When will we stop running code?

[Shepard]

I believe that running cod.e is necessary because you have no idea what your really going to.

While this may be true I should be more clear. Code 3 is used to oppose traffic and move through stop lights. I think EMD is necessary in order to determine a Code 2 response. For the majority of the time a twisted ankle will be bumped down and Ambulance and fire wont respond LNS.

I also agree with everythjng said. Everyone should be required to have full EVOC course and need to understand that Code 3 does not mean recklessness.

 

[Shishkabob]

Happens as long as you rely on the uneducated public to relay medical signs to dispatch.


And there are plenty of abusers who know just the right words to say to get a quicker response.

 

[Anonymous]

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...

This^

I was EOS 8 miles from station at 7:30 the other day, got to station at 8:20.

 

[NomadicMedic]

You are all missing the point. Reread the original post.

I specifically mention instances where the fire department EMTs are on scene (responding in an engine) and have determined that the patient is stable (that is, NON EMERGENT) and does not require an ALS level response and yet the BLS ambulance STILL responds hot to the call, after being requested by the fire EMTs on scene who have already assessed and began treating the patient.

Anthony mentioned the difference between a 40 minutes vs 6 minutes with lights and sirens. If the call is truly BLS, chances are the patient can wait 40 minutes. If the patient can't wait for definitive care, a paramedic should make that call and treat and transport accordingly.

Now I agree that there are ALS calls that may require a hot response (delta/echo priority), but a BLS transport only response should always be cold. And the transport should always be cold as well.

 

[Brad Z]

Anthony mentioned the difference between a 40 minutes vs 6 minutes with lights and sirens. If the call is truly BLS, chances are the patient can wait 40 minutes. If the patient can't wait for definitive care, a paramedic should make that call and treat and transport accordingly.

Now I agree that there are ALS calls that may require a hot response (delta/echo priority), but a BLS transport only response should always be cold. And the transport should always be cold as well.

But that's means two units (the Fire BLS folks and the responding BLS transport) will be out of service an additional 34 minutes. A code 3 response gets everyone back in service and ready for the next call sooner. Not saying that's a reason to go code 3 but certainly a consideration for some departments.

 

[NomadicMedic]

But that's means two units (the Fire BLS folks and the responding BLS transport) will be out of service an additional 34 minutes. A code 3 response gets everyone back in service and ready for the next call sooner. Not saying that's a reason to go code 3 but certainly a consideration for some departments.

Certainly not a reason to go code, ever.

If an ambulance was responding to an "arm pain" non emergent call with L&S, and they were involved in a traffic collision, the press ad public outcry would be disastrous if the reason they were responding code was "to get back in service quicker".

Sorry. Not a valid reason.

 

[Achilles]

But that's means two units (the Fire BLS folks and the responding BLS transport) will be out of service an additional 34 minutes. A code 3 response gets everyone back in service and ready for the next call sooner. Not saying that's a reason to go code 3 but certainly a consideration for some departments.

I would like to point something out. Not all firefighters are BLS, in fact a lot of departments require medic to get on the department.

 

[NomadicMedic]

Allow me to clarify further. The original post was regarding EMS response in Seattle and King County.

In both Seattle and King County the firefighters are required to be EMTs. A paramedic does not respond on an engine or in a paramedic unit unless they are specifically dispatched or requested by the EMTs that arrive on the engine. This is the way the King County medic one system was designed. Firefighters are the first responders. Once the firefighters have determined the need for transport, they call dispatch and request an ambulance. In Seattle BLS transport is provided by AMR. In South King County BLS transport is provided by TriMed. In many instances these private ambulance companies will respond code in order to meet the "response time guidelines" set forth in the contract.

They don't respond code because they have an emergency patient. They don't respond code because they need to get the fire unit back in service, they respond code because the contract requires a certain timeframe be met otherwise the private company pays a fine to the city.

Now tell me, is that a valid reason to endanger providers and the public?

 

[Brad Z]

Certainly not a reason to go code, ever.

If an ambulance was responding to an "arm pain" non emergent call with L&S, and they were involved in a traffic collision, the press ad public outcry would be disastrous if the reason they were responding code was "to get back in service quicker".

Sorry. Not a valid reason.

No department is ever going to say they they run L&S for unit availability. They don't need to. I'm just saying it's certainly a consideration, particularily in areas where a 40 minute response time can be shaved down to 6.

I'm not personally advocating L&S for stubbed toes. But certainly response time affects the total call time, which determines staffing levels. Every unit sitting in traffic heading to a non-critical call is unavailable for a critical call. That means either more units in service or longer response times.

I would like to point something out. Not all firefighters are BLS, in fact a lot of departments require medic to get on the department.

Understood, but that seemed to be the case in the original scenario.

 

[Shepard]

Allow me to clarify further. The original post was regarding EMS response in Seattle and King County.

In both Seattle and King County the firefighters are required to be EMTs. A paramedic does not respond on an engine or in a paramedic unit unless they are specifically dispatched or requested by the EMTs that arrive on the engine. This is the way the King County medic one system was designed. Firefighters are the first responders. Once the firefighters have determined the need for transport, they call dispatch and request an ambulance. In Seattle BLS transport is provided by AMR. In South King County BLS transport is provided by TriMed. In many instances these private ambulance companies will respond code in order to meet the "response time guidelines" set forth in the contract.

They don't respond code because they have an emergency patient. They don't respond code because they need to get the fire unit back in service, they respond code because the contract requires a certain timeframe be met otherwise the private company pays a fine to the city.

Now tell me, is that a valid reason to endanger providers and the public?

No. It is not. FD should request a non emergent ambulance. Running Code 3 to a non emergent call is unecessary and dangerous.

 

[DrParasite]

they respond code because the contract requires a certain timeframe be met otherwise the private company pays a fine to the city.

Now tell me, is that a valid reason to endanger providers and the public?

absolutely. the city requires it. if the city were to drop the response timeframe, then would the company still respond code?

The city wants it. whether or not it's valid isn't the point, the city (AHJ) wants it this way.

Using your logic, if the city cared about the public and providers, they wouldn't encourage this unsafe behavior. Since they obviously do, you can draw your own conclusions.

 

[Shishkabob]

I specifically mention instances where the fire department EMTs are on scene (responding in an engine) and have determined that the patient is stable (that is, NON EMERGENT) and does not require an ALS level response

Since everyone is thinking it, I'll be the first to say it: I don't always trust all my BLS first responders to make that determination, they're only marginally better than the lay person in recognizing sick, and they are just as apathetic when it comes to providing medical care.

No, no. They might view things as 'urgent' that an experienced Paramedic wouldn't, whilst they might view something as benign that the moment an experienced Paramedic lays eyes on the patient goes "We need to go, now". And some are just plain lazy and want ALS on scene as quickly as possible so they can toss it aside.









(Yup, I made gross generalizations in this post, "everyone is different", "there are good first responders", etc etc)

 

[Jambi]

Since everyone is thinking it, I'll be the first to say it: I don't always trust all my BLS first responders to make that determination, they're only marginally better than the lay person in recognizing sick, and they are just as apathetic when it comes to providing medical care.

No, no. They might view things as 'urgent' that an experienced Paramedic wouldn't, whilst they might view something as benign that the moment an experienced Paramedic lays eyes on the patient goes "We need to go, now". And some are just plain lazy and want ALS on scene as quickly as possible so they can toss it aside.









(Yup, I made gross generalizations in this post, "everyone is different", "there are good first responders", etc etc)

This

 

[Joe]

I read enough of this thread to decide that you guys always have to find something to complain about. Dont like running code? Go run ift dialysis calls. Or work for ups. The public expects us to. You all make it sound like every time we run l&s someone gets injured. I can count on 1 hand how many rigs ive seen crashed during emergent runs on one hand (1). Actually ive head of more crashed when not running code (6 or so) keep in mind we are dispatched to over 4k calls a month in my city

 

[NomadicMedic]

Since everyone is thinking it, I'll be the first to say it: I don't always trust all my BLS first responders to make that determination, they're only marginally better than the lay person in recognizing sick, and they are just as apathetic when it comes to providing medical care.

No, no. They might view things as 'urgent' that an experienced Paramedic wouldn't, whilst they might view something as benign that the moment an experienced Paramedic lays eyes on the patient goes "We need to go, now". And some are just plain lazy and want ALS on scene as quickly as possible so they can toss it aside.









(Yup, I made gross generalizations in this post, "everyone is different", "there are good first responders", etc etc)

Remember, they're not calling for a paramedic ambulance, they're EMTs on a fire engine calling for EMTs on an ambulance. No ALS response unless requested. If its an ALS call, the medic one paramedics transport and the private ambulance does nothing.

Here's the order of response.

911 call.
Fire engine with EMTs.
Patient contact.
If a BLS call, fire requests a private BLS ambulance.
If an ALS call, fire requests paramedics.
If ALS arrive and downgrades to BLS they request a private ambulance.

 

[rescue1]

I read enough of this thread to decide that you guys always have to find something to complain about. Dont like running code? Go run ift dialysis calls. Or work for ups. The public expects us to.

Since when is "The public expects us to" an acceptable reason for us to do something? The public as a whole has no knowledge of medicine or what it entails and their expectations should not determine operational procedure.

 

[Tigger]

I read enough of this thread to decide that you guys always have to find something to complain about. Dont like running code? Go run ift dialysis calls. Or work for ups. The public expects us to. You all make it sound like every time we run l&s someone gets injured. I can count on 1 hand how many rigs ive seen crashed during emergent runs on one hand (1). Actually ive head of more crashed when not running code (6 or so) keep in mind we are dispatched to over 4k calls a month in my city

And this is the attitude that will prevent any substantive change from happening in EMS. If the workforce will neither embrace nor seek change, it is not likely to happen.

Also, considering that most days trucks run non emergent far more often than emergent, it is not a stretch to have more trucks crash during non-emergent operations. I'm not sure many statistics exist showing how many accidents occur between other vehicles not including the ambulance as a result of emergent vehicle operations.

 

[NomadicMedic]

I read enough of this thread to decide that you guys always have to find something to complain about. Dont like running code? Go run ift dialysis calls. Or work for ups. The public expects us to. You all make it sound like every time we run l&s someone gets injured. I can count on 1 hand how many rigs ive seen crashed during emergent runs on one hand (1). Actually ive head of more crashed when not running code (6 or so) keep in mind we are dispatched to over 4k calls a month in my city

Really. How about a little research to back that up?

Emergency Medicine International
Volume 2010 (2010), Article ID 525979, 7 pages
doi:10.1155/2010/525979
Research Article
Ambulance Crash Characteristics in the US Defined by the Popular Press: A Retrospective Analysis
Teri L. Sanddal,1 Nels D. Sanddal,1 Nicolas Ward,2 and Laura Stanley2


"The ... essential issue that is verified in the analysis of these data is the fact that the use of lights or lights and sirens often places the responding ambulance and the civilian population at risk."

http://www.hindawi.com/journals/emi/2010/525979/

 

[DrParasite]

I can count on 1 hand how many rigs ive seen crashed during emergent runs on one hand (1). Actually ive head of more crashed when not running code (6 or so) keep in mind we are dispatched to over 4k calls a month in my city

the numbers you give don't matter. out of all the emergency runs, how many result in crashes? vs out of all the non-emergent runs, how many results in crashes?

to be even clearer on ratios, if you have 100 emergency runs, and the ambulance crashes on 1 of them, you have a 1% crash problem. if you have 1000 non-emergency runs (since most calls are non-emergencies), and 6 crash, then you have a 0.6% crash problem, which is less than the emergency rate, despite more crashes

statistically you have a higher chance of crashing with lights and sirens than without. that's just how the numbers are.

 

[Tigger]

Really. How about a little research to back that up?

Emergency Medicine International
Volume 2010 (2010), Article ID 525979, 7 pages
doi:10.1155/2010/525979
Research Article
Ambulance Crash Characteristics in the US Defined by the Popular Press: A Retrospective Analysis
Teri L. Sanddal,1 Nels D. Sanddal,1 Nicolas Ward,2 and Laura Stanley2


"The ... essential issue that is verified in the analysis of these data is the fact that the use of lights or lights and sirens often places the responding ambulance and the civilian population at risk."

http://www.hindawi.com/journals/emi/2010/525979/

Never mind the research, the public wants us to do it!