When will we stop running code?

[DrParasite]

The first thing that would help is making it illegal for all ambulances that are not part of a 911 system to use a lights and sren response or disobey any traffic law.

oh i disagree with you 100%. even IFTs ambulances, renal runs, and dialysis derby trucks can be dispatched to a routine run, and find their patient is really sick. If you want to say they shouldn't respond with L&S, that I can agree with.

but if you have a critical patient (even one that didn't come in as critical), and upon your assessment, you determine the patient needs a higher level of care than you can provide, than absolutely I can see the justification for using your L&S to get the patient to an ER.

 

[Tigger]

Who is going to do the review?

The company management who overbooks their dialysis transfers?

The company that wants to keep a contract for IFT with a specific hospital?

What is the penalty?

Against who?

If you need to do an emergent delivery or c-section staff your CCT with a doc that can do it.

Otherwise, no need to whine.

In disasters, countries ask for medical teams. Not individual surgeons or nurses.

If your team cannot handle a case, it is no more critical care than a 911 ambulance.

As for the IAFF, if EMS cannot police itself and outside agency needs to.

Who does the review for RSIs and other "advanced" procedures? Usually the company's QA. How is the use of L&S any different?

 

[RocketMedic]

oh i disagree with you 100%. even IFTs ambulances, renal runs, and dialysis derby trucks can be dispatched to a routine run, and find their patient is really sick. If you want to say they shouldn't respond with L&S, that I can agree with.

but if you have a critical patient (even one that didn't come in as critical), and upon your assessment, you determine the patient needs a higher level of care than you can provide, than absolutely I can see the justification for using your L&S to get the patient to an ER.

Many of these rigs are BLS only. This is why ALS 911 exists.

 

[DrParasite]

Many of these rigs are BLS only. This is why ALS 911 exists.

all the more reason to use L&S. BLS can give oxygen and rapid transport to either ALS or the hospital. if your ALS is 20 minutes out, and your BLS truck is 10 minutes from the ER, why not just load and go to the ER?

Of course, that would require your BLS crews to be able to identify a sick person, as well as what ALS can do for this sick person, and judging from what I have read on here, many cannot tell the difference between sick and not sick.

 

[JPINFV]

Who does the review for RSIs and other "advanced" procedures? Usually the company's QA. How is the use of L&S any different?

Something about chickens and the fox hole... or something like that.

 

[RocketMedic]

all the more reason to use L&S. BLS can give oxygen and rapid transport to either ALS or the hospital. if your ALS is 20 minutes out, and your BLS truck is 10 minutes from the ER, why not just load and go to the ER?

Of course, that would require your BLS crews to be able to identify a sick person, as well as what ALS can do for this sick person, and judging from what I have read on here, many cannot tell the difference between sick and not sick.

*cough Jersey medicine* uncough*

 

[ffemt8978]

So are we assuming that this discussion is only about running L&S within a town or city instead of long, deserted stretches of highways?

 

[RocketMedic]

So are we assuming that this discussion is only about running L&S within a town or city instead of long, deserted stretches of highways?

L&S in rural settings is just as dangerous. Plenty of drivers speed up and overdrive the truck and their abilities because it's rural and deserted, and get complacent.

 

[ffemt8978]

L&S in rural settings is just as dangerous. Plenty of drivers speed up and overdrive the truck and their abilities because it's rural and deserted, and get complacent.

Agreed, but complacency is not something that is exclusive to driving L&S or even in a rural area. For my agency, the difference in transport time to an ALS unit is 10 minutes, and to the hospital it is 20 minutes when we drive L&S on the highway and shut down the code when we approach city limits.

 

[Jambi]

...instead of long, deserted stretches of highways?

which seems pointless, though that me be your point no?

 

[usalsfyre]

Who is going to do the review?

My thought in my area is the local Regional Advisory Councils. We currently do an internal review of all emergent runs.

What is the penalty?

We start with education and move through the disciplinary process as needed. I assume a RAC would do something similar.

Against who?

At the regional level? Fine the company. This gives them incentive to educate their people

If you need to do an emergent delivery or c-section staff your CCT with a doc that can do it.

You're still delivering a 28 wk'r in the out-of-hospital environment which is less than ideal.

Otherwise, no need to whine.

Not whining, just disagreeing. I'm not a fun of running emergent by any means. But there are a very few circumstances where it's called for.

In disasters, countries ask for medical teams. Not individual surgeons or nurses.

If your team cannot handle a case, it is no more critical care than a 911 ambulance.

I would wager the vast (95%+) majority of CCT teams in the US are ill prepared for the above circumstance no matter what the team make up.

As for the IAFF, if EMS cannot police itself and outside agency needs to.

Then lets have it be a governmental function and not involve an organization that has shown no inkling towards actually improving EMS.

 

[ffemt8978]

which seems pointless, though that me be your point no?

See my post about transport times.

 

[DrParasite]

*cough Jersey medicine* uncough*

*cough if you want to wait for your 911 ALS units, you must have a plethora of unused ALS units just waiting around or too many ALS units who never see sick people, so you wouldn't know one if it spit in your face *uncough*

are you really arrogant enough to think that OK mortality rates are that much better than that of NJ? and if you are, do you have the date to back it up, as well as the hard evidence to conclusively show that it is a direct result of your all ALS systems?

if not, than feel free to STFU

 

[ffemt8978]

Play nice or become the focus of my complete and undivided attention.

 

[Tigger]

*cough if you want to wait for your 911 ALS units, you must have a plethora of unused ALS units just waiting around or too many ALS units who never see sick people, so you wouldn't know one if it spit in your face *uncough*

are you really arrogant enough to think that OK mortality rates are that much better than that of NJ? and if you are, do you have the date to back it up, as well as the hard evidence to conclusively show that it is a direct result of your all ALS systems?

If we limit mortality rates to be the only determinant of a successful system then we are doing our patients a disservice. If you break your leg do you want paramedics to show up immediately and provide pain control, or would you rather a BLS crew splint you, move you as scream to the truck, and then maybe get an ALS rendezvous on the way to the hospital? I know which one I want, and I know it from experience.

if not, than feel free to STFU

Also, feel free to be respectful.

 

[ffemt8978]

Last warning...

 

[Tigger]

Something about chickens and the fox hole... or something like that.

Yet so many are quick to praise services that have extensive in house review programs along with the ability to reeducate those that have made mistakes as progressive and those that we should look up to.

 

[JPINFV]

Yet so many are quick to praise services that have extensive in house review programs along with the ability to reeducate those that have made mistakes as progressive and those that we should look up to.

I might be assuming a little too much, but I get the feeling that the companies that play fast and loose with lights and sirens aren't the ones with the legitimate in-house review programs.

Of course no sooner I say then than I think, "Boston EMS."

 

[usalsfyre]

Yet so many are quick to praise services that have extensive in house review programs along with the ability to reeducate those that have made mistakes as progressive and those that we should look up to.

This is the point I'm making. I obviously work for a non-911 private. We're also HIGHLY aware of the liability involved in emergent response. If anyone gets caught running code to a dialysis run it would be bad to say the least.

 

[RocketMedic]

I feel that a huge portion of our accidents as an industry "running code" involve volunteers and ill-trained responders "racing to the scene because moments matter". Why do I pick on them? Because they are, statistically, the most common EMS providers, and they are the most likely to lack exposure to large vehicle operation and proper medical training. There is a definite time for speed and our alarm systems (respiratory distress, witnessed arrests, etc). These situations are few and far between. My service runs L/S to every call, regardless of priority, and it has killed and injured people. We have not learned from our mistakes, and expect EVOC classes to somehow keep accidents from happening.

Until we, as a profession, can keep our members from putting lightbars on POVs and educate our management staff as to the import of response times, we are going to keep seeing crashes, injuries and deaths.