On driving lights and sirens

[tssemt2010]

the city fire department (wont say a name because everyone knows who they are) transports L&S to the ER about 90+% of the time because they "have a busy system" yes they have a VERY busy system but is it worth puttin your patients at risk of being involved in a wreck enroute to the ER with a STABLE patient?

 

[mycrofft]

LS doesn't mean fast.

Necessarily.
The point about urban response speeding saving little time versus risk is lost on some laypersons and younger responders.

OK, if you take longer than the political minimum, have in mind the reason why. And remember you can discretely use LS for intersections and when you see traffic ahead congealing, then ooch through and continue.

 

[rmabrey]

"we don't have medics, what if she gets worse?"

Lamest excuse ever.

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[Medic2409]

IMHO, L&S is a tool, just like any other, and needs to be used appropriately.

Completely taking it away is, again, my opinion, foolish.

 

[enjoynz]

In NZ the dispatcher decides whether the ambulance goes out to a call under L & S.
Once the patient is on board the crew have to ask for clearence to travel to the hospital under L & S from dispatch.They don't normally ask for permission, unless the pt is one sick puppy!

 

[adamjh3]

In NZ the dispatcher decides whether the ambulance goes out to a call under L & S.
Once the patient is on board the crew have to ask for clearence to travel to the hospital under L & S from dispatch.They don't normally ask for permission, unless the pt is one sick puppy!

Just curious, have you had any issues with a dispatcher refusing clearance to transport l&s when indicated? What medical training does the dispatcher have?

Not trying to pick a fight, I'm just curious as to how well this system works.

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[R99]

In NZ the dispatcher decides whether the ambulance goes out to a call under L & S.
Once the patient is on board the crew have to ask for clearence to travel to the hospital under L & S from dispatch.They don't normally ask for permission, unless the pt is one sick puppy!

Hmmmm not sure where this came from but no "permission" is needed from EACC as long as I have been around (2007 onwards) who are they to decide how I transport a patient?

 

[enjoynz]

Just curious, have you had any issues with a dispatcher refusing clearance to transport l&s when indicated? What medical training does the dispatcher have?

Not trying to pick a fight, I'm just curious as to how well this system works.

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The dispatchers have set protocols (A Standard manuel of how to deal with any situation) ...All situations are covered with codes. These codes are used for dispatching the trucks/chopper... depending on the 111(911) call - re the condition, amount of patients and their location.

I've never heard of a dispatcher not letting a truck transport to hospital with L & S...Although the patient needs to be a priority 1(life threating condition) or 2 (unstable condition)for them to allow you to do so.

Here is a link to the Dispatch Service for our region..if you care to have a nosey!
http://www.wfa.org.nz/comms.htm

 

[enjoynz]

Hmmmm not sure where this came from but no "permission" is needed from EACC as long as I have been around (2007 onwards) who are they to decide how I transport a patient?

Are you in New Zealand?
If not...there is your answer.

 

[R99]

Are you in New Zealand?
If not...there is your answer.

Yes I am, "R99" should give it away lol

Maybe WFA are different but in Auckland at least its up to the crew on scene as to how the patient is transported.

I can find no reference in the Operations Manual either.

You are correct that the EACC determines if the job is p1/p2 based on the information received from the call taker.

To transport somebody to hospital with lights and siren they'd have to be pretty sick ie status one the risk is just not with it!

 

[akflightmedic]

Lights and sirens...great topic and you are wise with your concerns and discretionary use.

I will state this anecdotal piece. As I grew more confident in my skills, knowledge and education...I got slower and slower with my driving or driving requests.

I noticed that at times, the more serious a patient was, the slower the drive I requested. Yes there were times where we proceeded with urgency but more oft than naught we drove NO lights or sirens. I think it keeps you the provider in a clearer state of mind and it also reduces patient anxiety.

There were times of peak usage when the BC would order all trucks to go LnS to free up units but even then we drove with extreme caution. LnS does not mean to go balls to the walls, hang on edge of your seat and cut everyone off while laughing nervously and then getting angry when people do not move.

Ask yourselves this...how many times have you found yourself or your partner becoming angry at a driver who does not react to your lights and sirens even though you know you have a total BS patient in back or are responding to a total BS call? I can freely state in my early years, I found this quite prevalent among coworkers and caught myself doing it many times.

Anyways, back on topic....I have found one of the better uses for LnS is simply to keep forward motion and I do not mean at 65mph on a city street. I mean creeping along at congested intersections or if traffic is backed up for whatever reason...then you crawl thru the maze at a very reasonable pace.

 

[Meursault]

Ask yourselves this...how many times have you found yourself or your partner becoming angry at a driver who does not react to your lights and sirens even though you know you have a total BS patient in back or are responding to a total BS call?

I get angry when people don't move because occasionally screaming at cars that can't hear you is a prerequisite for a MA driver's license, because it's still a failure of driver education/awareness, and because I'm the one who has to justify long response times regardless of the nature of the call.

With a BS patient in back, I've likely either talked my partner out of requesting lights and sirens, agreed with my partner on the same, or not even asked and started transporting without them.

 

[Simusid]

We respond to all calls with lights and use sirens where appropriate. The only exception would be if dispatch instructs us otherwise (rare).

We transport all calls in the same way. Lights always on, sirens at intersections and overtaking cars. Our "policy" is to drive the speed limit unless it's a priority 1 code, trauma, etc. At red lights we clear each lane of traffic by stopping at each lane we cross and use eye contact to each vehicle, I don't know how standard that policy is in other services.

I was driving a particularly non-emergent patient last week in the normal fashion. On the way home I asked my senior medic if I should have gone with no L&S. He said using L&S lets us get back in service more quickly, and that had not occurred to me. I do agree with that policy. We have only 2 ALS trucks and due to staffing imbalances (years of experience) we may have the most senior medic at the hospital while the junior truck is heading to an "unknown medical" that turns into a code (happened last month).

 

[medicdan]

We respond to all calls with lights and use sirens where appropriate. The only exception would be if dispatch instructs us otherwise (rare).

We transport all calls in the same way. Lights always on, sirens at intersections and overtaking cars. Our "policy" is to drive the speed limit unless it's a priority 1 code, trauma, etc. At red lights we clear each lane of traffic by stopping at each lane we cross and use eye contact to each vehicle, I don't know how standard that policy is in other services.

I was driving a particularly non-emergent patient last week in the normal fashion. On the way home I asked my senior medic if I should have gone with no L&S. He said using L&S lets us get back in service more quickly, and that had not occurred to me. I do agree with that policy. We have only 2 ALS trucks and due to staffing imbalances (years of experience) we may have the most senior medic at the hospital while the junior truck is heading to an "unknown medical" that turns into a code (happened last month).

Two questions: first, shouldn't both medic trucks be equally qualified to perform on any call, despite disparities in experience between staff?
What I was originally trying to ask is whether the cost of accidents as a result of driving L&S for all calls is less than the cost to add a new truck, if you really need to maintain unit availability?

 

[Simusid]

Two questions: first, shouldn't both medic trucks be equally qualified to perform on any call, despite disparities in experience between staff?
What I was originally trying to ask is whether the cost of accidents as a result of driving L&S for all calls is less than the cost to add a new truck, if you really need to maintain unit availability?

I would bet that truck staffing is worthy of it's own thread. We're a mixed paid/volunteer service. We have categories of Junior medics with less than 1 or 2 years experience, Senior medics with roughly 10+ years experience, and Staff medics make up the middle. We can run an ALS truck with a P/B but we would probably only do that with a Senior medic. A typical shift might be a senior, a staff, junior, and two basics. And again, the basic experience may be anywhere from zero to 2+ years (basics with 2 years experience either go to medic school or quit). We would typically staff the trucks with senior/Basic and Staff/Junior/Basic.

We provide medic scholarships and benefit from a lot of volunteer ride time and post license volunteer shifts as new medics gain experience. That led to what we call our "mentor/shadow" program. With the above staffing, we would dispatch the junior truck to the call with L&S while the senior truck would call "on the road in service - proceeding to call". The senior truck will oversee and make sure the junior truck is all set and if so will return to the station. This maximizes the training of our staff. The 18 year senior medic has no real need to refresh his IV or intubation skills.

I will say that the cost of PROPERLY driving with L&S is low, that is my opinion. Obviously that does not always happen.

 

[Tigger]

Lamest excuse ever.

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You got that right. I love when my partner decides to overrule me and take someone in emergent right after I told them not too, citing the above excuse as justification.

 

[Handsome Robb]

Remind me to stay far away from Massachusetts. Every patient gets transported RLS? That's absurd.

The busy excuse sucks, I run in a high volume, urban system with no 911 backup agency, we are it as far as transport goes. It isn't common but every now and again we will end up with no transport units available and 911 calls pending. If you used "we had to get back in service faster" as your justification for transporting RLS you'd be out of a job pretty quickly.

 

[Simusid]

Remind me to stay far away from Massachusetts. Every patient gets transported RLS? That's absurd.

The busy excuse sucks, I run in a high volume, urban system with no 911 backup agency, we are it as far as transport goes. It isn't common but every now and again we will end up with no transport units available and 911 calls pending. If you used "we had to get back in service faster" as your justification for transporting RLS you'd be out of a job pretty quickly.

Why exactly does the busy "excuse" suck? If we're not in town and there is a dispatch, we have to call mutual aid. This means a 6 minute response time turns into a 12+ minute response time. It makes more sense to SAFELY drive L&S and end up with better call coverage.

 

[exodus]

Why exactly does the busy "excuse" suck? If we're not in town and there is a dispatch, we have to call mutual aid. This means a 6 minute response time turns into a 12+ minute response time. It makes more sense to SAFELY drive L&S and end up with better call coverage.

Because everytime there is 12+ minute response time the patient will die. What about first responders or FD?

 

[Handsome Robb]

Why exactly does the busy "excuse" suck? If we're not in town and there is a dispatch, we have to call mutual aid. This means a 6 minute response time turns into a 12+ minute response time. It makes more sense to SAFELY drive L&S and end up with better call coverage.

No it doesn't, sorry.

A miniscule amount of calls are actually truly time sensitive.

You can say everyone drives super cautiously with or without a patient but the fact of the matter is you are still opposing traffic signals. All it takes is one person to miss something and now you have a unit OOS + a patient who is probably in a lot more trouble now than they were before, a crew out of service, another ambulance(s) responding to your scene to deal with the mess. Doesn't sound like a good situation to me.

If your citizens are complaining about response times and you are as busy as you say, they can cough up some more money for better coverage. If you live in the sticks that's your choice but you need to recognize you will not get the same 911 service you would in a large urban area.

We had a unit get into an accident responding code to a call. Took them, 3 other ambulances a supervisor and multiple PD units and an engine crew out of service to deal with.

So we went from being Level 3 (3 units available) to level 0 (none available) then eventually to status 6 (calls pending). Talk about a fuster cluck.