Red Mist Avoidance

[LondonMedic]

One of the organisations that I work with does not tell it's driving crew member what the job is, merely where it is.

The idea is that the driver avoids, as much as possible, the 'red mist' by not knowing whether it's a child or really time critical job or something else that gets the adrenaline pumping.

I can't tell whether this actually works, since almost all of their jobs would get the adrenaline going, or whether it's just a gimmick. They do have an admirable safety record, but with so few operational vehicles it's hard to put into statistical context.

What do you think?

 

[medichopeful]

The problem with that that I see would be knowing what to look for on scene, what equipment to bring in, and other relevant pieces of information. I can see why they would do it, but it just doesn't seem like it gives enough information to do the job effectively. I suppose they could tell the other members, but sending the driver (who I assume is a medical provider) into a scene with no information just sounds foolish.

 

[medic417]

So you respond lights and sirens to every call? That seems to needlessly put the public at risk.

 

[dave3189]

What a horrible idea! Any good EMT or Medic should be considering differential diagnosis as well as scene safety en route to the call. How do you do that if you're in the dark as to the nature of the call? This is an example of micro-managing to the extreme!

 

[akflightmedic]

This is typical in flight medicine, we did this in the Arctic when pushing the limits was sometimes viewed "favorably".

We had a sterile cockpit. The pilot would not be told what the call was, he would only be asked if we could go.

We also never told him the severity once we were loaded, only requested our band aid hospital or the more advanced one a few hours away.

I could see the usefulness in an EMS response however I do not see how it would be accomplished. Unless the driver is purely a driver for a specialty team but even then most specialty teams do not run balls to the wall to get somewhere.

If it were me and my partner, we would share the info as we need to perform mental checklists and prepare for various scenarios.

 

[zmedic]

You always drive safely, but you know what? I drive a little different based on the call and I think that's a good thing. If I'm going L & S because On Star called that there was a crash with airbags deployed but no reports of injury, I may not be going up on the curb to get around stopped traffic because I think I can wait the extra minute. If the call is for CPR in progress, I'm still going to be safe, but I'm going to jump that curb, or the median to get into the intersection etc. And I think that's okay.

 

[VentMedic]

This is typical in flight medicine, we did this in the Arctic when pushing the limits was sometimes viewed "favorably".

We had a sterile cockpit. The pilot would not be told what the call was, he would only be asked if we could go.

We also never told him the severity once we were loaded, only requested our band aid hospital or the more advanced one a few hours away.

That is essentially the same for our pilot on Flight and the ambulances we use to pick up the team. Unfortunately many ambulances respond L&S just because it is a flight team coming in even though we have given them an almost exact ETA. It is sometimes amusing to watch their response and sometimes very scary since we see the swerving of the ambulance and other vehicles to maneuver out of each others way. After a flight that has taken 2 hours to arrange and another 2 hours in transit, 2 minutes won't make that much difference. These ambulance crews may know what type of patient we are coming for and assume it is serious for us to fly. However, we still insist on a nice quiet ride to the hospital at regular road speed without the L&S and will rarely discuss any information that might influence their driving.

The same goes for Specialty ground transport. Our physicians will be giving instructions by phone to the sending physician which allows us time for a quiet and smooth ride to that facility. Once the patient (usually infant or child) is on board, we expect another smooth ride and often we will give very little information to the driver of the Specialty team who is part of the hospital motor/transport division or to the contracted ambulance service if we have to use one. Since we may spend several hours in transit or many hours at the sending hospital stabilizing the patient, our attorneys have told us it is hard to justify running L&S and speeding to save a couple minutes to and from the airport. We can save time by a smoother intake process to get the team enroute quicker.

 

[medic417]

You always drive safely, but you know what? I drive a little different based on the call and I think that's a good thing. If I'm going L & S because On Star called that there was a crash with airbags deployed but no reports of injury, I may not be going up on the curb to get around stopped traffic because I think I can wait the extra minute. If the call is for CPR in progress, I'm still going to be safe, but I'm going to jump that curb, or the median to get into the intersection etc. And I think that's okay.

Remind never to ride with you. That is unacceptable driving no matter type of call.

 

[exodus]

Remind never to ride with you. That is unacceptable driving no matter type of call.

In some parts of cities, to be able to go oncomming, you may have to hop a curb... Obviously it won't be with a PT in the back. But I would have no problem hopping a small curb. If it's done slowly and safely. What is the problem?

 

[wyoskibum]

Don't be so quick to judge...

Remind never to ride with you. That is unacceptable driving no matter type of call.

You have no idea what conditions exist. It may be the only way to get from A to B. If the traffic is suppose to pull to the right and there is little or no room to pull to the right, the reality is that you may have to go in the breakdown lane or up and over a curb to get by. Of course you are going very slow when you jump the curb and it can be done safely depending on the curbs.

 

[medicdan]

Ditto, per above. One of the contracts my company has is ground transfers for incoming helicopter and air ambulance transports. Because we only serve as transport, no patient care, we are not told patient acuity or complaint, just pickup time and drop-off location. We are expected to follow the directions of the flight crew in terms of type of response, and even in high acuity cases, that is often to drive normally, no lights, no sirens.

The reality is that the flight crew doesn't know us (although we get to know each other over time), and I completely understand their feelings of unsafety in the back with an unknown driver.

For another contract we hold, we select only excellent experienced drivers and do NICU and PICU transports, in a dedicated ambulance. We load a transport isolette, MD or RRT and RN, and go where ever called, either to bring patients into the city, or "discharge" them. Many of the responses are with lights, but no change in speed, because of our precious cargo. That pleases the staff in the back, doesn't throw the patient around, and our bosses who feel they need to justify the billing.

Because only a few drivers work these shifts, the hospital staff gets to know us, and we them. They trust us with safe transportation, but still do not let the driver know what the patient condition is.

 

[akflightmedic]

You always drive safely, but you know what? I drive a little different based on the call and I think that's a good thing. If I'm going L & S because On Star called that there was a crash with airbags deployed but no reports of injury, I may not be going up on the curb to get around stopped traffic because I think I can wait the extra minute. If the call is for CPR in progress, I'm still going to be safe, but I'm going to jump that curb, or the median to get into the intersection etc. And I think that's okay.

To all who responded to this post...the issue is not the curb hopping. I think the opposition is due to the fact that "CPR in progress" would encourage you to do so as opposed to 100 other calls where curb hopping would actually make a difference.

 

[mycrofft]

I'm with AK here

Besides, how often is dispatch wrong?
Besides, "jumping" curbs etc will kill your vehicle and cause accidents in the long run, no matter how safely you think you're doing it.
If seconds count, then your pt's going to die, that's the hard truth.

 

[zmedic]

Remind never to ride with you. That is unacceptable driving no matter type of call.

Everything I mentioned was part of our acceptable protocols. I'm not going to type out what our driving protocols were because I don't have time, but we were allowed to cross the median head on if the median was less than a certain depth, if we were within a certain distance of the intersection. Same with going up on the curb, certain max speeds, if no pedestrians were present etc etc.

I'm just saying there are times that I wouldn't use the maximally agressive but allowable methods of driving for certain calls that were still L & S. Does that really make me dangerous?

 

[zmedic]

To all who responded to this post...the issue is not the curb hopping. I think the opposition is due to the fact that "CPR in progress" would encourage you to do so as opposed to 100 other calls where curb hopping would actually make a difference.

I would curb hop for respiratory distress, MVC with injuries etc. (not that I had an actual list). But I see no reason to do so for things like unconfirmed structure fire, which used to be a code 3 response. We're just going to sit standby and where we were the vast majority of these turned out of be false alarms.

I think this sterile cockpit idea makes a lot more sense for flights, where the big question is go/no go, and the consequences are much higher for a bad decision. In the rig, we're going and I think you'd have to have some pretty good data to support rolling this out for a lot of services. Which would be pretty hard to do because ambulance crashes are pretty rare so you'd need a lot of people involved to show a difference in the crash rate between sterile and non sterile.

Aside from which I don't know how you'd tell one person and not the other. Most ambulances are dispatched via radios where everyone is listening. And as has been mentioned above, you bring difference gear, you get your head set for different things. Mentally it helps to know you are rolling up to "MVC with multiple fatalities" vs "rear ended with neck pain."

 

[Jon]

Many flight services are very careful about doing this.

I don't see how it would work in 911 response... I've got a radio and an MDC up front in the cab... any info the attendant gets, the driver does too.

As for driving different - I'm thinking...and yeah, I guess I take some greater, but calculated risks if the information I get makes the call sound "bad". Perhaps I could rephrase that: I think I probably take fewer risks and 'slow down' when the information I'm getting makes the call seem less critical. Including not bothering to turn the lights on at all sometimes (some of that is Squad SOP, some is my discretion).



I've driven a couple of last-minute shifts for the local Children's Hosp. retrieval team... they discussed some of the patient's condition, etc, after I explained that I was a paramedic student most of the way though class, and more than anything we discussed pediatric assessment and what they do. Almost all of their ground transports are non-emergent, with time spent on the floor or in the referring ED to stabilize before leaving, if needed. Further, when they determine they have a very critical patient, they will make the choice to fly the patient back, with the transport team on the chopper as well.



I can't see doing it anyway else... but I imagine that it could be done if the system was set up different.

 

[RescueYou]

eh, they should know. here, everyone hears the call come in. the driver needs to know whether or not to go full L and S or not and whether to be really "pushy" in traffic. Also, there are often mulitple ways to a call and the route you take with a pedi code and a FDGB are different. Also, it's not rare for us to have an ALS truck with a medic in the back and the EMT driving and the EMT needs to be aware of what they are heading towards.

 

[akflightmedic]

eh, they should know. here, everyone hears the call come in. the driver needs to know whether or not to go full L and S or not and whether to be really "pushy" in traffic. Also, there are often mulitple ways to a call and the route you take with a pedi code and a FDGB are different. Also, it's not rare for us to have an ALS truck with a medic in the back and the EMT driving and the EMT needs to be aware of what they are heading towards.

Full lights and sirens as opposed to....half lights and sirens??

Regardless of your response mode, this is not something which is determined by medic of the day. Your service should have clear guidelines in place ranging from everyone call gets LnS to the trained EMD making the determination based on established agreed upon guidelines. To do anything else is less than responsible and sets one up for huge liability claims.

I also find it interesting that you choose routes based on what you are responding to. Everyone gets the most expedient route regardless of call. You can not cherry pick and you should not base your response on what you think is going on...that FDGB could be something very serious and fixable, maybe more so than that pedi code.

Same with your "pushy" in traffic comment. Read some studies on urban light and siren use and see what that pushiness in traffic truly gets you. Now compare that pushiness with you creating another call (as in causing a wreck) and any intelligent person can reason out that the pushiness was not needed.

Your verbage use and thought patterns embarrass the profession.

FDGB = Fall down go boom for those that are not sure what is being discussed.

As stated earlier, I do not think it is practical but the arguments for or against are quite revealing and disappointing.

 

[RescueYou]

Full lights and sirens as opposed to....half lights and sirens??

Regardless of your response mode, this is not something which is determined by medic of the day. Your service should have clear guidelines in place ranging from everyone call gets LnS to the trained EMD making the determination based on established agreed upon guidelines. To do anything else is less than responsible and sets one up for huge liability claims.

I also find it interesting that you choose routes based on what you are responding to. Everyone gets the most expedient route regardless of call. You can not cherry pick and you should not base your response on what you think is going on...that FDGB could be something very serious and fixable, maybe more so than that pedi code.

Same with your "pushy" in traffic comment. Read some studies on urban light and siren use and see what that pushiness in traffic truly gets you. Now compare that pushiness with you creating another call (as in causing a wreck) and any intelligent person can reason out that the pushiness was not needed.

Your verbage use and thought patterns embarrass the profession.

FDGB = Fall down go boom for those that are not sure what is being discussed.

As stated earlier, I do not think it is practical but the arguments for or against are quite revealing and disappointing.

omg. u seriously should try just going with lights and no siren sometimes. when it's 5am and only 10 cars are out, u dont need 2 wake the entire town with ur sirens, but the rig lights change the stoplights.

we dont actually "pick routes" so-to-speak. just sometimes u know certains streets can have more cars parked on the side (making it a one way street sometimes) or some have more children to be aware of playing and u choose which would be faster depending on the time and day.

FDGBs here are rarely serious. I just used that as an example. But seriously. A frequent flyer who calls because they are "too relaxed" is not as high of a priority as an MCI MVA. If you don't know that, I hope you never do triage.

And I'm not really going to argue the "pushy" thing. I never drive so I can't give a true description of what is meant.

I just know that if I were the driver, I would want to know what I'm going to, especially if I'm the EMT.

 

[medichopeful]

omg. u seriously should try just going with lights and no siren sometimes. when it's 5am and only 10 cars are out, u dont need 2 wake the entire town with ur sirens, but the rig lights change the stoplights.

we dont actually "pick routes" so-to-speak. just sometimes u know certains streets can have more cars parked on the side (making it a one way street sometimes) or some have more children to be aware of playing and u choose which would be faster depending on the time and day.

FDGBs here are rarely serious. I just used that as an example. But seriously. A frequent flyer who calls because they are "too relaxed" is not as high of a priority as an MCI MVA. If you don't know that, I hope you never do triage.

And I'm not really going to argue the "pushy" thing. I never drive so I can't give a true description of what is meant.

I just know that if I were the driver, I would want to know what I'm going to, especially if I'm the EMT.

I'm sorry. It's hard to take someone seriously who doesn't write out a three letter word ("you"). It really doesn't gain much respect in a professional setting.