areas and as a basic. Perhaps in the urban environment this would be true, or perhaps I am just old school in my mentality. I was always taught, and have always practiced, a speedy arrival at the ED is imperative. For patients, whether medical or trauma, who are in a reasonable amount of distress the "Golden Hour" is stressed, and in a rural situations where a prolonged transport time is already present, transport should not be delayed; in these cases it should be expedited.

There are apparently many people here who disagree with me and we all have our opinions; however experience has taught me a very different lesson in the care for the critical patient.

In response to another post, no the pt mentioned was not a trauma pt, but he was a medical pt. who suffered a witnessed cardiac arrest. Again, my partner and I were both volunteers and we were both basics, and so our skills, experience, and equipment was limited. Moreover, I have never given up on a pt when there is a chance he/ she may still live. Many take me overly optimistic, and maybe I am, but I am too old to change my ways.

I do agree; you should never get into such a hurry as to cause an accident, for this is simply counterproductive, but I don't taking one's time and delaying transport is always the best decision either.
 
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I have always served in rural areas and as a basic. Perhaps in the urban environment this would be true, or perhaps I am just old school in my mentality. I was always taught, and have always practiced, a speedy arrival at the ED is imperative. For patients, whether medical or trauma, who are in a reasonable amount of distress the "Golden Hour" is stressed, and in a rural situation where a prolonged transport time is already present, transport should not be delayed; in these cases it should be expedited.

There are apparently many people here who disagree with me and we all have our opinions; however experience has taught me a very different lesson ion the care or the critical patient.

IN response to another post, not the pt mentioned was not a trauma pt, but he was a pt. who suffered a witness cardiac arrest. Again, my partner and I were both volunteers and we were both basics, and so our skills, experience, and equipment was limited. Moreover, I have never given up on a pt when there is a change he/ she may still live. Many take me overly optimistic, and maybe I am, but I am too old to change my ways.

I do agree; you should never get into such a hurry as to cause an accident, for this is simply counterproductive, but I don't taking one's time and delaying transport is always the best decision either.
 
Thats because everyone here at EMTLIFE assumes you can just throw a blanket over EMS, that one area is no different then any other. Some areas have vastly different operating procedure from CPAP, ultrasound, pain mngmt, airway choices and so on.

Some areas may still need emergent transport while other may not. Simple as that, throw a patient in the street and take one hundred providers and you may get one hundred different treatment plans based on area. In one area its an emergency it may not be in another because treatment is withinn the providers reach.
 
CAOX3 said:
Thats because everyone here at EMTLIFE assumes you can just throw a blanket over EMS, that one area is no different then any other. Some areas have vastly different operating procedure from CPAP, ultrasound, pain mngmt, airway choices and so on.

Some areas may still need emergent transport while other may not. Simple as that, throw a patient in the street and take one hundred providers and you may get one hundred different treatment plans based on area. In one area its an emergency it may not be in another because treatment is withinn the providers reach.
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This is exactly what I'm saying - why not add the education and skills we need to effectively treat people?? If you need to transport people emergently all the time, you aren't up to par with the current standard of care.

Why is there any need for a speedy delivery to the ER? At least in most cases, as I said before, I am providing exactly the same treatment that the ER would.

The other thing that is being argued is the "golden hour". The truth is that it doesn't exist. Read the OP's post and the study, or abstract, or at least Bledsoe's article. It's a huge study that says that time doesn't matter!

Going lights and sirens doesn't benefit anyone, except those patients in which we can't establish an airway and a few other rare examples. It doesn't matter if you are in a rural or metro area. And if you are in a rural area, why would you need the l/s anyway???
 
redcrossemt said:
And if you are in a rural area, why would you need the l/s anyway???
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Because the county says so, in my rural service's case. Actually, we usually only just use the lights, and turn on the sirens if we're around other cars or an area where we could come across them suddenly.

We respond to all calls l/s unless police or something request otherwise, which is also dictated by the county. Some calls get much faster responses than others; we're usually not going to go much past the speed limit getting there. When we transport, we rarely use anything unless it's a bad airway, uncontrollable bleeding, or something of the sort. Those are often far enough away for helicopters anyways.

We also don't worry about getting back for more calls. We have a lot of backups, and it's usually not all that busy anyways. We've got spare medics with flycars at home, which can meet up with BLS units anywhere in the region, so we're never taking ambulances out of service for that. We've got engines with medical gear and trained people, which can get on scene and get the ball rolling. We've also got wonderful folks from the surrounding stations and counties who will also jump in as needed. If it's really that crazy, dispatch can page the off-duty people and bring them in too.
 
redcrossemt said:
And if you are in a rural area, why would you need the l/s anyway???
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Umm..rural areas have traffic too..

Or that one person driving under the speed limit for the 10 mile stretch for single lane roadway.

What about deer? You have to make sure they know you have the right of way. :P
 
And five is four.

Search "Golden Hour" in the back threads.

Take estimated time to arrival at hospital, figure out what the pt will need for this condition during that time, and do it. Works everywhere everytime, except when the unexpected pops up, then bad things occur.

Paradoxically, the areas needing ALS most because of long transport times do not attract and maintain enough ALS for the same reason they don't attract and keep MD's and hospitals.

 
mycrofft said:
Search "Golden Hour" in the back threads.
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I searched, and didn't find THIS particular article. And I found this article interesting with it's mention of a 4 minute response time, while being basically the ideal golden hour, totally unrealistic. It made me think about all the times we do go lights and sirens and if they are worth the risk for little benefit.
 
Seaglass said:
Because the county says so, in my rural service's case. Actually, we usually only just use the lights, and turn on the sirens if we're around other cars or an area where we could come across them suddenly.
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Sure the county can say so.... The jurisdiction I work in requires an emergency response to all calls except psychiatric emergencies. Just because something is the status quo doesn't mean it is the best thing for the patient or our communities in general.
 
mycrofft said:
Take estimated time to arrival at hospital, figure out what the pt will need for this condition during that time, and do it.
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Exactly.

Providers should be able to do all of the commonly needed treatments for their anticipated transport times. Rural services therefore, probably need the most well educated clinicians, and the most skills/medications. However, as mycrofft said, these are the areas that have the hardest time recruiting and maintaining ALS resources and keeping up their providers' skills.
 
redcrossemt said:
Sure the county can say so.... The jurisdiction I work in requires an emergency response to all calls except psychiatric emergencies. Just because something is the status quo doesn't mean it is the best thing for the patient or our communities in general.
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Of course not, but we're not exactly going to benefit our patients and communities by disregarding that and having providers suspended. Responding at about the speed limit with l/s seems like a reasonable compromise to me. All we're essentially doing is asking other drivers to yield the right-of-way, which makes sense when the initial dispatch is often misleading.

Do you know why they decided to have psychiatric emergencies as the sole exception? Seems like an odd choice to me... some of them can be rather time-sensitive.
 
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