Lights and Sirens Use

Bullets

Bullets

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With the death of another one of our brothers in a traffic crash i find myself revisiting my departments response policy. While this specific accident did not involve the use of lights and sirens as a contributing factor, it has been one in other LODDs. My intention is to remove lights and sirens from BLS level responses. Is anyone aware of any other agencies that have done this? While a stack of LODD reports should be enough, Im expecting a fight from our governing body and id like to come prepared as best i can.
 
Why? I understand the knee jerk reaction to the LODD; if lights and sirens are that big of an issue, shouldn't they be removed from PD and FD vehicles too? Instead of a department rule, shouldn't it be townwide? Will you be ok with the ambulance taking a nice easy ride, while the first responder (PD or FD) goes hot to the scene?

if you do remove L&S responses, will the governing body be ok with longer response times? What should your crew's response be to the questions "what took you so long?"

For all the LODD, there are plenty of agencies that use L&S all the time without a LODD....

What about calls where what the caller tells dispatch and what the patient condition is are miles apart? remember, garbage in, garbage out, and most callers do lie to dispatch (either intentionally or due to ignorance).

My first volunteer squad responded to all calls L&S; our dispatchers were too stupid and unreliable, and many BLS dispatches turned out to be cardiac arrests. The only call we didn't use L&S were for fire calls; however any confirmed working structure fire was a L&S response, as well as automatic request for an additional ambulance
 
There are many areas that do not respond Lights and sirens for all calls. For the past year or so my part time system has been incorporating a EMD system where based on the 911 call and complaint we will either respond code 2 (normal driving) or code 3 (lights and sirens) in an ALS only system. This is for ambulance and fire departments. Our policing agencies around here respond code 2 for the vast majority of incidents and will usually have to get approval from a supervisor on duty or dispatch to go code 3.
 
DrParasite said:
Why? I understand the knee jerk reaction to the LODD; if lights and sirens are that big of an issue, shouldn't they be removed from PD and FD vehicles too? Instead of a department rule, shouldn't it be townwide? Will you be ok with the ambulance taking a nice easy ride, while the first responder (PD or FD) goes hot to the scene?
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I dont have control over what the PD or FD does. i am not advocating for their removal, the staff has had discretion on L&S use for some time so we already respond cold to many calls. Yes, i am ok with those agencies setting whatever policy they want. Currently our cops do not routinely use Lights to go to medicals, the FD uses lights to everything.

if you do remove L&S responses, will the governing body be ok with longer response times? What should your crew's response be to the questions "what took you so long?"
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We are not currently judged nor is our contract based on our response times. They are happy with our level of service. Our response will continue to be, "We got here as quickly as we could as safe as we could"


What about calls where what the caller tells dispatch and what the patient condition is are miles apart? remember, garbage in, garbage out, and most callers do lie to dispatch (either intentionally or due to ignorance).
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It is what it is. If we get in a crash going there then does it matter what the caller says? Our dispatchers are an accredited agency that uses an endorsed EMD system. They are professionals and quite good at their job. I trust them to do it correctly and get it right most of the time. While there will be occasions that what is said is not reality, they are few and far between.

My first volunteer squad responded to all calls L&S; our dispatchers were too stupid and unreliable, and many BLS dispatches turned out to be cardiac arrests. The only call we didn't use L&S were for fire calls; however any confirmed working structure fire was a L&S response, as well as automatic request for an additional ambulance
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If anything, going cold to fires is our best option based on how the FD responds to calls (recklessly).
 
We have a lot of calls that we don't respond lights and sirens for, as it should be. Sorry, but not driving emergent for the PEG tube that needs to be swapped.
 
Bullets said:
It is what it is. If we get in a crash going there then does it matter what the caller says?
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yes, but you know as well as I do, you can get in a crash without L&S. just look at all the MVCs in your coverage area. I know that, statistically, L&S do increase the risk of a crash, and, again statistically, the use of L&S doesn't save you a significant amount of time (IIRC, 60 seconds at the most), but statistics can also be manipulated to whatever point of view you want.
Bullets said:
Our dispatchers are an accredited agency that uses an endorsed EMD system. They are professionals and quite good at their job. I trust them to do it correctly and get it right most of the time. While there will be occasions that what is said is not reality, they are few and far between.
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I used to work for an accredited 911 center, which used EMD (likely the same one used by your system). people still lie to dispatchers, and some call takers are still better than others at following the system (we had QA/QI, but it was more of a joke than anything else).

Who are you trying to convince? You mention that you are bringing the idea to your governing body.... are these elder EMS people, or town officials? If you are the head boss, you make the policy, and run the day to day operations. Do you have to run all policies by this governing body? wasn't running the organization what you were hired to do?

I'm actually 100% in favor of more cold responses, especially when EMS isn't going to do any timely interventions. If it's not an ABC issue, and the ambulance and crew is going to be simply providing a comfortable ride to the hospital, there is no need to rush. I'm also a huge opponent of hurry up and wait; so if there is a shooting/stabbing, or EDP, or assault in progress and you are advised to stage until PD clears the scene, what purpose does responding L&S serve? It's not better than the FDs that use lights and sirens when responding to a cover assignment for a structure fire.
 
I'd be very cautions about making policies about require a non-emergent response to all 'BLS' calls.

I've had many calls where a cough was actually a kid in respiratory extremis from croup or asthma, weakness calls that end up being strokes, fevers that end up being immunocompromised patients in septic shock, and so on. Meanwhile most of the unknown man down calls that would be emergent end up be a bum sleeping on the side of the sidewalk (+/- ETOH). Department policies put your organization at risk if something goes wrong and someone convince a court that your policy seriously contributed towards their poor outcome.

There will always be some increased risk in running emergent, but I think that a large portion of the risk can be mitigated by how you drive rather than simply eliminating the use of lights and sirens. For example driving in the opposing lane of traffic and not stopping at red lights are two very dangerous habits that I've seen across many different departments, and yet I've also never seen a serious effort by those agencies to curb those behaviors.
 
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I have never worked anywhere that BLS responses got a lights and sirens response. I know these places exist however.

Everywhere I've worked had used EMD and ProQA to determine response levels. Anything determined to be BLS gets a cold response. What is considered a BLS responses will vary by agency based on medical direction.

I think a lot of responses that get lights and sirens don't need them. However as we all know, caller info is notoriously unreliable. In many areas where traffic is not a concern there is little time saved with lights and sirens. However in more urban areas it is my experience that lights and sirens save significant time.

I don't think I'm at a point where I would advocate for complete removal of lights and sirens, but I do think they see over used.
 
For better or for worse we are crew discretion for lights and sirens use, with the caveat that alpha and bravo level calls should nearly always be non-emergent with exception of unknown injury traffic accidents. In our area it really does not make much different. We have one area of highway in town that gets busy and everything else is rural.
 
Tigger said:
For better or for worse we are crew discretion for lights and sirens use, with the caveat that alpha and bravo level calls should nearly always be non-emergent with exception of unknown injury traffic accidents. In our area it really does not make much different. We have one area of highway in town that gets busy and everything else is rural.
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Interesting distinction. We are the opposite. Unknown injury accidents are no lights or sirens for us. We also have a degree of crew discretion.
 
We’re still technically 100 percent L&S to all calls, but such is life.

Admittedly, they do help considerably with traffic at times.
 
The reason that this is invalid is because any lawyer can fight any point. If you make your policy to respond, you are at risk as well. When you are responding lights/sirens to a org tube replacement from a nursing home and collide with another vehicle, try to prove that it was necessary and not at your fault. That will be hard

Peak said:
I'd be very cautions about making policies about require a non-emergent response to all 'BLS' calls.

I've had many calls where a cough was actually a kid in respiratory extremis from croup or asthma, weakness calls that end up being strokes, fevers that end up being immunocompromised patients in septic shock, and so on. Meanwhile most of the unknown man down calls that would be emergent end up be a bum sleeping on the side of the sidewalk (+/- ETOH). Department policies put your organization at risk if something goes wrong and someone convince a court that your policy seriously contributed towards their poor outcome.

There will always be some increased risk in running emergent, but I think that a large portion of the risk can be mitigated by how you drive rather than simply eliminating the use of lights and sirens. For example driving in the opposing lane of traffic and not stopping at red lights are two very dangerous habits that I've seen across many different departments, and yet I've also never seen a serious effort by those agencies to curb those behaviors.
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We're 100% all calls responding on my 911 truck; crew's choice when transporting.

I think the better questions are:

In the LODDs you've had from MVAs what were the contributing factors?

What driver education is provided, both running cold and hot?

Are you strictly 911 or a mix of IFT and 911?
 
ZombieEMT said:
The reason that this is invalid is because any lawyer can fight any point. If you make your policy to respond, you are at risk as well. When you are responding lights/sirens to a org tube replacement from a nursing home and collide with another vehicle, try to prove that it was necessary and not at your fault. That will be hard
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Yes and no.

My father in law is a lawyer and often deals with personal injury and medical cases. And we discuss things like this all the time.

In the example of an OG tube replacement, you'd be hard pressed to prove that lights and sirens is industry standard.
 
NPO said:
Interesting distinction. We are the opposite. Unknown injury accidents are no lights or sirens for us. We also have a degree of crew discretion.
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Unknown injury means no one is on scene to confirm one way or another. In an more built up area I would not like this policy but here people have to drive quite a ways to get cell service so there is really no way to get any info about the scene. Law enforcement is also not allowed to decide on injuries one way or another (I have mixed thoughts on this), so even if they are on scene they cannot shut us down per their own command staff.
 
Tigger said:
Unknown injury means no one is on scene to confirm one way or another. In an more built up area I would not like this policy but here people have to drive quite a ways to get cell service so there is really no way to get any info about the scene. Law enforcement is also not allowed to decide on injuries one way or another (I have mixed thoughts on this), so even if they are on scene they cannot shut us down per their own command staff.
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I understand that. We are also pretty rural, but I think the assumption is, if someone made the call, someone is on scene. (We really don't get much of the "caller didn't stop" type calls).

Obviously any high MOI would be a priority response though. I remember one time, we were sent no lights or sirens for a roll over, unknown injuries, possibly someone inside, no one on scene. That's one of the few times I have overrode the response determinant and did respond lights and sirens.
 
ZombieEMT said:
The reason that this is invalid is because any lawyer can fight any point. If you make your policy to respond, you are at risk as well. When you are responding lights/sirens to a org tube replacement from a nursing home and collide with another vehicle, try to prove that it was necessary and not at your fault. That will be hard
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I think you misunderstood my post. I'm not for responding to all calls emergent, I'm for not having blanket policies in general. The more professional your clinicians are the less you need blanket policies.

The more policies a department has, especially ones that can often result in poor outcomes, the larger the risk that falls onto the department.

Not that I in any way justify running code for a g-tube replacement (nor should it fall on EMS anyway), but the longer it is out the more likely it is to close up and require dilation or complete replacement. I would wager that I could find a lawyer who would be willing to pursue litigation if someone required more care due to a slower response, regardless of how ridiculous that notion is.
 
Peak said:
I've had many calls where a cough was actually a kid in respiratory extremis from croup or asthma, weakness calls that end up being strokes, fevers that end up being immunocompromised patients in septic shock, and so on. Meanwhile most of the unknown man down calls that would be emergent end up be a bum sleeping on the side of the sidewalk (+/- ETOH). Department policies put your organization at risk if something goes wrong and someone convince a court that your policy seriously contributed towards their poor outcome.
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while I've had similar experienced, I will also say that leaving it up to the crews discretion transfers the liability from the organization to the individual. Personally, I would rather my organization assume that risk instead of my as the lowly provider.
NPO said:
I understand that. We are also pretty rural, but I think the assumption is, if someone made the call, someone is on scene. (We really don't get much of the "caller didn't stop" type calls).
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That's a dangerous assumption..... we have passerbys call in crashes on the highways all the time, and they rarely stop (heck, I don't blame them, I want to be off the highway as quick as possible).

Maybe rural life is different than a 2+ lane in each direction highway, but the FD is sent on MVAs with possible/unknown injuries. if the caller says no injuries, LEO only is sent. one particular city that I used to work in sends 2 engines, 1 ladder, 1 EMS rescue, 1 BLS ambulance, 1 fire rescue, one PD rescue, 1 PD patrol car (likely state police), 1 Batt Chief, and maybe an EMS chief to every crash on the highway where it's not confirmed that their are no injuries. Heck, if EMS or PD is on scene, and confirms no injuries, and FD gets the report of a crash, they will still send an engine, ladder, rescue, and BC for "an MVA possible injuries and possible entrapment."

NPO said:
In the example of an OG tube replacement, you'd be hard pressed to prove that lights and sirens is industry standard.
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How would you prove that it isn't? or rather, how easy would it be to prove that it is?
 
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