Responding and Transporting Code 3

[chaz90]

This isn't necessarily directed at any one person, but some of these posts really make me wonder if anyone is reading the rest of the thread before commenting.

[Rialaigh]

Originally Posted by slewy

Are you serious? 1 or 2 MINUTES is huge.

I would do some research on this but if I had to venture a guess, 10 minutes isn't huge in 99.99% of transports. Certainly does not make a difference in most codes if you haven't gotten a pulse back yet.

[kindofafireguy]

Originally Posted by slewy

Are you serious? 1 or 2 MINUTES is huge.

. . . I hope this was sarcasm. Hard to tell online.

[Emtbob]

As I seem to have a different response area than most people responding to this thread, I feel I should reply.

In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be. Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.

The standard around here seems to be an excessive amount of emergent transports though. The mentality of care throughout the region is mostly scoop and go (even for ALS), and our protocols reflect that. I don't even have a complete (or partially complete, lacking a fast acting steroid) algorithm for anaphylaxis, as apparently medics have trouble getting an IV started with a full assessment and maybe one medication given.

On the other hand, chiefs here can post some truly amazing numbers for our responses. Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset. The objective data there makes people very happy, at least in reports. Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.

[slewy]

100% agree

[Chase]

Originally Posted by Emtbob

On the other hand, chiefs here can post some truly amazing numbers for our responses. Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset. The objective data there makes people very happy, at least in reports. Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.

But how much of that is EMS transport time? And how much time was actually saved running code 3?

Quoting those times does not really mean much without a breakdown. A dispatch to balloon time of 35 minutes is exceptional but that does not tell me much about the EMS system since transport is the least complicated step in the process. It would however make me assume that the hospital and cath lab are very good at what they do.

[Akulahawk]

Originally Posted by Chase

But how much of that is EMS transport time? And how much time was actually saved running code 3?

Quoting those times does not really mean much without a breakdown. A dispatch to balloon time of 35 minutes is exceptional but that does not tell me much about the EMS system since transport is the least complicated step in the process. It would however make me assume that the hospital and cath lab are very good at what they do.

In the downtown area of Sacramento, those times would not be uncommon at all. Why? That area has about a 5-6 minute response time, they tend to be on scene less than 10 minutes, and transport times to the hospital can be maybe 10 minutes. As long as the cath lab is ready to go and the ED staff is confident (relatively speaking) in what they're getting, it's not impossible to have dispatch to needle/balloon times of < 40 minutes.

In the more rural areas, in order to have such fast times, you'd have to have a helo.

[medichopeful]

Originally Posted by slewy

Are you serious? 1 or 2 MINUTES is huge.

With the exception of certain situations, if 1-2 minutes is really that vital for the patient, they very well may not survive anyways.

[Bullets]

Originally Posted by Emtbob

As I seem to have a different response area than most people responding to this thread, I feel I should reply.

In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be. Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.

The standard around here seems to be an excessive amount of emergent transports though. The mentality of care throughout the region is mostly scoop and go (even for ALS), and our protocols reflect that. I don't even have a complete (or partially complete, lacking a fast acting steroid) algorithm for anaphylaxis, as apparently medics have trouble getting an IV started with a full assessment and maybe one medication given.

On the other hand, chiefs here can post some truly amazing numbers for our responses. Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset. The objective data there makes people very happy, at least in reports. Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.

Most of the people here work in urban/suburban areas

Overuse of L/S in the cities is more due to understaffing then need. Because there are not enough units to handle the calls, the units that are on are pressured to turn around quickly so they use the L/S to reduce their times. Seems to be common amongst the big city FD EMS agencies, philly, baltimore, NY and DC

[Robb]

Originally Posted by Bullets

I'm not saying don't start the line and take the time to get a good access. If we have a 2:1 or 4:1 provider to patient ratio then the patient gets better attention being with EMS. Let's do the treatments on scene while the patient has multiple providers working on him.

If the condition is so severe that we cant stay then we need to get you to an advanced care facility and IV access won't be beneficial.

Add to that our local hospitals consider field starts "dirty" and like to pull them once the patient is in their care, it isn't beneficial to pull over for a stick

I'm not sure what you're getting at. I sit on scene a lot. I've got no problem sitting on scene and getting stuff done. If I've got a real short transport absolutely I'll make sure everything is done that I want done before we turn a wheel, but if I've got some time to do stuff there's no reason to not get moving towards the ER. If I get everything done on scene what am I going to do for those 20-30 minutes on the ride in from one of our outlying valleys? I This is just something we'll have to agree to disagree.

Originally Posted by cruiseforever

Does your service use Opticoms? If they do what is your experience?

Meh, they work but you have to give them time to work, the light still has to cycle through being yellow, turning red then turning yours green. Plus when they change like that you still need to clear those intersections since it's usually an unexpected change and it can definitely mess with traffic. I've seen plenty of cars run through lights that have been changed by an opticom.

Another problem is there are a couple different models and brands and they don't play nice. Also the traffic signals have to be equipped to read opticoms.

FWIW they aren't including them on our new units from what I've heard.

Originally Posted by slewy

Are you serious? 1 or 2 MINUTES is huge.

Give me two examples where this is true. Not trying to be an ass but there really isn't all that many cases where minutes make the difference. It's really frustrating transporting a stroke in code 3, clean the unit do another run and come back 40 minutes later to find them still sitting in the ER

Originally Posted by Emtbob

As I seem to have a different response area than most people responding to this thread, I feel I should reply.

In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be. Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.

The standard around here seems to be an excessive amount of emergent transports though. The mentality of care throughout the region is mostly scoop and go (even for ALS), and our protocols reflect that. I don't even have a complete (or partially complete, lacking a fast acting steroid) algorithm for anaphylaxis, as apparently medics have trouble getting an IV started with a full assessment and maybe one medication given.

On the other hand, chiefs here can post some truly amazing numbers for our responses. Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset. The objective data there makes people very happy, at least in reports. Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.

Heavy traffic situations are definitely one of those that you can save a substantial amount of time. There's a place for lights and sirens transport, it's just not as often as people like to think.