Limited use of Lights and sirens

[medic417]

As for the "window" idea (i'm thinking CVA here...that's the evidence i'm most familliar with). This is a huge pet peeve of mine. It is NOT(!) the case that any old time within the 3 hour window is OK .

I will not do your research. But I suggest you research your 3 hour post now as well as transport.

 

[jrm818]

Do you know what a stress response is?

Do you really want the patient to also needlessly experience

Increased HR
Increased BP
Increased RR
Glucose abnormalities

while also coping with any of the disease processes mentioned.

This has been researched carefully for years and articles can even be found in THE JOURNAL: JEMS.


nope...never heard of stress. I must have missed that issue of JEMS, since that's my only source for information. I tend to focus on the lightbar ads more anywyas...

Seriously, a lot of that is Non-unique...there will be a stress response anyways...psychologically mediated when they realize they are having a stroke or MI, and if there are any physiological changes (changed ICP, BP, local hypoxia, etc) there will be a stress response too.

Will a siren increase the stress response a bit? Sure...i could see that. how much is the change? who knows...I'd guess that it's not that much more than what it would be if they were just moved quickly into the ambulance...either way they'll pick up on the urgency. I doubt that the small net increase in stress response would correlate with a significantly altered clinical outcome. I even more doubt that there is any evidence to suggest such a causative effect.

10 characters

 

[medic417]

I've never asked what our insurance stipulations are...hmm, I might have to go look that one up.

I do know that we are self insured to a point, but I don't know what the point is either.

And for further clarification, most of our transport speeds are in the 70-75mph range...although we have done 90 on a few occasions.

Might double check insurance and state laws to make sure if the unthinkable happens you don't get hung out to dry.

 

[medic417]

If this is directed at me you can go pound sand. I know plenty of big words, never read JEMS, and you have no idea what my educational background is. Just because we disagree doesn't mean I'm some moron who has never read a real academic journal or done a literature search.

Please do not allow your stress to cause you to start reading into posts. I ask you please calm down as I never called you a moron. If Jems is not your only source of Medical reading it obviously was not directed to you. I do not want this thread locked or you to get into trouble for attacking.

 

[jrm818]

I will not do you research. But I suggest you research your 3 hour post now as well as transport.

I never asked you to do my research. There is a difference between giving me citations and giving warrants to a claim.

You siad "you are harming your patients." I dont need citations, but the general idea of HOW L/S harms patients would be nice. IE you could say "it causes a stress response." or whatever it causes. Sorry, I dont think many people are going to say "OK...well medic417 said it was bad on EMTLife.com so it must be so." Give me a direction and I"ll do my own research....

the 3 hour refrence was simply because that is commonly taken to be the window for tpa. Yes I know there is talk of modifying the window, but in a lot (if not most) of places 3 hours is still the limit.

 

[VentMedic]

Originally Posted by ffemt8978

I've never asked what our insurance stipulations are...hmm, I might have to go look that one up.

I do know that we are self insured to a point, but I don't know what the point is either.

And for further clarification, most of our transport speeds are in the 70-75mph range...although we have done 90 on a few occasions.

Might double check insurance and state laws to make sure if the unthinkable happens you don't get hung out to dry.

You might also take another EVOC class and review what can happen for each additional 5 mph with a vehicle the size of an ambulance. You put way to much trust into a piece of machinery. The difference between 60 and 90 is very significant if something happens that will cause your driver or that vehicle to want to stop.

 

[jrm818]

[...]I never called you a moron. If Jems is not your only source of Medical reading it obviously was not directed to you. I do not want this thread locked or you to get into trouble for attacking.

Then I withdraw the comment. Too late to edit it. I still think the shot about failing to understand and having problems is a cheap shot...even if not directed at me.

 

[AJ Hidell]

Which ones, and how would L&S hurt?

Vent laid it out for you very nicely just a few posts back. Did you miss that, or are you intentionally refusing to acknowledge it? Please tell us how you can justify, on any level, elevating the heart rate and blood pressure of an MI, CVA, or AAA patient.

Regardless, ever heard of Evidence Based Medicine? That means we do things because they are proven by scientific and statistical analysis to be helpful, and without significant risk. "What does it hurt?" is not a valid justification for any medical or operational procedure. And neither is "well, I think...". It's a lazy, unintelligent, and uneducated way to do things, and it puts your patients, your partner, the general public, and yourself at unjustifiable risk.

 

[ffemt8978]

Originally Posted by ffemt8978



You might also take another EVOC class and review what can happen for each additional 5 mph with a vehicle the size of an ambulance. You put way to much trust into a piece of machinery. The difference between 60 and 90 is very significant if something happens that will cause your driver or that vehicle to want to stop.

We do mandatory EVIP on a yearly basis, and most of our ambulance drivers have CDL's with several years of experience driving.

 

[medic417]

I never asked you to do my research. There is a difference between giving me citations and giving warrants to a claim.

You siad "you are harming your patients." I dont need citations, but the general idea of HOW L/S harms patients would be nice. IE you could say "it causes a stress response." or whatever it causes. Sorry, I dont think many people are going to say "OK...well medic417 said it was bad on EMTLife.com so it must be so." Give me a direction and I"ll do my own research....

the 3 hour refrence was simply because that is commonly taken to be the window for tpa. Yes I know there is talk of modifying the window, but in a lot (if not most) of places 3 hours is still the limit.

Well lets see you could research by key words, but I am confident you know that. You could even read just about all the EMS books, again I am sure you know that. They say transport calm quite.

Just because the hospital still goes by old data does not change the actual window, and many if not most are going to the much broader window with a preference for inside the 3.


Point being you stress them by driving fast and L&S. But by adding 1-15 minutes on the trip and all remaining calm you cause patient to decide hey they're calm I'm in good hands, they relax, BP and HR lower. Wow less stress on the heart and blood vessels. You just bought the patient more time than driving L&S every could.

 

[medic417]

http://www.youtube.com/user/ParamedicSafety

Ambulance crash videos. Shows what happens in patient compartment.

 

[jrm818]

Vent laid it out for you very nicely just a few posts back. Did you miss that, or are you intentionally refusing to acknowledge it? Please tell us how you can justify, on any level, elevating the heart rate and blood pressure of an MI, CVA, or AAA patient.

Regardless, ever heard of Evidence Based Medicine? That means we do things because they are proven by scientific and statistical analysis to be helpful, and without significant risk. "What does it hurt?" is not a valid justification for any medical or operational procedure. And neither is "well, I think...". It's a lazy, unintelligent, and uneducated way to do things, and it puts your patients, your partner, the general public, and yourself at unjustifiable risk.

Oh good lord. I responded to Vent, as did I to JPINV when he brought up a stress response initially. I'll give you the benefit of the doubt that I responded while you were posting....

I never said "what does it hurt" as a justification...it was an actual question. Acutally..I wanted to know what evidence you were basing the claim on. Nor did I ever say "I think," rather, I've said multiple times "evidence (that scientific stuff) shows improved outcomes with shorter onset to treatment times." My opinion is based on my interpretation of the literature I have seen on the issue.

I resent the implication that I am somehow lazy or uneducated, and there is no need for that to be in your post at all. I provided warrants for all my claims, which included my interpretations of scientific studies which I have acutally read. Quit assuming....

EDIT:

Sidenote scientific rant. nothing is EVER "proven" in scientific studies. hypotheses are supported or refuted. evidence changes, and so do ideas about best practices. That happens all the time. As a result there are differing interpretations of evidence, and people can disagree about what the evidence says....

 

[VentMedic]

This is all the hand holding you are getting. I just did a quick search and found several good articles.
http://scholar.google.com/

Working in EMS and on Specialty transports for several years, I also have experience that tells me what patients go through. It's not rocket science, just a little commonsense.

 

[AJ Hidell]

I resent the implication that I am somehow lazy or uneducated, and there is no need for that to be in your post at all.

It did need to be there, because it is the very foundation of this entire discussion of the original post. Whether it applies to you personally or not is entirely up to you, not me. But whether it applies to you or not, to choose procedures with no basis in proven evidence is indeed, lazy, unintelligent, and uneducated. Regardless, we are talking about a decision making process as a whole, not any individual person. But if the shoe fits, wear it.

 

[UrbanEmt]

Lights and sirens give me a headache. I dont like headaches.

We dont use them unless its justified, it rarley is.

 

[VentMedic]

Our transport distances are 60-75 miles one way, to the nearest facility. Two lane highways where the speed limit is 55 or 60. For the most part, yes, we can effectively work at 85-90, although if we can't we ask the driver to slow down and take it easy until we complete whatever procedure we're doing at the time.

This is where we would consider a helicopter especially if the patient meets the criteria that requires you to run L&S at 90 mph for the transport.

 

[ffemt8978]

This is where we would consider a helicopter especially if the patient meets the criteria that requires you to run L&S at 90 mph for the transport.

HEMS is my preferred ALS transport, but since there is only one helicopter in the center part of the state, and the next available one has a 75 minute ETA there are times we're stuck transporting via ground.

 

[DR_KSIDE]

PDs do have very strict rules for running L&S fortunately or it would be one noisy mess if they ran L&S to ALL of their calls.

The other article I posted involved the FD.
Redundant Response Under Fire in Florida

It wanted answers why 3 vehicles, 2 of which are FD, respond L&S to every call regardless how minor.

I would have to disagree, but I am not looking to go head to head against you Vent, just want my opinion heard. Be it some departments probably do have policies, but most that I have seen, worked for and with, leave the discretion WHERE it should be, with the officer or the driver. Our FD in the town I currently work, they don't seem to get out much so they pretty much run L&S to everything, most of there calls just happen to be code 3. Again, when it comes to our EMS, its left up to the discretion of the driver and the crew, and the same with our PD, it is always up to the officer. People talk about liability and such, which will always be there in the sue happy society that we live in, but what it comes down to is the training and education that you give your people before you clear them to drive your vehicles♠, you can't just let the rookies get behind the wheel and go. I believe that everyone should go through some sort of EVOC course, but even then it doesn't prepare you for every scenario, but at least it gives you more of a feeling to what you are capable of and how your vehicle will handle with you behind the wheel.

Note: I am both and officer and a EMT/Driver, I also have been through and helped teach multiple pursuit courses and defensive driving courses. I also teach the driving portion of EVOC for our dept and EMS and in the spring our FD will go through our course. If your dept is looking for a course the try I will send you a basic EVOC course and layout.

 

[medic417]

http://www.medscape.com/viewarticle/582754

Good article on Trauma and scene times.

 

[VentMedic]

I would have to disagree, but I am not looking to go head to head against you Vent, just want my opinion heard. Be it some departments probably do have policies, but most that I have seen, worked for and with, leave the discretion WHERE it should be, with the officer or the driver. Our FD in the town I currently work, they don't seem to get out much so they pretty much run L&S to everything, most of there calls just happen to be code 3. Again, when it comes to our EMS, its left up to the discretion of the driver and the crew, and the same with our PD, it is always up to the officer. People talk about liability and such, which will always be there in the sue happy society that we live in, but what it comes down to is the training and education that you give your people before you clear them to drive your vehicles♠, you can't just let the rookies get behind the wheel and go. I believe that everyone should go through some sort of EVOC course, but even then it doesn't prepare you for every scenario, but at least it gives you more of a feeling to what you are capable of and how your vehicle will handle with you behind the wheel.

Note: I am both and officer and a EMT/Driver, I also have been through and helped teach multiple pursuit courses and defensive driving courses. I also teach the driving portion of EVOC for our dept and EMS and in the spring our FD will go through our course. If your dept is looking for a course the try I will send you a basic EVOC course and layout.

So what part do you disagree with? I stated PD has policies and do not run L&S to everything. Is that not true? If I want to file a complaint about the dog next door barking all night, are you as an LEO going to respond L&S to take my complaint?

In the article referenced, all vehicles respond L&S if they are dispatched by 911 regardless of the emergency. I don't agree with that.

Why do you think I am looking for a basic EVOC course? EVOC is a requirement for all who drive ambulances in my state.

It should involve a little more than just educating someone to drive an ambulance. This thread is also being discussed from the medical aspect. Are you (not in the personal sense) so uncomfortable with the patient care you provide that you must run real fast to the hospital? Yes, this may be true at the BLS level but even then L&S are not always warranted. However, if you are a competent healthcare provider, you should be able to assess and provide the necessary level of care to get the patient to the hospital safely while initiating the needed medical care.