When will we stop running code?

[Veneficus]

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.

I think you missed the point.

We Have told them for years that response times mattered.

We Have told them the metric of good EMS is response times.

After a few decades of us spouting this BS. They believe it and expect it.

We are responsible for this.

 

[Shishkabob]

And it doesn't help when the firefighters unions are still pushing "quicker responses", while actual medically proficient agencies are pushing "better patient outcomes not solely based on response time"

 

[WuLabsWuTecH]

First unit in and First ALS unit here go code. Unless it's a potential for multiple patients (like MVCs) where first 2 transport units will go code, or unresponsive/arrest/critical patients, where first unit + first 2 ALS units will go code.

The rationale is until we get medically trained eyes on scene, we simply don't know what we have. How many times has that lift assist turned into an arrest? Or that leg pain turned into an MI?

But yes, if there are already units on scene, and it's not a life threat, then there is no reason to go code. Our response times are measured based on first unit on scene. If there is a downgrade, there is no statistic that keeps track of how long it takes other units to get there.

 

[VFlutter]

The public's expectations should not dictate our practice. But running code is so engrained into the culture of EMS that it will be hard, if not impossible, to convince the majority to change.

Family members often get frustrated when they see the code team walking. They expect them to be running down the halls with loaded Epi syringes dogging wheelchairs and hurdling stretchers as if that will make everything better.


Except I have to admit its a little annoying when Anethesia gingerly strolls down the hall eating an apple while you bag the patient.

 

[Shishkabob]

I guess the public would be just as angry when they find out we eat, sleep and joke on the way to calls.... all at the same time, backwards, while blindfolded.

 

[Veneficus]

Except I have to admit its a little annoying when Anethesia gingerly strolls down the hall eating an apple while you bag the patient.

You make that sound bad...

It was an apple, not a candy bar

 

[WuLabsWuTecH]

The public's expectations should not dictate our practice. But running code is so engrained into the culture of EMS that it will be hard, if not impossible, to convince the majority to change.

Family members often get frustrated when they see the code team walking. They expect them to be running down the halls with loaded Epi syringes dogging wheelchairs and hurdling stretchers as if that will make everything better.


Except I have to admit its a little annoying when Anethesia gingerly strolls down the hall eating an apple while you bag the patient.

Except that the public's expectations do need to be taken into account. The taxpayers are the ones that sign your paycheck at the end of the day. It's our job to educate them to change their expectation, but if after all is said and done, the public wants something from their public services, THEY are going to get it. You upset the public, and suddenly the prospects of that replacement levy getting passed don't look so hot anymore...

 

[Trashtruck]

L/S are good when the pt smells, the pt is annoying, you're tired of making small talk and could care less about what they think is 'wrong' with them, you are hungry and the food you just heated up/bought is now cooling on the front dash, you ordered to-go and need to get back before they close, you have to go to the bathroom, your RN crush of the week is getting off of work soon, you are trying to get off of work on time, oh, and if it's rush hour and the pt is actually critical.

I'd add the emoticon 'smiley face' if I knew how...

 

[AnthonyM83]

If this is what we want, then we're probably going to need additional funding from the city in order to vastly increase the number of units out there. OR we can also just have people wait an hour or more for a BLS response (because of that one 40 minutes away is on a call, you fall back on the one an hour away, and so on). Maybe this would discourage people from calling BUT also consider, those first responders are stuck on scene with her for that hour. Really?

An additional way to look at this problem is asking: Why are these units running hot? There's a difference between going code 3 and actually getting there urgently. Most of my code 3 responses feel like code 2 responses. Only difference is I'll occasionally be opposing traffic. And stop light waits get reduced to stop sign waits. Still dangerous, but not nearly as dangerous as "rushing" to get there.

 

[Achilles]

L/S are good when the pt smells, the pt is annoying, you're tired of making small talk and could care less about what they think is 'wrong' with them, you are hungry and the food you just heated up/bought is now cooling on the front dash, you ordered to-go and need to get back before they close, you have to go to the bathroom, your RN crush of the week is getting off of work soon, you are trying to get off of work on time, oh, and if it's rush hour and the pt is actually critical.

I'd add the emoticon 'smiley face' if I knew how...

:rofl::rofl:

 

[RanchoEMT]

All Ready Do...

On top of Code 3 responses my system also provides code 2 responses with non-emergent BLS calls or patients deemed stable by an on scene care provider with a response time frame twice that of our normal 10 minute 911 response. Once on scene we can upgrade(from code2) or Downgrade(from code3) as we see fit. Not all of our transports go code 3(lights and sirens) to the ER... Good System.

 

[triemal04]

An additional way to look at this problem is asking: Why are these units running hot? There's a difference between going code 3 and actually getting there urgently. Most of my code 3 responses feel like code 2 responses. Only difference is I'll occasionally be opposing traffic. And stop light waits get reduced to stop sign waits. Still dangerous, but not nearly as dangerous as "rushing" to get there.

I guess that's really something to consider, and differentiate when you're talking about emergent driving. When someone says to me "code 3" "hot" or whatever, I'm thinking of someone using lights, sirens, speeding, etc etc.

I work in an area that, depending on the time of day can have hellish traffic; turning on the lights to get around traffic jambs while still driving the speed limit or under the posted limit is still more dangerous than normal driving, but I think less so than doing the same with a higher speed. In the right setting I don't have much problem doing that and think it is appropriate. In the right setting is where it get's sticky though.

And really, most of the time saved in shorter trips doesn't come from how fast you are driving anyway.

 

[mycrofft]

Lights, siren, and legal speed .

 

[PNW EMT]

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.

I am glad I am not the only one who feels the way you do. I work primarily in the county to the north of the one you mention however the culture there is quite similar. Unfortunately I think what it boils down to is no matter how many good reasons we come up with for why this practice is dangerous and unneccessary, the people who need to speak up about it to effect change are the private ambulance companies who won't because they don't want to rock the boat with their contracted cities/fire departments. My question is: If an ambulance crew crashes responding to a BS call because the company officer requested they respond red who's liable? The crew for responding code to a non-emergency call with EMTs on scene? The company for supporting the "FD is in charge, do what they say" mentality, or the FD/company officer for requesting a code red response for something ridiculous? Unfortunately I think until it happens it won't be addressed.

 

[Brandon275]

This is a touchy subject and one with no good solution. Obviously we all know that going to calls hot is a danger and 95% of the time this level of response is not required. We have all been sent hot to calls and gotten on scene and have found someone standing outside holding their bags and waiting for us to show up. On the flip side we have all been sent alpha level response for the seemingly b/s complaint and found a train wreck. Again, no easy solution here.

 

[Veneficus]

This is a touchy subject and one with no good solution. Obviously we all know that going to calls hot is a danger and 95% of the time this level of response is not required. We have all been sent hot to calls and gotten on scene and have found someone standing outside holding their bags and waiting for us to show up. On the flip side we have all been sent alpha level response for the seemingly b/s complaint and found a train wreck. Again, no easy solution here.

I blame the dispatcher

(que the upset dispatcher who can't take a joke flipping out on this post)

Even when you find a trainwreck, their condition is almost never helped by the speed of response or transport.

Sure there may be the occasional penetrating trauma that will benefit from a 3 minute ride to a level 1 trauma center, but it boils down to risk/benefit.

How many lives ad health are you going to risk in order to do it?

Consider not just the provider. But if a provider isfound criminally responsible for injury or death that will impact his/her family plus the family of whomever is injured or killed. Including in wake effect accidents.

For what? To save some time running the dialysis derby?

Responding to toe pain so the firefighters can get back to the station to watch tv, spoon, or workout while they wait for "the big one?"

So you can make it to the next toe pain in less than 8:59 90% of the time?

Maybe so you feel you saved a life giving somebody a ride to the hospital?

It is not reall a touchy topic, it is just another case of tradition overcoming reason and sanity.

Even the FD would be hard pressed to justify it for response times. It was developed when 8 minutes or less to water on a fire would save a structure. Modern construction has all but eliminated that possibility, and the inadequete intitial manpower responding to a working structure fire outside of big city or regional departments eliminates not only the need of an L&S response, it completely makes effecting a save (of life or property) hopeless.

We drive code for 2 reasons.

1. We want to.
2. The public expects it because we tell them it matters.

 

[RocketMedic]

My service responds L/S to everything and anything.

 

[DarkStarr]

My service responds L/S to everything and anything.

That's annoying.

 

[MexDefender]

That's annoying.

We do the same.

What's to be annoyed about?

As a kid you enjoyed it and as a newbie you did as well. Burnouts or just getting too old for it seems to be a common trend. That said I don't disagree with anyone's points.

 

[rhan101277]

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.

Here where I work we don't run lights and sirens to every 911 call. It has to meet specific guidelines to be considered a life threatening emergency. We have the lights and sirens call codes which are the life threatening emergency, then we have a non-life threatening emergency and both of those are lights and sirens. Then we have immediate/emergent response which is non lights and sirens for things such as, been sick for several days, non traumatic back pain, toe stubs, minor lacerations, insert minor chief complaint here. Even in calls sent out as life threatening the medic on scene decides whether to go lights or siren or code 3 back to the hospital. Code 3 is no lights and sirens around here.