Lights and sirens? & responding to a scene.

[Medic]

Hello all.

Basically asking you guys why you think lights & sirens do or don't work,read a few posts where people think they are useless, others don't.



Do you feel they are just and added danger to your ambo and the cars around you while responding?

Should they only be used as a warning light for scene safety and scrap the siren?

I honestly think they helps a lot. Especially with in cities and busy urban areas. to warn people that there is a incident of sort and to proceed with caution. There should be laws put in place so people don't get too carried away.

I'm interested to see your responses.

 

[fortsmithman]

In the nearly 2 yrs I've been a member of my service we've only used lights and sirens maybe 10 times. We've used our lightbar numerous times when we've operated as ground support for air medevac. That's due to Transport Canada regs that require all vehicle to use roof emergency light on all vehicles while on the tarmac.

 

[Medic]

Never used them to go through a red light or any thing or to warn a car to move over on the free way?

The companies i know use L&S to scene and just Lights some times sirens depending on the pt's priority on the way back to hospital.

 

[daedalus]

They are found to only reduce response times in the tens of seconds scale, which does not contribute to better patient outcomes, add to that responding lights and sirens is extremely dangerous and kills emergency workers and the public when it is not done right.

I think it has a place in EMS, but not as prolific as it is now.

 

[JPINFV]

They are found to only reduce response times in the tens of seconds scale, which does not contribute to better patient outcomes, add to that responding lights and sirens is extremely dangerous and kills emergency workers and the public when it is not done right.

I think it has a place in EMS, but not as prolific as it is now.

I agree. I've seen two to three studies on L/S and L/S generally saves up to a couple of minutes. Similarly, the authors of every study I've seen have concluded that while a statistically significant amount of time is saved, that time is almost never clinically significant.

 

[karaya]

Every EMS provider that I ride with all over the country uses lights and sirens on most calls. Those with EMD typically only respond l/s with life threatening type calls only. Patient assistance, "I stubbed my big toe", etc. type calls are generally non-emergent response and are dispatched as such.

 

[daedalus]

Every EMS provider that I ride with all over the country uses lights and sirens on most calls. Those with EMD typically only respond l/s with life threatening type calls only. Patient assistance, "I stubbed my big toe", etc. type calls are generally non-emergent response and are dispatched as such.

This.

I hear of radicals calling for the removal of emergency equipment from ambulances, but I do not quite think we are there. Triage and no-code responses to low priority calls can cut down on our use of L&S significantly. While I am aware of such systems in Ventura and Santa Barbara, unfortunately Los ANgeles feels the need to go code 3 to every call. Dangerous.

The use of L&S should always be a risk vs benefit in the providers head, just like everything else in medicine.

 

[DV_EMT]

I hear of radicals calling for the removal of emergency equipment from ambulances, but I do not quite think we are there. Triage and no-code responses to low priority calls can cut down on our use of L&S significantly. While I am aware of such systems in Ventura and Santa Barbara, unfortunately Los ANgeles feels the need to go code 3 to every call. Dangerous.

yep, I agree with daedalus... here in SB (and Santa Maria cause I hearthir radios as well) anything life threatining (chest pain/sob/trauma calls) get code 3. everything else is just plain old code 2.

IMO, the way that SB does it is very appropriate. but LA countys "go CODE" for everything is a hazzard... ESP with traffic the way

 

[karaya]

yep, I agree with daedalus... here in SB (and Santa Maria cause I hearthir radios as well) anything life threatining (chest pain/sob/trauma calls) get code 3. everything else is just plain old code 2.

What is code 2? No lights and siren?

 

[atropine]

I don't know any better, but in LA County if the medics are transporting every thing is L&S, until it changes thats just the way it is for now.

 

[Mountain Res-Q]

My issue with EMS and Fire in my area is that 95% of all calls get a code 3 response; while only 2% of all calls get a code three return to the hospital. The code 3 response only shaves a few seconds off most calls while endangering the lives of the crews and of the public. Why? Because grandma isn't feeling well and we are CYAing it by saying "well it could be the start of (insert life threatening condidtion here)"? We all know that 90% of the calls (in hidsight) did not warrent a code 3 response and code 3 returns are rare.

On ambo 95% of the 911 calls we got were dispatched out as code 3 and when we get there we find a tweeker with a bleeding scab on their leg (example). We risked our lives and the lives of the public for this? However, a child found floating in a pool (example) deserves every extra second code 3 can give them in the response and for the return to the hospital. The issue is that intial report and a response to most 911 calls as "OMG... soemone is dying!" Then, when we get on scene we tke those extra seconds to ensure scene safety and then walk (never run) to the patient? Drive fast? Walk slow? WTF? We preach "take five... alive" but somehow need those extra 5 seconds that a code 3 response MAY provide?

Having said that... in some areas code 3 does more than shave a few seconds off the response. It is justified in some cases. Unfortunately, most agencies follow a textbook response pattern that endangers lives with little or no discernable benifit. Maybe if we lost the L&S in EMS and Fire, some of the Trauma-Watching-Whackers would go away...

 

[firetender]

What is code 2? No lights and siren?

In Santa Barbara, where I worked a generation ago, Code 2 was lights, no sirens.

Being a Dinosaur and having seen how emergency services were done pre-ALS, as an EMT where rapid response was one of your biggest tools and as paramedic living through countless incidences where a minute or even less made a HUGE difference...

...and let's not forget, though it's not a race, the more quickly you get to a life-threatening situation the less time the incompetent and dangerous have to ruin your patient...

My hope: L & S is here to stay.

The studies measure travel time from hospital to scene (etc.) and back and the end result; morbidity and mortality. But there's NO way to measure the extra time lost on the consequences of having to "adapt" to traffic.

Using lights and siren allowed me to move steadily and smoothly to and from a scene. Besides opening pathways for the rig, it helped me to establish an internal rhythm of calm rather than having to be confined and frustrated by the actions of the drivers around me. Establishing control begins the second you get the call

To hospital, even in non-life threatening emergencies, Code 3 for a couple of fractures, all else stable, means eliminating a really miserable ride (therefore entry point to recovery) for the patient. I want the choice.

As I read through the various statistics and studies that come up on this site I'm amazed at how LITTLE they deal with the human element of delivering the therapy, etc. the "fuzzy thinking" that makes an approach valuable and not just statistically significant.

 

[JPINFV]

To hospital, even in non-life threatening emergencies, Code 3 for a couple of fractures, all else stable, means eliminating a really miserable ride (therefore entry point to recovery) for the patient. I want the choice.

So, your saying that as a paramedic if you had the choice between real pain management and using lights and sirens, you'd choose lights and sirens?

 

[guardian528]

What is code 2? No lights and siren?

urgent, but obey all traffic laws, no L&S

 

[CollegeBoy]

In an open, rural area, lights do more than most people would expect. Around here there are mainly two lane roads that are in fairly crappy shape. It is not uncommon that when meeting somebody speeds must be slowed significantly because roads are narrow and putting a tire onto the edge would likely pull the vehicle in and flip it. Lights slow people enough that they can move over without risk, and we can procede without slowing significantly. It also helps that normal visibility on these roads are probably five miles maybee more so approaching vehicles can be seen easier making for very few surprises.

Protocals state that sirens should only be used in poor visibility situations (rare outside of weather), when cars refuse to budge, but most commonly at busy intersections. There are about 5 intersections in the county that we are supposed to use a siren at even if there is no traffic.

 

[firetender]

So, your saying that as a paramedic if you had the choice between real pain management and using lights and sirens, you'd choose lights and sirens?

We're talking about one of many tools here.

 

[Mountain Res-Q]

We're talking about one of many tools here.

Tools are only useful is used properly and appropriately. L&S are no different. They have their place and use. But over use and improper use may one day dictate that they are removed from a proper place in the field... L&S to every call is stupid, unnecessary, and dangerous... just like saying that all patients get oxygen at 15lpm or every patient gets morphine in case they may develop pain...

and that is coming form someone that has an addiction to pretty flashing lights...

 

[dragonjbynight]

and that is coming form someone that has an addiction to pretty flashing lights...

still haven't found the cure for that addiction..lol

All in all I agree. I have the same issues as ruralemt, narrow roads, tons of 90degree curves, running lights isn't just to get to the scene faster, it helps as warning for oncoming traffic. I know when i drive our rig to scene, unless it comes through as a time sensitive call, I don't go much more than 5-10 over the limit (sometimes less as the roads are horrible) At the same time, I see no reason to be doing 90 miles an hour down a 45mph road for a broken arm.

I believe L&S is here to stay, but increased caution in use would be advisable.
I also agree with having to stop, or at least california rolling stop at every intersection even with L&S. I've seen many close calls over the years at intersections where drivers just blow through without even slowing.

 

[BLSBoy]

I would LOVE to see the data from the studies that say only a few seconds are saved.
How long was it to the hospital?
How many traffic lights were there?
Were said traffic lights synced?
Hows the traffic?
What time of the day was it done?
What day of the week was it done?

Round here, RLS saves 5+ minutes, easy.
However, use em when they are needed!
I just love the BLS crews that recall us (Medics), and then go screaming to the hospital RLS. :glare:

 

[EMSLaw]

I just love the BLS crews that recall us (Medics), and then go screaming to the hospital RLS. :glare:

I've never seen that here, not that it doesn't happen. Given what I know about some EMTs, and some squads, it wouldn't surprise me at all.

What has happened is something like, "Do we have an ETA on medics?" "Medic Unit X is coming from XXX (some town far away.)." "We'll meet them en-route." THEN we go code 3.

Of course, the whole "we'll meet them on the way" thing doesn't always go according to plan. And I have heard at least one story of a BLS unit being turned away at a Trauma Center because "no medics, no trauma." Even if ALS was not available or was further away from us than we were from the hospital.