When will we stop running code?

[NomadicMedic]

I read a post in another thread that said, when referring to a city's BLS ambulance response, "you must be excited, you get to run code to everything".

When are we going to stop endangering ourselves and the public, by driving recklessly, with lights and sirens, to calls that are simply not emergent.

In the instance mentioned above, it should be recognized that the ambulance responding code has been requested by fire department EMTs on scene who have made contact and evaluated the patient, determining that ALS interventions are not needed and the patient can be safely transported to the ED via a BLS unit. Yet, due to contracted response time requirements, they respond with lights and sirens.

Headache? Lights and sirens.
Stubbed toe? Lights and sirens.

Need to go to the hospital because you just don't feel well?

Lights and sirens.

It's unnecessary and put providers and the public at risk.

I'll be honest, I'm nervous every time I respond to a call hot.

 

[Cup of Joe]

"but when people call us, they expect us to use the lights and sirens to take them to the hospital, thats why they called." :glare: (don't worry, I smacked that person upside the head for you already)

I agree with you. They have very limited benefits, if any.

As for responding to a call, we are basically required to here. The public around here feels like they're getting ripped off if we don't pull up with the lights on. For transporting, it will be no lights or sirens majority of the time when I'm in charge.

 

[TransportJockey]

I hate that. And one of the reasons I very rarely run code at all (the other being long straight strectches of endless back roads)

 

[Chief Complaint]

We don't respond code to calls such as headaches and stubbed toes. If dispatch provides us with enough info to determine that its a "nuisance" call we just drive like regular folk.

 

[EpiEMS]

Only life threats and unknowns deserve a code response. Isn't that just common sense?

 

[NomadicMedic]

I wish it was as simple as "what I think is a priority call gets lights and sirens"

We respond hot to Charlie, Delta and Echo level calls. (For those of you not familiar with Priority Medical Dispatch cards, here's a link. http://wiki.radioreference.com/index.php/Medical_Priority_Dispatch_System)

Most of the Charlie/Delta calls are really non emergent, but I can't decide that... It's a response criteria set by the agency.

 

[DesertMedic66]

Any 911 call gets a code 3 response by ambulance and fire department for my area. I've been dispatched out literally for a "toe pain". When we got on scene the patient is in full arrest. Also vise versa. I don't see my system ever going code 2 (normal driving) to 911 calls anytime in the near or far future.

People who call 911 are usually not realible. So we have no way of knowing what is actually going on. It's to the point now where we just get an adress of the call and either "unknown medical aid" or "traffic collision" when we are dispatched.

 

[Shepard]

Here you run Code 3 to everything unless determined to be Code 2 response by EMD. I believe that running code is necessary because you have no idea what your really going to. Transport is always Code 2 except in a few circumstance as dictacted by state law.

 

[rescue1]

We go hot to calls dispatched as "ALS", which includes unknowns. We also go hot to accidents with confirmed injury. Anything thing else is cold. I'd say I go no lights and sirens about 50% of the time.
That being said, everyone has probably been bit in the *** by a misleading dispatch complaint, so I can sort of understand running hot to calls. My pet peeve is transporting emergently.

There are only a few patients that truely benefit from the saved minutes of L/S, mainly severe trauma. Yet you still see units transporting hot for simple fractures, complaints of "feeling sick", and similar calls. Even better are calls with 30 minute on scene times spent assessing the patient, followed by L/S transport.
There is nothing that those saved minutes will do for that patient except endanger them.

Luckily, where I work we transport with lights very rarely.

 

[Medic Tim]

Even better are calls with 30 minute on scene times spent assessing the patient, followed by L/S transport.

And then spend 5+ minutes before unloading the pt once at the hospital.

We have priority dispatch. We run hot to about 60% of our calls. Most of them do not require a hot responce. I can count on one hand the number of times I have gone to the hospital hot this year. We have some crews that go hot for just about everything. It has been my experience that ppl who run code for everything are not comfortable in their assessment/skills or are new.

 

[leoemt]

I read a post in another thread that said, when referring to a city's BLS ambulance response, "you must be excited, you get to run code to everything".

When are we going to stop endangering ourselves and the public, by driving recklessly, with lights and sirens, to calls that are simply not emergent.

In the instance mentioned above, it should be recognized that the ambulance responding code has been requested by fire department EMTs on scene who have made contact and evaluated the patient, determining that ALS interventions are not needed and the patient can be safely transported to the ED via a BLS unit. Yet, due to contracted response time requirements, they respond with lights and sirens.

Headache? Lights and sirens.
Stubbed toe? Lights and sirens.

Need to go to the hospital because you just don't feel well?

Lights and sirens.

It's unnecessary and put providers and the public at risk.

I'll be honest, I'm nervous every time I respond to a call hot.

I don't think the issue is running code too much, rather I think its lack of training and experience. I am probably one of the safest drivers out there when it comes to driving code. Then again, I have a "real" EVOC course under my belt at the WSP Academy.

Recently, I had a 40 mile long code run and when the call was done my partner looked at me and said "that was by far the safest driving I have seen."

Lights and sirens REQUEST the right-of -way, they don't guarantee it. Once providers get that through their heads and stop driving like there a race car then we can minimize crashes.

My biggest pet peeve is the videos on youtube of ambulances running code and they approach a controlled intersection and have a red light. Instead of going around traffic, or waiting for the light to change they get right behind the motorists and start blasting airhorns and sirens until said motorist pulls into the intersection against the light.

 

[DrParasite]

Yet, due to contracted response time requirements, they respond with lights and sirens.

This is probably the #1 reason why managers write policies that say every response must have lights and sirens. The public insists on a rapid response when they call 911, they want shorter run numbers, and they want the ambulance to show up with it's L&S on, so they know they came quickly

The #1 reason providers want to go L&S is similar to why every patients needs ALS (or at least an ALS assessment), your headache might be a stroke, and your stubbed toe might actually be referred cardiac pain for a diabetic (or so it was told to me by someone online). what you are dispatched to and what you really have can be two different things (911 callers are rarely accurate, and garbage in/ garbage out).

I must say, I do think we should be responding to all calls with an illness or injury L&S. Been burned too many times by inaccurate dispatches, as well as having patients and family say "you took forever to get here!!!"

Now transporting emergently, that's a different story altogether, and should be avoided except the patient is experiencing a time critical medical emergency that cannot be resolved in the field.

My biggest pet peeve is the videos on youtube of ambulances running code and they approach a controlled intersection and have a red light. Instead of going around traffic, or waiting for the light to change they get right behind the motorists and start blasting airhorns and sirens until said motorist pulls into the intersection against the light.

Fire trucks are the absolute biggest offenders of this, usually with a guy in the front seat of the truck doing the recording. I've also seen PD go L&S to routine calls, speeding up the road and pushing people out of their way. So it's not a problem that is limited to EMS people.

 

[Veneficus]

The emperor's new cloths

There really isn't a need for a lights and siren response or transport.

But, for decades, since the very inception of EMS, in order to sell our services to the public, we tricked them by telling them how important response times are.

It was an easy metric for them to follow and the call volumes were low enough that a response based system actually worked.

It was probably your boss that sold the public on paying your salary with response times. (Just like the special fabric that only the worthy could see)

Now we simply have to perpetuate our own lie.

If you look at the NFPA recommendations as well as the common fire service mantra of a goal of 8:59, anyone with a CPR card knows this will never work.

With brain death in an arrest in 6-8 minutes, 8:59 90% simply will not be fast enough. We know and preach that bystander CPR will make the difference between life and death in SCA.

Now somebody else will probably talk about other "life threatening" emergencies, but it was the Canadian's often quoted sudy that shows ALS makes minimal difference in mortality, but reduces length of hospital stay.

So what does a BLS response actually do for these same people? They either transport or babysit waiting for the mythical ALS to show up perform some voodoo and...Wait for it...transport.

Imagine the public outcry of a disatcher who said "we'll get to you in due time." People would be calling for heads.

Many years ago now I did some research for a safety committee where I worked. I had statistics from the insurance institute of America, I had medical research and opinions on time sensitive conditions, I had the combined experience of hundreds of EMS workers of all levels who identified most calls were simply not emergencies.

Driving code is purely psychological for responders and patients. It carries no benefit and as you identified, carries significant risk. (when I did my research on it, the insurance people claimed it statistically raised the chances of a collision 300%, and traffic has probably increased exponentially since then.)

As call volume increases beyond our financial and physical capability to actually respond to calls in the recommended time, what will we do then? Logicially we will increase the time we say should be the benchmark.

Do you know where that 8:59 benchmark came from?
It was what the average professional FD in the US could reasonably get 90% of the time. It is a standard based off of the average performance now 30 years ago.

If it was so important, with fire calls decreasing and EMS calls increasing, if response time mattered so much, wouldn't it have been logical to close engine companies and replace them with 1 or 2 ambulances per station?

Didn't see that happen did you?
(I better not get started on NFPA though, it is complete BS in itscurrent form, just look at the minimum manning recommendations for fire apparatus, anyone who has tried fire suppression other than standing there and watching the building burn knows it is not enough. You don't see major city FDs with unit staffing that low. Wonder why?)

Back on point, if you stopped responding lights and sirens, the negative public perception and backlash would be devastating to EMS.

Do not start that fight my friend, it is a loser.

What will change it is when we realize we cannot be a response agency and need to be proactive, only then will EMS have the interaction and public relations, and documented numbers to start changing public opinion slowly.

We must move away from the easy metric of response time. But it is hard to do when it is so often used. We created this monster and now it is out of control.

In the meanwhile, you have discovered the naked truth.

 

[Melclin]

Similar to other posts, we go L/S to many jobs based on MPDS, but transport very very few people that way.

I feel L/S has its place. Done properly, its pretty safe, its just a matter of doing it properly. I feel that there are jobs that are time critical to the extent that minutes will make a difference. Cardiac arrest, major trauma, choking/apnea. While the benefit may be small and infrequent, many of the benefits we provide could be described similarly. Especially in the city, you could knock of 10 or 15 mins or more in peak hour. I think it would be absurd to be sitting their at an empty intersection waiting for a long light cycle on the way to an arrest.

This is all predicated on the idea that L/S driving is safe and that is reasonably true here. I'm aware of only 3 fatalities in the past thirty years, state wide. Serious injury is more common but still very rare. I may be wrong but I have been told that our accident rate on L/S drives is no different to non-L/S and the fatality/injury rate at least in ambulances (fly cars are another matter) is not any different to the general population who of course are not driving L/S. We have a pretty strong culture of safe L/S driving (although safe is a relative term) and widespread recognition of the idea that minutes and seconds make very little difference in the majority of cases. A week of driver training (I think it might now be two weeks) based on a model of low risk driving was part of my induction into the service. You don't drive L/S during your first 6 months, after which you are instructed and signed off in L/S driving by in our in house facilitators.

RE public perception, we make a point of turning the lights and bells off before getting near the pt (unless there is an obvious need for the beacons eg MVAs). I've been told it has to do with trying to maintain a sense of calm (similar to one of the reasons we don't run at jobs), but I'm not exactly sure of the origin of that culture.

Also, I feel at least for myself, driving L/S to more jobs than is strictly necessary helps maintain the skill of that kind of driving. I'd suggest the possibility that the very occasional L/S drive may present more dangers that doing it more regularly.

 

[mycrofft]

Lights and siren while driving the safe speed limit can save time for longer distances and through medium to light urban traffic. Whether the time is effective varies from pt to pt, but if thirty seconds' or two minutes' time will make the difference in a pt's outcome, they are probably too damaged to survive the ride to definitive care.

What lights and siren do as well as make the drive a little safer and smoother (for a driver who is patient and competent!!!) is to add another layer of the social glue we call "expectation to be rescued". As in , "I can calmly drive to the freeway, drive eighty MPH while curling my eyelashes and talking on the cell phone, and get to my work, every day, because if something goes awry those nice young men and women in the ambulance will rush to my aid. Like Jack Webb said".

If I hear the term "Code 2" again I'm going to have a hair transplant so I can rip it out (again). Either you are prudently driving without warning devices activated, or you are driving prudently but sometimes exceptionally (using legally sanctioned exceptions to the law like using the shoulder, using turnarounds on the freeway, etc.) WITH warning devices, or you are driving foolishly. The true concept of "Code 2" is driving with alacrity (which you should always prudently do) but WITHOUT warning devices...which should be the basic level of performance, not a "special code".

MANY are given to understand Code 2 means drive fast and exceptionally, but without warning devices. (Why, so you don't interfere with people on their cell phones?). It is NEVER defensible, and is just silly/dangerous, to drive in any manner other than an efficient common motorist might when you are not using your sanctioned warning devices.

 

[triemal04]

I believe that running code is necessary because you have no idea what your really going to. Transport is always Code 2 except in a few circumstance as dictacted by state law.

So? You take the information you have at hand and what can reasonably be assumed to go along with that and run with it. Thinking it's a good idea to respond emergently because the "twisted ankle" might actually be someone who has a life threatening and time sensistive problem is silly.

Unless you have a very different definition of what "code 2" is, that is completely ridiculous. Generally the only people I know that use/say that are cops, both when they're calling for cover, and responding to such a call or certain other types. Basically they drive near emergently, without any warning devices (other than maybe at intersections) because it's only an "urgent" call, not "emergent" and to lower their profile. No reason to do that in an ambulance, and damn sure not with a patient in the back.

 

[triemal04]

The #1 reason providers want to go L&S is similar to why every patients needs ALS.

No, probably the real reason that most people, if they are being honest, want to drive emergently is because they thinks it's fun/sexy/cool/something like that. Excuses like "we don't know what is really wrong" "I've been burned before" "callers aren't reliable" are excuses. While there may be truth to it, there isn't enough to necessitate a mandatory emergent responce to all calls. Plus, when you look at how much time is actually saved, and the very few conditions where that small amount would actually make a real difference, it becomes even less neccasary.

 

[Tigger]

Here you run Code 3 to everything unless determined to be Code 2 response by EMD. I believe that running code is necessary because you have no idea what your really going to. Transport is always Code 2 except in a few circumstance as dictacted by state law.

Can cite the laws applicable in these instances?

 

[AnthonyM83]

I know some people want to get ride of code 3 responses altogether. I have to warn that I can have a 40 minute non-emergent response to a call under 3 miles away in Los Angeles traffic. Adding lights/sirens cuts that down to 6 minutes. Has nothing to do with speeding, rather being able to oppose traffic. We have blocks and blocks of gridlock. I know of several specific blocks that takes about 15 minutes to get by (one block per 15 minutes!)

And we're already saturated with ambulances...the calls just keep coming out. Five within that saturated 5 square mile area in 10 minutes. Then five more...

 

[Shepard]

For the record: Code 2 in my area and as far as I know California in general is non emergent, non lights and sirens, follow all traffic laws and signals. California Ambulance Driver's Handbook says a few times thats Code 3 transport should be avoided except in the case of uncontrolled hemorrhage, stroke or complicated child birth.