Emergency Response (Lights and Siren) for EMS Calls

[antiquefirelt 994]

It pretty sad that here in Westchester there is no priority system for dispatching ambulances and medics to calls. The fact that I have to go RLS to every call I get dispatched to is kinda ludicrous.

Why do you have to? In my state and I presume most if not all others, the driver is still responsible for driving. This means you're liable if you drive without due regard for the safety of others. It is no stretch for 12 of your peers to determine that if you used lights and sirens for a hang nail, you did not use "due regard". Our Fire/EMS dept. is dispatched without the EMD codes but we are given the chief complaint, pertinent history and usually the pt's age. From this information the EMS crew assigned to the bus will determine how to travel. They announce "enroute, emergency status" or "enroute non-emergency". This was if the dispatcher has more information that would change their mind, they give it to them or let their impression be known. This also allows the duty officer to interject if he feels they've made an error in response mode (very rare).

We also tried responding to AFA's and other calls with a single unit using lights and sirens and others responding cold. This turned out to be a more dangerous situation where we are based out of one station. Drivers were very confused with how to react after pulling over for the lead unit running lights and sirens and then pulling back out in front of other apparatus that had no lights or sirens. Now all units respond in emergency fashion to calls that we feel warrant it, and many others the responding units respond cold, usually typical single engine calls like bark mulch fires, dumpsters without exposures, odor in the area, spilled fluids, etc.

[FFLieu 70]

I think it depends on the type of call and the time of day. Am I going to a fall-down-go-boom call at 3am when there's no one on the road or am I going to a CPR in progress during rush hour or at the height of the Saturday afternoon mall traffic? There needs to be a bit of a level of common sense when you use lights and sirens. Just because you may feel as if you need to go full-out, ba**s-to-the-wall in response, that doesn't necessarily mean that it's safe; you have to take into consideration other cars, pedestrians, and the like, because you might inadvertently cause another EMS call in addition to the one you're going to already. It's like I tell my people: if you get hurt on your way to the job, you're useless to the person who needs help.

[Skooter92 7]

I see no reason to transport a code RLS under just about any circumstances, especially a medical code that hasn't responded to ACLS within a given timeframe. Persistent asystole shouldn't be transported without extenuating circumstances anyways. And having someone risking injury in the back of a moving rig while doing manual CPR (usually unbelted due to the fact that most so-called CPR seats are useless for that very purpose) is criminal. Spend the money/get a grant for a LUCAS or Autopulse. $10k vs provider injury. The two systems I work in have devices in each rig. Back to the point of the thread, RLS to the ED if you have interventions in place and timewise earlier arrival won't make a difference IMHO constitutes negligent and potentially criminal conduct if something happens. Period.

[Boss159 7]

A priority system based on a sequence of standard questions and adding any other pertinent info to decide the response seems to work up here. Granted I've been to life threatening and fatal priority 3's and 4's (NLS side of the scale), and been to very minor almost "laughable" for better lack of an appropriate term priority 1's. From my time spent behind the wheel of an ambulance, in our rural setting, RLS for the majority of transports results in minimal time gained. Not that I am denying their credibility in the ease of transport, but it is just something to think about.

I have been there as well, also we have our 'regulars' (in nice terms) where as 911 dispatches a priority 1 response for a seizure because the CAD says so, even though it's the 40th time they have called 911 in a month because they sold/taken all their narcotics, 7 day supply lasting only one day! I digress, the dispatchers are well aware of the BS nature of this caller but have to follow protocol and dispatch it P1. I and most of the crews know of this person, very well and do not respond 'code 3'.

However now that there is priority dispatching, what liability are crews taking by reducing their response to calls like my above mentioned patient when the one time out of 700 it's a true life threat, the EMD from the CAD gets it wrong, call taker gets it wrong or patient embellishes their symptoms to get a faster response? This happens day in and day out, all of us who have been doing this for years have been there, what we all need to do is the seasoned veterans need to educate the newbies, as with most emergency services problems education is the key, pass your knowledge on to the next generation, be it patient education, driving, BLS/ALS skills and techniques and believe it or not, common sense can be passed on. (to a slight degree)

[FFLieu 70]

And having someone risking injury in the back of a moving rig while doing manual CPR (usually unbelted due to the fact that most so-called CPR seats are useless for that very purpose) is criminal. ... Back to the point of the thread, RLS to the ED if you have interventions in place and timewise earlier arrival won't make a difference IMHO constitutes negligent and potentially criminal conduct if something happens. Period.

How exactly would it be "criminal" if I were following the exact letter of the vehicle and traffic law (in my case, NJSA Title 39), yielding to every traffic control device, and operating my rig with the same due regard set forth within the context of those very laws? Clearly, I cannot be branded a criminal if I am within the scope of an already established - and constitutional - law.

[NWFDMedic 58]

I have been there as well, also we have our 'regulars' (in nice terms) where as 911 dispatches a priority 1 response for a seizure because the CAD says so, even though it's the 40th time they have called 911 in a month because they sold/taken all their narcotics, 7 day supply lasting only one day! I digress, the dispatchers are well aware of the BS nature of this caller but have to follow protocol and dispatch it P1. I and most of the crews know of this person, very well and do not respond 'code 3'.

However now that there is priority dispatching, what liability are crews taking by reducing their response to calls like my above mentioned patient when the one time out of 700 it's a true life threat, the EMD from the CAD gets it wrong, call taker gets it wrong or patient embellishes their symptoms to get a faster response? This happens day in and day out, all of us who have been doing this for years have been there, what we all need to do is the seasoned veterans need to educate the newbies, as with most emergency services problems education is the key, pass your knowledge on to the next generation, be it patient education, driving, BLS/ALS skills and techniques and believe it or not, common sense can be passed on. (to a slight degree)

The answer to this is pretty simple. If you go into court for whatever purpose, the best thing you can have on your side is the fact that you followed the standard. If your dispatch center sends you on a "with traffic" response based on some sort of EMD, you better be traveling that way. The same goes for the "code" response. You're getting a dispatch from some sort of dispatch center that says "a 50 year old patient in seizures". You generally haven't gotten the full text of the 1 to 2 minute phone call. You must rely on their judgment and their adherence to protocols and do your job based on those standards. If you get dispatched on a "with traffic" response to a call that sounds more serious from the information that you are given, you should be asking or telling dispatch you are upgrading your response (and similarly if you are downgrading).

I know there are several agencies out there that go "code" response to every call, regardless of what your dispatcher says. All I have to say to that is, you better have a darn good liability policy when you get to court. It's very damaging to walk into court and have the plaintiff's (or prosecution's) lawyer ask "so, why exactly did you choose not to follow the nationally accepted standard?" Likewise, if you follow the standard and end up in court over that call that was dispatched low priority that should have been high, adherence to standard will usually negate any negligence claim.

[Guest alsfirefighter]

In My Corps, We Go Lights and sirens to every call (unless specified by the patient that they do not want to have a lights and sirens approach to their house). I like this policy becuase you can never rely on the dipatch information (not criticizing dispachers, I really apprechiate all you guys do) but it has been my experiance that what we get called out for is very different than what we have to deal with on scene, and you never know when a "diabetic emergancy" will turn into a cardiac arrest. (yes this has happened) We have lights and sirens for a reason, so use them, just not excessively

I just have to. First every cardiac arrest is usually predisposed by some other form of event or illness...even "sudden cardiac arrest" is usually preluded by an underlying arrythmia so that's your first weak argument. Secondly give me a percentage wise of how often you can "never rely on dispatch information." My agency does over 3000 ALSFR and BLSFR responses a year and I bet 99% of the dispatch information is correct. So that's your second weak argument. If your agency is having an issue..you need to address it with your dispatching agency. But spoken well like what I hear from most uninformed, more opinion then fact buffs, but based on your age category I can't hold you over responsible for your comments.

Fact is you only save seconds with an emergency response. Or lights and sirens. Maybe you can give me a good excuse as to why when I TOT a job to BLS they opt to go lights and sirens to the hospital? Is there any BLS level issue that a medic turns the patient over to BLS that's a true emergency? I haven't figured that one out yet. Lets hurry up and get there..only for a good aggressive ALS provider to get good care underway...then if that provider is worth his/her salt...take a nice easy ride to the ER. So does that make sense? I don't use lights and sirens to transport cardiac arrests to the hospital. Problem there? I think not. On average...20 seconds quicker. Not worth my life for the one with less then 1/2% chance of survival and even less at that point as we do all of the same stuff they're going to do in the ED and often pronounce less then 5 minutes when we come through the door.

Knock off the excuses. Lights and Sirens are over used and sooner or later luck runs out. They should be used for True Emergencies and that we all know is less then 1% of what we're doing.

Experienced providers know there is a major difference in driving skill for a driver when using lights/sirens vs. not. With them on..braking and acceleration control often gives causing a jerky ride. Don't think so..pay attention next time when you take off with a trauma or severe medical emergency. If you were gonna use them..have them leave them off...then after a minute tell them to turn them on and see how your ride changes. Your brain processes about 400 items of information/decisions a minute when operating a vehicle with lights and sirens engaged...something has to give. Keep in mind you might not get into an accident..but you can cause significant numbers and severity of rebound accidents of other vehicles.

Bob Faugh always said it best in his lectures...saving seconds...costing lives.

[minivac 0]

I just have to. First every cardiac arrest is usually predisposed by some other form of event or illness...even "sudden cardiac arrest" is usually preluded by an underlying arrythmia so that's your first weak argument. Secondly give me a percentage wise of how often you can "never rely on dispatch information." My agency does over 3000 ALSFR and BLSFR responses a year and I bet 99% of the dispatch information is correct. So that's your second weak argument. If your agency is having an issue..you need to address it with your dispatching agency. But spoken well like what I hear from most uninformed, more opinion then fact buffs, but based on your age category I can't hold you over responsible for your comments.

Fact is you only save seconds with an emergency response. Or lights and sirens. Maybe you can give me a good excuse as to why when I TOT a job to BLS they opt to go lights and sirens to the hospital? Is there any BLS level issue that a medic turns the patient over to BLS that's a true emergency? I haven't figured that one out yet. Lets hurry up and get there..only for a good aggressive ALS provider to get good care underway...then if that provider is worth his/her salt...take a nice easy ride to the ER. So does that make sense? I don't use lights and sirens to transport cardiac arrests to the hospital. Problem there? I think not. On average...20 seconds quicker. Not worth my life for the one with less then 1/2% chance of survival and even less at that point as we do all of the same stuff they're going to do in the ED and often pronounce less then 5 minutes when we come through the door.

Knock off the excuses. Lights and Sirens are over used and sooner or later luck runs out. They should be used for True Emergencies and that we all know is less then 1% of what we're doing.

Experienced providers know there is a major difference in driving skill for a driver when using lights/sirens vs. not. With them on..braking and acceleration control often gives causing a jerky ride. Don't think so..pay attention next time when you take off with a trauma or severe medical emergency. If you were gonna use them..have them leave them off...then after a minute tell them to turn them on and see how your ride changes. Your brain processes about 400 items of information/decisions a minute when operating a vehicle with lights and sirens engaged...something has to give. Keep in mind you might not get into an accident..but you can cause significant numbers and severity of rebound accidents of other vehicles.

Bob Faugh always said it best in his lectures...saving seconds...costing lives.

As I said, we do NOT have a problem with out dispatch angency, they tell us what info they gather, which is very useful. But if lights and sirens do not help, why not take them off all fire apperatus, ems rigs, and police cars?

[firebuff860 54]

I would venture to guess there are very few if any members here who have never abused lights and sirens, or have not been on a piece of equipment that has. If we are going to start topics about things that are abused it would need it's own section, if not it's own server here. And the article referenced was in 1996!

Do some EMS employees abuse privlege? Yes

Do some Police Officers abuse privlege? Yes

Do some Firefighters abuse privlege? Yes

I did not read the first thread that this was linked to but the article referenced (from 1996) could have easily put PD or FD instead of EMS providers for his purposes of pointing out abuse.

[Atv300 69]

I would venture to guess there are very few if any members here who have never abused lights and sirens, or have not been on a piece of equipment that has. If we are going to start topics about things that are abused it would need it's own section, if not it's own server here. And the article referenced was in 1996!

Do some EMS employees abuse privlege? Yes

Do some Police Officers abuse privlege? Yes

Do some Firefighters abuse privlege? Yes

I did not read the first thread that this was linked to but the article referenced (from 1996) could have easily put PD or FD instead of EMS providers for his purposes of pointing out abuse.

I agree 100% everone has or has been around an abuse of the lights and sirens. I say its up to the discretion of the driver/emt or paramedic in the back to run red lights to the hospital. For Some time we have had the priority system now so I drive based on that you have to you are not the one taking the call your 30th call might be the one that person is in real need (the boy who cried wolf).

Edited September 18, 2010 by Atv300

[ckroll 101]

As I said, we do NOT have a problem with out dispatch angency, they tell us what info they gather, which is very useful. But if lights and sirens do not help, why not take them off all fire apperatus, ems rigs, and police cars?

First, one of the things I love about sites like this is that anyone of any age or background can get us up and talking about stuff. I think this is great and this is not a bad question. We should all be able to answer it. To rephrase it a bit, why put them on in the first place ?

Any call for aid probably trumps what the majority of citizens are out doing in their cars on a given morning. The ability to cross the yellow line, to use the oncoming lane, to not wait for 6 cars waiting for a light to change and then turn left,.....well, lights or sirens help us do that. Abiding by every traffic control device and waiting for every driver in front of us is using a lot of time that most drivers will gladly give us if they know we have someplace to go. Lights and sirens let other drivers know a vehicle may not be where they expect it to be and that that vehicle would like a little courtesy.

Lights and sirens are like any other tool, useful if used wisely and for an intended purpose. Light functions in a straight line. It is very useful for signaling oncoming traffic and moderately useful for signaling same direction traffic ahead [if the driver is using his rear view mirror for more than hanging fuzzy dice]. Lights have no effect on traffic that is not direct line of sight.

Sound MAY--and that's a huge 'may'--- signal drivers not in line of sight. Physics here is key and I will skip the details unless people really want me to dig it up, but given sight lines in intersections, sound proofing in cars, reaction time of sober adults, and speed through intersections------- 10 to 15 miles an hour is as fast as a vehicle RLS can enter an intersection against a stop sign or red light. And that is if no one is texting.

So for me, lights [and much less often, sirens] is a way to say, "Excuse me." and move to the head of the line , but it doesn't mean one has to significantly increase speed. And if one does increase speed to the point that one outruns the usefulness of the lights and sirens, then that person is begging to have a collision for which that person will be responsible,and which will significantly increase response time for that call.

So, yes light and sirens are an essential part of the conversation that emergency vehicles have with other vehicles out on the road. But that conversation is a dialogue, not a monologue. Lights and sirens in no way give us the right to be aggressive with or disrespectful to other drivers.

[helicopper 1,050]

I would venture to guess there are very few if any members here who have never abused lights and sirens, or have not been on a piece of equipment that has. If we are going to start topics about things that are abused it would need it's own section, if not it's own server here. And the article referenced was in 1996!

Do some EMS employees abuse privlege? Yes

Do some Police Officers abuse privlege? Yes

Do some Firefighters abuse privlege? Yes

I did not read the first thread that this was linked to but the article referenced (from 1996) could have easily put PD or FD instead of EMS providers for his purposes of pointing out abuse.

I made the point in the original thread that despite the article being 14 years old it is still true today. You could do a lot of things like substituting PD or FD but that wasn't the point of this thread.

My main point is that we are our own worst enemies and still make the same stupid mistakes. It is only a matter of time before there is a horrific crash that we all shake our heads about? Because we don't train our drivers adequately, we don't manage/supervise adequately, and we still permit the abuse. I've heard alot of excuses for abusing lights and siren and not one will stand up in court when, as ALSFF wrote, somebody's luck runs out.

[Atv300 69]

My chief said it best in my book (in new York any ways) we should treat priority 1-3 with a little common sense because you don't know what you have until you get there even with the best dispatchers so you could argue getting care there could make a difference. A priority 4 response most of the time no need to get there in a hurry so why run the risk of using reds. Now on the trip to the hospital is different when you know what you have "The chief said to me the Driver is responsible to be able to articulate the need for the EMERGENCY mode of travel and if it will make a difference in the outcome of the patient" (i.e. code or near code v.s. compound fracture the code can have a different outcome with the higher level of care in some cases but the chance is there, broken bones with P.M.S what is the extra Min's).

The thread is about our service being its own worst enemies and its true.

[Remember585 815]

Thats not completele correct. We have a partial system based on priority dispatch thru 60 Control. Which currently only looks at type and number of resources and can implement the other if depts request. The problem is they can only do this if they get proper info from the caller and 70% of the time the local PD does not transfer the call to them.

[antiquefirelt 994]

I didn't know Alan Brunacini smoked. Kinda hypocritical.

[minivac 0]

First, one of the things I love about sites like this is that anyone of any age or background can get us up and talking about stuff. I think this is great and this is not a bad question. We should all be able to answer it. To rephrase it a bit, why put them on in the first place ?

Any call for aid probably trumps what the majority of citizens are out doing in their cars on a given morning. The ability to cross the yellow line, to use the oncoming lane, to not wait for 6 cars waiting for a light to change and then turn left,.....well, lights or sirens help us do that. Abiding by every traffic control device and waiting for every driver in front of us is using a lot of time that most drivers will gladly give us if they know we have someplace to go. Lights and sirens let other drivers know a vehicle may not be where they expect it to be and that that vehicle would like a little courtesy.

Lights and sirens are like any other tool, useful if used wisely and for an intended purpose. Light functions in a straight line. It is very useful for signaling oncoming traffic and moderately useful for signaling same direction traffic ahead [if the driver is using his rear view mirror for more than hanging fuzzy dice]. Lights have no effect on traffic that is not direct line of sight.

Sound MAY--and that's a huge 'may'--- signal drivers not in line of sight. Physics here is key and I will skip the details unless people really want me to dig it up, but given sight lines in intersections, sound proofing in cars, reaction time of sober adults, and speed through intersections------- 10 to 15 miles an hour is as fast as a vehicle RLS can enter an intersection against a stop sign or red light. And that is if no one is texting.

So for me, lights [and much less often, sirens] is a way to say, "Excuse me." and move to the head of the line , but it doesn't mean one has to significantly increase speed. And if one does increase speed to the point that one outruns the usefulness of the lights and sirens, then that person is begging to have a collision for which that person will be responsible,and which will significantly increase response time for that call.

So, yes light and sirens are an essential part of the conversation that emergency vehicles have with other vehicles out on the road. But that conversation is a dialogue, not a monologue. Lights and sirens in no way give us the right to be aggressive with or disrespectful to other drivers.

I agree 100% Thank you for better phrasing my question!

[Mark Z 18]

. I say its up to the discretion of the driver/emt or paramedic in the back to run red lights to the hospital.

I as a matter of policy do not run RLS to the hospital unless ABSOLUTELY NECCESARY, I can count the number of times I thought it needed on the fingers of both hands. My service does transport cardiac arrests RLS but I am listening to those that say that we may not have to do even that. In my limited experience transport RLS is VERY RARELY NEEDED. Priorty dispatching can work and there are agencies in my area that handle all calls priorty 1 no matter what he call is so there is work to be done in educating people all over.

[Atv300 69]

I agree 90-95% of my runs lights are off going to the hospital like I said if it can be a life saving move to run reds then there on other then that no lights. Quick question whats most peoples drive time to there hospital? Mine baisic hospital 25-30min. Trauma or cardiac 45+ min the only reason I say this I have proved it it can go both ways lights saved 3-5 min to the hospital vs tooling along with trafic and both times were similar trafic volume. That can make a difference in some cases.

[Monty 35]

I would venture to guess there are very few if any members here who have never abused lights and sirens, or have not been on a piece of equipment that has. If we are going to start topics about things that are abused it would need it's own section, if not it's own server here. And the article referenced was in 1996!

Do some EMS employees abuse privlege? Yes

Do some Police Officers abuse privlege? Yes

Do some Firefighters abuse privlege? Yes

I did not read the first thread that this was linked to but the article referenced (from 1996) could have easily put PD or FD instead of EMS providers for his purposes of pointing out abuse.

I posted this information originally on the NY Blue lights thread. There are some other more recent studies - that are similar in their conclusions.

Just because something has been done historically, does not mean that we shouldn't look to make things better going forward. I suspect that PD makes the most runs, followed by EMS then Fire. There's probably a good reason you see PD cars in NYC, Yonkers etc, turn their lights on to get across an intersection, but turn them off when they have a clear block. How many times do they respond 'hot' to an alarm? They've done the analysis that Capt Nechis did and realized that statistically there is a higher risk with L&S than to be gained from getting to the alarm site that little bit quicker.

I've heard of 'studies' on L&S vs. 'On the quiet' responses. Doing a quick google search I found some articles - interestingly mostly about EMS:

* This research paper (from a USFA course candidate?) seems to be pretty thorough discussing prioritized EMS hot/cold responses. This found hot was 66 seconds faster over an average time of 365 seconds - so about 18% faster for the City of Londonderry, NH.

* A study on EMS scene to ER reponses. Essentially, they said that on average, L&S was 43.5 seconds faster. It seems the average response time without L&S was measured at 406 seconds. So, L&S was about 10% faster.

* Another similar study, in an urban environment measured a difference of 106 seconds faster. However the online synopsis doesn't give the average travel time.

Both of these articles suggest that a minute or two faster ER arrival does not result in better patient outcome - in most situations.

For a 5 minute L&S response, is that 65 seconds saved important? Always? Usually? Sometimes? Rarely? Maybe something to think about.

I also found a couple of Police based articles such as http://policedriving.../article145.htm - which backs up the theory of using amber lights, reduced lights at a scene, and lights only facing the oncoming traffic. Again, something that may be worth thinking about.

[v85 212]

I agree that RLS responses should not be used for low priority alpha calls. (That is the point of an alpha response). But I do have some serious reservations about using these studies. It is not that the studies are intrinsically flawed, because they appear very professionally conducted. The potential problem is how do the districts examined in the study compare with our districts.

For example:

How does the traffic volume compare

How do the number of red lights and intersections compare.

Is the department a career or staffed volunteer department with rigs ready to go or on the road, or is it a full volunteer department?

All of these can affect the amount of time difference between hot and cold responses.

[SRS131EMTFF 471]

I agree that RLS responses should not be used for low priority alpha calls. (That is the point of an alpha response). But I do have some serious reservations about using these studies. It is not that the studies are intrinsically flawed, because they appear very professionally conducted. The potential problem is how do the districts examined in the study compare with our districts.

For example:

How does the traffic volume compare

How do the number of red lights and intersections compare.

Is the department a career or staffed volunteer department with rigs ready to go or on the road, or is it a full volunteer department?

All of these can affect the amount of time difference between hot and cold responses.

I will agree they play a role in response time but their role is negligible.

1. Time and traffic dont care if you are career or volly. The clock starts when you start moving the rig, a volunteer ambulance will not get there in any less time than a career ambulance from the time the rig starts moving. This is a staffing question not a RLS question

2. This is a preplan issue, if you know that certain roads are congested during certain issues, its simple do not take them. This is not a RLS issue because wall to wall traffic does not get out of the way for RLS just because you want them to do. What you need to do is figure out better ways to get where you are going without encountering traffic. This is a driver training issue.

3. This is another pre-plan, SOP, technology issue not a RLS issue, if you have many intersections and red-lights get an Opti-Com systems so you do not even need to worry about going RLS through a intersection because your light will always we green. I know of squads in rural, rural vermont with the nearest Hospital never mind cardiac/trauma center is 2 hours away that have Opti-com systems for every light between them and the hospital. They gain from RLS maybe five minutes tops and that is on a 60 miles one way where ever they are going. That is to show you the issue is on your end, not embracing technology that could make you safer and more efficient, not the RLS end.

While the issues you mentioned are valid, just a little forethought, rational thinking and taking a step back from the adrenaline rush you get from RLS you will realize that RLS are more dangerous to us as EMS workers then whatever issue the patient is calling you for.

Edited September 20, 2010 by bvfdjc316

[antiquefirelt 994]

I will agree they play a role in response time but their role is negligible.

1. Time and traffic dont care if you are career or volly. The clock starts when you start moving the rig, a volunteer ambulance will not get there in any less time than a career ambulance from the time the rig starts moving. This is a staffing question not a RLS question

I'd have to disagree here. The only time that really matter is the time that 911 recieves the call to the time that a provider arrives and begins the assessment/care. Overlooking the time taken to process calls, dispatch them and get a unit enroute is putting all the emphasis on the driving time, leading to people driving faster and more recklessly as they try to cut the total response time.

[SRS131EMTFF 471]

I'd have to disagree here. The only time that really matter is the time that 911 recieves the call to the time that a provider arrives and begins the assessment/care. Overlooking the time taken to process calls, dispatch them and get a unit enroute is putting all the emphasis on the driving time, leading to people driving faster and more recklessly as they try to cut the total response time.

I will certainly agree, putting emphasis on how quickly you can get to the scene will cause people to drive faster and more recklessly. Maybe I just misinterpreted the original posters thoughts but I though he was saying that the need to run RLS increases with a unstaffed crew as opposed to a staffed crew because an unstaffed crew is already behind the eight ball regarding call taking, dispatching, assembly at station and response and therefore would have a greater need to run RLS. What I was saying is that having a staffed crew partially eliminates starting behind the eight ball potentially reducing the need for RLS. Please tell me if I am completely off base here.

Like I said before, you are totally right, putting the emphasis on driving time can and will create unsafe driving. Could shifting the emphasis from driving time to staffing levels consequently increase driver safety? I wonder what the disparity in accident numbers is regarding staffed vs. unstaffed ambulances?

[v85 212]

I guess I have a hard time understanding one thing.

Haven't we always been told that Emergency Services is business in which minutes and sometimes seconds DO count? Now we are saying that they don't, and that the extra minute(s) shaved off by RLS isn't worth it?

Couldn't those extra minutes be the difference between bleeding out and not, or permanent brain damage from lack of O2 or not, or a 10% per minute difference in survival rates with CPR/AED?

I know the reply to this will be "But most calls aren't like that." but they could be. Say a call comes in for an unconcious, or for severe bleeding. Would you rather operate on the assumption that "they just fainted from not eating enough/saw a spider, etc." or "The bleeding probably isn't that bad/ it will be stopped when we get there etc..." and end up having a patient die or be in really bad shape, or go with the assumption that the call is life-threatening.

Also, I think there needs to be a distincition made between RLS responses and reckless responses. The two terms are not equal. I have been a part of multiple RLS responses where we were going slower than the posted speed limit, never went on the wrong side of the road, etc.

Just as a final note, these are my personal opinions as to the matter, and do not represent the official opinions of any service I am connected with in any way.

[antiquefirelt 994]

I guess I have a hard time understanding one thing.

Haven't we always been told that Emergency Services is business in which minutes and sometimes seconds DO count? Now we are saying that they don't, and that the extra minute(s) shaved off by RLS isn't worth it?

Couldn't those extra minutes be the difference between bleeding out and not, or permanent brain damage from lack of O2 or not, or a 10% per minute difference in survival rates with CPR/AED?

This is why there are no absolutes in this line of work. We cannot justify running RLS all the time, nor can we ignore that sometimes RLS are warranted. Our policy does not spell out exact rules when or when not to use RLS. We allow for the crews assessment of the dispatch information. Our personnel know the administration takes operating safely seriously and generally makes responsible/defensible decisions. Typically our buses run RLS to any unconscious, chest pain, SOB/DB, GSW's, motor vehicle accidents with no other info, industrial accidents, significant trauma/bleeding, and others. Additionally any unconscious, industrial accidents, MVA's and significant falls get an Engine assist. On the other hand, we run cold to closed fractures, typical musko-skelatal injuries, general illness, nausea/vomiting, headaches, etc. We used to run cold to stroke calls, but our local hospital has become a "stroke center" and we are participating in a study that requests we respond to and transport any suspected stroke patient with onset <60 minutes, ASAP.

Edited September 21, 2010 by antiquefirelt

[ckroll 101]

I guess I have a hard time understanding one thing.

.....

Haven't we always been told that Emergency Services is business in which minutes and sometimes seconds DO count? Now we are saying that they don't, and that the extra minute(s) shaved off by RLS isn't worth it?

.......

Also, I think there needs to be a distincition made between RLS responses and reckless responses.

Ah, another 'grasshopper'... What I would say is that 'shorter time to patient' is always better. That said, if this is THE goal, then there are many ways to achieve it. Every 'way' has a 'cost' associated with it. Cost/benefit is a decision that gets made long before we get dispatched to a call in the form of staffing and system management. The greater determinant in how long it takes to get help to a patient is how far away from the patient the help is, not how fast you drive.

Almost invariably, it is trained bystanders whose instantaneous help keeps a patient viable until EMS gets there that make the larger difference in outcome. And yet basic emergency tactics aren't even taught in schools. One can get a driver's license and not know what to do at an auto accident.

Minutes also carry different values. If time from injury to arrival of useful EMS is under 8 minutes AND it is a critical call, then shaving time here might make sense. If time from injury to EMS arrival is going to be 15 to 20 minutes, then shaving a minute or two here doesn't have nearly as much value.

As for RLS versus reckless, half of all drivers are below average. One need not be reckless to meet up with an inattentive driver who completely isn't prepared to stop or take evasive action.

Whether RLS has value needs to be evaluated case by case. I think the wise responder does this starting from the position that RLS is not worth it and then tries to build a case that it is,not the other way around.

These are good questions. If at 20, one does not have the 'fire in the belly' then one shouldn't be in emergency services. If one still has it at 50, then they also shouldn't be in emergency services. Remembering one of the great quotes on why a driver didn't go all that fast..."If the fire's any good it will still be going when I get there."

[Goose 188]

This is definitely a complex issue.

In a perfect world we would have a centralized dispatching agency that handled all incoming 911 calls and preformed EMD on all requests for an ambulance. This agency would prioritize said requests based on national standards and dispatch units appropriately. And the SOG would dictate how to respond to each priority level. This is never going to be perfect - i've worked in putnam and dutchess which both use priority based systems and while they get it right 95% of the time, i recall a few times i was sent to an MI that got sent Alpha and a courtesy ride was sent Charlie or Delta. The inherent flaw is that it's all based on the availability and accuracy of the information the dispatcher receives.

Westchester has a few problems. The county cannot mandate that 60 control or a hypothetical Westchester 911 Center be the only PSAP county wide. I wish they had the power, i really do. I think it would be more benificial to the dispatchers (ie: greater career path and increased room for advancement) and it's a win/win for county residents and Fire, Police, and EMS. No transferring calls 50 times or anyone being in the dark. Give every rig an MDT and send jobs to units on that so everyone can see the particulars and responding units and give dispositions via the computer and save valuable radio air time. The biggest benefit would be an EMD certified staff that would prioritize jobs accordingly.

Westchester's biggest problem is that we don't have the above. We have some 48 or so PSAPs, most of those being police departments, who answer the 911 calls. I think there are some inherent benifits to being dispatched by PD in small communities, but as far as this topic is concerned - i don't know of any off the top of my head that have EMD certified desk sergeants, patrol staff, or independent dispatchers to prioritize EMS calls if they do the dispatching. This creates a conundrum. If i call for a bus at home and say hey, i think i'm having a heart attack the desk sgt is going to say ok, we will send you a bus right now. He will dispatch the sector car and the bus to a possible heart attack. Sounds legit, no? Maybe, suppose it could go both ways - could be an MI or it could be anxiety, costochondritis, or maybe i just have a headache and didn't want to wait 15 minutes for a bus. In a system like that, from where i sit, it almost behooves the agency to respond emergency to every job because there is very little to go by

Complex topic, but no matter how you decide or are advised to respond, do so as safe as possible.

[v85 212]

This is definitely a complex issue.

In a perfect world we would have a centralized dispatching agency that handled all incoming 911 calls and preformed EMD on all requests for an ambulance. This agency would prioritize said requests based on national standards and dispatch units appropriately. And the SOG would dictate how to respond to each priority level. This is never going to be perfect - i've worked in putnam and dutchess which both use priority based systems and while they get it right 95% of the time, i recall a few times i was sent to an MI that got sent Alpha and a courtesy ride was sent Charlie or Delta. The inherent flaw is that it's all based on the availability and accuracy of the information the dispatcher receives.

Westchester has a few problems. The county cannot mandate that 60 control or a hypothetical Westchester 911 Center be the only PSAP county wide. I wish they had the power, i really do. I think it would be more benificial to the dispatchers (ie: greater career path and increased room for advancement) and it's a win/win for county residents and Fire, Police, and EMS. No transferring calls 50 times or anyone being in the dark. Give every rig an MDT and send jobs to units on that so everyone can see the particulars and responding units and give dispositions via the computer and save valuable radio air time. The biggest benefit would be an EMD certified staff that would prioritize jobs accordingly.

Westchester's biggest problem is that we don't have the above. We have some 48 or so PSAPs, most of those being police departments, who answer the 911 calls. I think there are some inherent benifits to being dispatched by PD in small communities, but as far as this topic is concerned - i don't know of any off the top of my head that have EMD certified desk sergeants, patrol staff, or independent dispatchers to prioritize EMS calls if they do the dispatching. This creates a conundrum. If i call for a bus at home and say hey, i think i'm having a heart attack the desk sgt is going to say ok, we will send you a bus right now. He will dispatch the sector car and the bus to a possible heart attack. Sounds legit, no? Maybe, suppose it could go both ways - could be an MI or it could be anxiety, costochondritis, or maybe i just have a headache and didn't want to wait 15 minutes for a bus. In a system like that, from where i sit, it almost behooves the agency to respond emergency to every job because there is very little to go by

Complex topic, but no matter how you decide or are advised to respond, do so as safe as possible.

What about trying something like Orange County has then, where all 911 calls are answered by the county, but local towns still have the option of maintaing their own dispatch to handle the radio communications and actual coordination of on scene efforts.

If it is implemented correctly, and I do realize how big of an if that is, something like this could be the best of both worlds. You get a countywide dispatch and its benefits, and still maintain "local control" enough to quiet the politicians.

[Goose 188]

What about trying something like Orange County has then, where all 911 calls are answered by the county, but local towns still have the option of maintaing their own dispatch to handle the radio communications and actual coordination of on scene efforts.

If it is implemented correctly, and I do realize how big of an if that is, something like this could be the best of both worlds. You get a countywide dispatch and its benefits, and still maintain "local control" enough to quiet the politicians.

Personally, this is an all or nothing proposition. Either the county does it, does it right and does it the first time or don't bother at all. The problem state wide, but especially in Westchester, is the whole local control issue. You get a gross duplication of resources an and outrageous tax bill.

[FFEMT150 214]

Many of us will argue that there is no need to go lights and siren to the hospital with an arrest. It is difficult enough to properly perform CPR in an ambulance without being bounced around in the back by someone sailing to the hospital like that. With ALS on board there is very little else that the hospital can do to improve the outcome so it really isn't necessary.

In most cases there is no need to transport an arrest. There is nothing that the hospital can do that the medic hasn't done. In most cases when you transport a code there is just a body in a bed at the ED...sorry folks but thats the ugly truth. If you are able to get some signs of life back then yes, light it up and go.

And Chris, you also pointed out a sad reality, failure of management to properly train. I know atleast one agency that i have transported with that takes EVERYTHING to the ER hot.

To all the future supervisors out there: The guy driving isn't the only one who will be on trial, even if your just a vollie!