Code 3

[Angel]

or lights and sirens...for clarification

Im going to try and make this as short winded as possible. But I am curious about medicals, and when people decide to go code 3.

my situation was a 35 YOF hx asthma, basically having an asthma attack all day refractory to home meds and was continuing to get worse. Vitals were ok, 130/70's, Sinus Tach 123, 26-30
very little lung sounds, (wheezes up top) and none below, SpO2 stayed in the high 90s, 5-6 word sentences, had a dry cough, no cyanosis and no accessory muscles, but she was clearly working to breathe. initially she was put on an albuterol and atrovent via HHN but kept complaining it was getting worse and not helping, so she got put on CPAP with those 2, no epi was given but the CPAP did help

she was transported code 3 to the ER, and was put on bipap, given solumedrol and a mag drip

later on I was told I should not have taken her code 3 and given a list of reasons why (not worth the potential car accident, misuse of code 3 ect ect)
while I disagree, im kind of curious what others would have done.

 

[wtferick]

Had one similar to that type of call aswell. Took it code 3, ended up surpassing a chest pain pt aswell brought by another crew.

 

[Brandon O]

Just as a passing point: it's only called "code 3" in California and maybe some similar haunts.

Terminology in this business is never as universal as it seems. Although I admit the "code 3 club" seems to have nationwide acceptance...

 

[Angel]

noted, i cant change the title so I just put it in the post. Again, Im a self centered californian and forget not everything is the same

 

[Gurby]

I feel like it's hard to say without seeing the patient... Respiratory patients can crash hard and fast, so I think erring on the side of caution and going lights + sirens is fine here. During my ride time we had a patient who I thought wasn't that sick, and 30 seconds later we're bagging and pt is tubed on arrival. Then again, that was a 75 year old COPD'er - I guess a 35yo has less risk of crashing all at once like that?

 

[OnceAnEMT]

I think it definitely depends on the holistic patient presentation, and its something that we can't really quarterback from here. That said, I've had patients come in to the ED from a code 3 trip that was escalated because of respiratory deterioration. The way I see it, if you aren't the fix and that patient needs a fix yesterday, then its worth code 3. That includes your gut feeling that you are missing something or you don't feel comfortable with this crashing patient. Now, this should follow up with education on how to better handle the situation (which you've done), so "I wasn't feeling it" isn't an infinite excuse, but I don't think it is "wrong". All of that said, other factors still play a role in the decision to escalate. Was going code 3 worth the time saved, if any time saved?

 

[teedubbyaw]

And it's universally known as code 3 almost everywhere...

Our transport times in the city are generally short (<10min) unless it's trauma, then we're looking at a 45 minute transport w/o lights. I tend to only use code 3 if we're going to our trauma center and it is a busy time during the day and the pt's condition necessitates it.

Any decreased LOC/GCS due to an acute life threatening medical issue will get code 3. I try not to use it otherwise, especially in airway pt's. Lights and sirens only makes patients freak out more.

 

[Brandon O]

And it's universally known as code 3 almost everywhere...

You're quite a traveler!

 

[RefriedEMT]

heard of code 3 but my area and all the EMT's and medics ive talked to just say going priority.

 

[OnceAnEMT]

heard of code 3 but my area and all the EMT's and medics ive talked to just say going priority.

To which I say "Priority what?"

"Emergent" and "Non-emergent" are more common here, but code 1/3 still come out as lingo from time to time.

 

[PotatoMedic]

Just in the few places I have worked and heard on the radio I have heard, "Priority" "Red" "Code" "Emergent" "L&S." Probably a few more that I can't remember.

 

[RebelAngel]

Code 3 in our county means third call for said EMS service.

Our priorities go from Alpha (asinine) to Delta (don't get in my way), lol.

I've seen lights and sirens go on at EMT discretion for nothing an times when Paramedics probably should have run lights and siren bit for whatever reason didn't.

 

[Ewok Jerky]

As others have pointed out its a case by case basis. Just about anybody who is unstable, altered, or scares me some other way.

Also as others have stated, scary airways can get very scary very quick (for everyone involved).

Once you have someone on CPAP I wouldn't be surprised if you went in hot.

 

[Angel]

I too have had a pt go from alert and talking to us bagging her within a span of 10 minutes so I know things can go to crap fast and always keep that in the back of my mind. I feel fine going code 3 with cpap even though this pt wasnt on the crap end of the spectrum yet, she had the potential to go there.
IDK, my partner chalked it up to me being new and not cynical yet.

I guess the next step is to wait and hear from the bosses (and QA), though, based on past experience, they wont have an issue with it.

 

[Handsome Robb]

Emergent transport is very rarely worth the risk to you, your partner, your patient or others on the road.

I wasn't there so I'm not going to tell you you were wrong but personally I would not have transported this patient emergent from the information provided. Also, I would be dinged and thoroughly questioned by QA as to my reasoning for why I went emergent with the patient you described.

The only times I really go code with a patient anymore is CVA patients who're tPA candidates or severe traumas that are circling the drain. We get dinged by QA for not taking STEMIs emergent but there was a study done about it actually having a negative effect on outcomes. Increased anxiety = catecholamine release = increased afterload, HR and cardiac workload = increased MVO2 = worsening injury and infarction. I don't have the study handy but I will look for it for you.

If you think about it how often is it that if you take a FF and go emergent that the Engine is rolling into the hospital as you're backing up or unloading the PT and they didn't go emergent following you. It really doesn't save that much time.

Even with your experience of needing to bag the patient what does emergent transport do to help them? You're supporting their airway, oxygenating and ventilating them.

Regarding CPAP patients, personally CPAP =/= emergent transport. The question I will ask is if she's not sick enough to need CPAP/BiPAP why does she need to be transported emergently?

There really are only a handful of things where minutes and seconds actually count.

 

[Angel]

that being said, why go code 3 at all? is a couple of seconds/minutes going to make a difference for said CVA? (unloading the gurney takes "seconds" inputting the ER code takes "seconds") Trauma pt? no, and I know code 3 only saves seconds, but Ive seen the cluster going code 2 for critical pts causes for the ER and the delay in care.
To me none of these are good excuses NOT to go code 3 vs going but I do appreciate your opinion.

 

[RedAirplane]

Doesn't the latest version of NIMS/ICS discourage any codes, including "Code 3?"

Everyone says it all the time, but isn't the federally correct phrase something like "high priority" or "lights and sirens?"

 

[Handsome Robb]

Alright, the thread is about the patient not the terminology.

 

[PotatoMedic]

Aside from the code 3 part. I read you posy and skimmed the rest past mine. Did you try a mag or epi neb? Or can you not do any of those?

 

[captaindepth]

Has anyone decided to take a pt emergently in order to have the proper reception at the ER when you arrive? meaning that the pt may not truly require emergent transport but in order to get the "big room" at the ED with the appropriate staff/resources waiting for your arrival, then just bring the pt in emergently.

The pt in the original post was certainly sounds like they were in respiratory distress but maintaining well (overall) with good O2 sats and expected vital signs for a moderate/severe asthma attack. With the improvement following CPAP I think starting off non emergent and being ready to upgrade to emergent at the slightest sign of deterioration is appropriate.