What Does "Expedite The Medic" Mean?

[x635 4,066]

Occasionally, I'll hear the term "Expedite the medic".

What does that mean? Does the medic put the truck into jet powered mode? Drive even faster and less cautiously?

Wouldn't it be more prudent to say "Advise the medic that the patient is complaining of chest pain, and is pale, cool, and diaphoretic with a pulse of 50". (Not every first responder is equipped at first with a BP cuff). At least the medic will have an idea what they are going to.

When that term is used by a unit on scene, the dispatcher or field unit should be asked why.

Should the term "Expedite" be thrown out of our vocabulary?

[paratrooper75 41]

You hit the expedite button in the flycar/amblaunce to get to the scene 10 seconds faster and make no difference in patient outcome while endangering yourself and your crew for no reason.

[firemoose827 324]

I feel that term needs to be thrown out.

We already have our level of response's out by my area, Im sure everyone uses something similar to this style dispatch system; Alpha response- Non-emergency BLS response, no lights or sirens, mostly for lift assists and cold/flu like symptoms. Bravo- Emergency BLS response such as broken bones, bleeding, trauma, lights and sirens. Charlie- Non emergent ALS call (Im not sure how many of them there are, but that's what our response guidelines have it as being). Delta- ALS emergency like chest pains, strokes, dyspnea and such. Echo- pulseless breathless patient, codes, basically everyone come thats close by. Why then do we need to say "Expedite"? I feel that if an EMT is dispatched to a BLS call only to arrive and find a code, they should simply ask for the call to be upgraded to an Echo response...plain and simple.

Use what you have and dont complicate things or do something that will make a rookies adrenaline go through the roof and cause an accident all because he/she heard "Expedite to the scene!!!" I have heard plenty of squads in my area simply call for the upgrade from Bravo to Charlie or Delta and its just as effective of getting the point across.

Same as fire calls; I have heard first responders such as PD or firefighters in POV arrive on scene and call for the FD to "Expedite" to the scene for possible entrapment...Just call the dispatch and ask them to advise all responding units that there is a possible victim unaccounted for. We all know as firefighters that a search should be done for every call anyway, so why say "expedite"?

[SageVigiles 1,194]

"Expedite the Medic/Bus/Whatever" is one of those phrases that only (read: SHOULD only) have an effect on the person saying it. When the fecal material has contacted the oscillating climate control device beyond a level at which you are trained to handle, its reassuring to say that and hear that help is on the way.

Example: Department dispatched at 2AM on a weeknight for marine units to assist the PD with an ETOH threatening to drown themselves (a whacky enough call as it is.) Two fairly inexperienced, non-EMS trained Firefighters respond to the firehouse, only to find that there are 2 very serious stabbing victims parked on the front, one unconscious, one losing consciousness after driving themselves to the station. After ensuring the scene was safe, the Firefighters requested EMS and additional personnel on the radio.

Yeah, I definitely said "expedite the medic and ambulance" on that call, for four reasons:

1. This needed to be a higher priority call than the drunk wannabe Jacque Cousteau. (Were there better ways to communicate that? Definitely, but see #4)

2. It definitely made me feel better knowing the cavalry was on the way and realized how serious this was, even if they weren't going any faster than before.

3. I had no idea how to take vitals and communicate the seriousness of their injuries as Seth described, we just stumbled upon this medical.

4. I was young and dumb and thought that's just one of those things you say on the radio. I'm still young, just a little less dumb...

Realistically the phrase is completely useless to anyone other than the person saying it and shouldn't really be used anymore.

Edited November 4, 2013 by SageVigiles

[Remember585 815]

Drive fast, take chances.

[Ga-Lin 86]

Back in the day when I worked NYC the PD would ALWAYS say "Put a rush on the bus centrel" no matter what the call, either it was bad and the didn't want to watch with thier hands in thier pockets or it was utter nonsence and they didn't want to stand around with thier hands in thier pockets. Expecting us to put it in warp speed in order to get there....as if. I would , same as now, just aknowledge the message and continue as I was.

[FireMedic049 597]

Occasionally, I'll hear the term "Expedite the medic".

What does that mean?

Typically it means that the person saying it is feeling overwhelmed and unprepared to handle what's in front of them.

Does the medic put the truck into jet powered mode? Drive even faster and less cautiously?

Driving faster does not automatically equate to driving less cautiously.

Wouldn't it be more prudent to say "Advise the medic that the patient is complaining of chest pain, and is pale, cool, and diaphoretic with a pulse of 50". (Not every first responder is equipped at first with a BP cuff).

I would say it's more informative than it is prudent. Based on the signs you listed, I would say that using the "expedite" term would be inappropriate. "Expedite" should be reserved for truly critical, life threatening situations. Ideally, some sense of why would be included.

At least the medic will have an idea what they are going to.

The responding unit should already have an idea as to what they are going to based on the dispatch. In 20+ years of running EMS calls, it's pretty rare to be dispatched on a call and have absolutely no idea of what the issue might be. Yes, the dispatch information doesn't always line up with what's actually found, but it usually puts you in the ballpark.

When that term is used by a unit on scene, the dispatcher or field unit should be asked why.

Should the term "Expedite" be thrown out of our vocabulary?

No, I don't think it needs to be thrown out, it just needs to be used more judiciously. The term does have some value (if used properly) to convey a high level of urgency or seriousness to an incident. In my area, GSWs are not an uncommon thing and run the gambit from grazing to swiss cheese. Obviously we respond appropriately for a GSW, but a request to "expedite" from our PD conveys to us that it's a pretty serious GSW rather than something minor or that we should respond recklessly.

Edited November 4, 2013 by FireMedic049

[SRS131EMTFF 471]

It means someone forgot that BLS comes before ALS.

[wcr20 17]

My Favorite was always just the opposite command: "Respond with caution". I always wanted to ask if they thought we were using reckless abandon before they gave that sage advise.

[voltage1256 42]

I think its got a psychological effect... "Expedite", "Have them step it up" maybe gives the crew on scene some "comfort" that the enroute unit(s) know they have an uncomfortable or more serious situation on their hands... whether those enroute maintain the same speed or not... that's also a different story. In my head at least I sort of see it as emergency services communicating with each other through a different "lingo" to get their views of the situation across without using language that may further upset patients or civilians around the incident.

[meat441 43]

What good old day's of hearing Expedite the bus, one of the best was Put a push on the bus, I need a quick ETA, Don't they understand I need them now, This is a (BAD) patient. My partner and I would don our Superman outfit's, thump our chests 3 times with our fists, yell for Scotty to beam us up, hit warp 10, arrive on scene and stand with our hands on our hips and say! Did anyone call for the (PRO"S FROM DOVER)? MASH day's for those who don't remember? (THEN) to hear, we thought the patient wasn't breathing? Sir what happened? I WAS SLEEPING. LOLL. PLEASE STOP.

[sympathomedic 383]

An anonymous friend of mine who is a police officer tells me of an officer on his job that asked for an "expedite on EMS and the medical examiner!".

I read an article in one of the journals about this subject and it boiled to to the "Expediter" being out of their element, or comfort zone. While I loath unneeded code 3 driving, I do appreciate knowing that I am heading to a scene that is more emergent than the typical not-so-emergent calls that make up 95% (that is a real stat, BTW) of the tour. I may not drive any faster, but I may move a little quicker in getting the gear un-secured and getting to the pt. I may don gloves in route, other little things to prepare for a bad call.

[antiquefirelt 994]

I don't like calls to expedite. Typically they're yelled into the radio by an LEO or untrained firefighter/fire officer who is facing a situation outside their comfort zone. The problem is that it does in many cases lead to people mashing down on the throttle. Face it, not everyone has the wherewithal to process the request, realize they're already travelling at the fastest rate they felt safe at and continue without change. Most of the people making the request would totally understand the reasoning behind this on any other day, but seeing the situation at that moment they want professional assistance, now! Excited voices on the radio perpetuate excitement, we should be working to de-escalate excitement, not increase it.

I'm sure the police officers in our area are not always monitoring our dispatch channel so they have no idea how our bus was dispatched and if they're travelling RLS or not, especially if the call they (the LEO's) responded to themselves caught them off guard. Much like an IC yelling into the radio at a fire, this gives the perception of a loss of control or a chaotic scene. Most of the time RLS is used, the unit is travelling as fast as the driver feels is safe. A better way of handling this would be for the person making the request to try and calmly call dispatch and tell them the current conditions and ask to advise the ambulance of them. This allows the dispatcher to pass on relevant information in a more beneficial manner. While the bus won't travel any faster the crew will be better prepared when they arrive. Win, win.

Edited November 5, 2013 by antiquefirelt

[EMT111 149]

To be honest though, we all know one or two people who will take their time responding to any call. I had a driver get pissed at me one day for using RLS going to a unconcious, unresponsive, unknown breathing call cause the medics (an ALS flycar with a single medic) will get their first, and she still barley reached the speed limit

[wraftery 1,275]

Expedite is not necessarily a bad thing as long as the message is not interpreted as go to warp speed, abandon all caution, etc, etc.

If it's taken as only an advisory to that incoming unit that the situation is serious and time is of the essence. It's the same as giving the first due Truck an "expedite" because you have working fire with people trapped on the floor above. Now the incoming officer has a tactical objective.

If the medic goes to "warp speed" on the word "expedite" he doesn't need to throw out a word from his vocabulary, he needs training and a little more experience.

[FFBlaser 24]

I use the term when talking about response levels... There are times when we are paged to an Alpha level call down the street and we arrive to what is actually a Delta or Echo level call. And the ambulance (third service around here) is fifteen minutes out because of traffic, we will say, Dispatch, engine 9, go ahead and have medic 21 expedite, our patient is so and so..

[PEMO3 523]

[wraftery 1,275]

[AFS1970 504]

What it really means is this.

There is nothing I can do, but people are watching, so I will say something meaningless into my radio so that the public thinks I am in complete command and control of the situation.

[EMTF469 9]

I have to agree. I hate being told that police on scene request that you expedite your response. Hey I'm already doing 60 mph on country roads and you want me to expedite??? Correct me if I'm wrong, but the old addage is still being taught. Priority 1 is your own safety, 2nd is your partner, 3rd is by-standers, and 4th is the patient. The newspaper headline would read...EMS responder killed en route to call, police report excessive speed as the primary cause. This would be followed up by a story line of how EMS responders think they are aove the law.

[velcroMedic1987 330]

So what are any of the expedite critics doing to educate the offenders? Or are you just criticizing them and expecting it to get better magically.

[wraftery 1,275]

Expedite is not necessarily a bad thing as long as the message is not interpreted as go to warp speed, abandon all caution, etc, etc.

If it's taken as only an advisory to that incoming unit that the situation is serious and time is of the essence. It's the same as giving the first due Truck an "expedite" because you have working fire with people trapped on the floor above. Now the incoming officer has a tactical objective.

If the medic goes to "warp speed" on the word "expedite" he doesn't need to throw out a word from his vocabulary, he needs training and a little more experience.

Thinking a little more about the incoming truck company. Telling him to "expedite, we've got people on the fire escape on the floor above" also tells other incoming companies that they should leave room for the truck. Everybody responding in will know what is going on. This only works, however, if your people are well trained and professional. Then they won't go into semi-panic mode and drive recklessly to get there.

Would the above situation have any different if the truck company officer, while responding, heard a "Mayday, Mayday, Firefighter is on the floor above and his egress is blocked.?" Would he abandon all caution or would he act the same as the fire escape situation?

Would it be different again if the radio message was "First due truck...front of the building...get your stick up forthwith."

My point is that if you are poorly trained, poorly disciplined, etc, you may abandon all caution at the word "expedite" but you probably are also the guy who responds to a reported "Trash can fire on a street corner" with reckless abandon also.

[GBFD111 73]

As stated earlier, and I agree that to "expedite" is a phrase we use to make ourselves on scene feel better in an uncomfortable or serious situation. It can be beneficial to get across that the call is serious and we need all hands on deck as soon as possible but at what cost?

For example, you have an ambulance driver who just got cleared 2 days prior to drive the ambulance. This is also the first time that the driver has ever drove anything bigger than a Toyota Prius. Now the driver hears the word "expedite" and pushes the gas pedal through the floor without using "due regard" on his/her response. Keep in mind this is the first time he/she has ever responded to a call, want to impress the other members on his/her "savy driving" and then rolls and crashes the ambulance.

(I know arguments can occur that "well that person shouldn't be driving the ambulance but lets forget about that because it DOES and CAN happen, especially in the world of volunteers)

Words like "expedite" may very well be uncomfortable for incoming responders. What should be done is to either communicate with Dispatch or to the Incoming Units on the patients current condition.

Now you are NOT telling the new driver how to drive which will make the driver feel more comfortable. Also you are giving crucial updates to the EMT's/Medics/First Responders to help in best outcome of the patient.

Will everyone stop saying "expedite?" No. Its a good discussion, especially for officers and those who really do care, but radio etiquette and proper word choices that should and should not be said over the radio is way too long of a discussion and will never end.

Just my 2 cents...

[velcroMedic1987 330]

As stated earlier, and I agree that to "expedite" is a phrase we use to make ourselves on scene feel better in an uncomfortable or serious situation. It can be beneficial to get across that the call is serious and we need all hands on deck as soon as possible but at what cost?

For example, you have an ambulance driver who just got cleared 2 days prior to drive the ambulance. This is also the first time that the driver has ever drove anything bigger than a Toyota Prius. Now the driver hears the word "expedite" and pushes the gas pedal through the floor without using "due regard" on his/her response. Keep in mind this is the first time he/she has ever responded to a call, want to impress the other members on his/her "savy driving" and then rolls and crashes the ambulance.

That's not the message to expedite, that's the failure to properly train and supervise the driver.

[RES24CUE 168]

I think it means that the electrician who is yelling into the radio (and all of the high school students under his command...assuming its after 2:30) can't handle the situation and they want someone who has undergone some formal training in patient care to arrive more quickly to let them off the hook.

Plus it sounds really cool when said electrician yells "expedite the medic" into the radio so that all his mutual aid buddies who are sitting by their scanners or walking arount with their pagers on "c" to hear.

Very authoritative...

[AFS1970 504]

I think it means that the electrician who is yelling into the radio (and all of the high school students under his command...assuming its after 2:30) can't handle the situation and they want someone who has undergone some formal training in patient care to arrive more quickly to let them off the hook.

Plus it sounds really cool when said electrician yells "expedite the medic" into the radio so that all his mutual aid buddies who are sitting by their scanners or walking arount with their pagers on "c" to hear.

Very authoritative...

I think you are way off base here, because where I hear this most over the radio and there is only one electrician that I know of and no High Schoolers who are police officers in my city. However traditionally my city refuses to refresh the police officers CFR, which runs out 3 years after the academy, they carry no first aid equipment other than a defibrillator and generally make this call as one of two EMS options, the other being cancel EMS.

I assume your statement is a dig as some volunteer fire department but at least around here the units going to Medical calls have some base line training, although experience is sometimes lacking. That is being corrected with each refresher course now that some old attitudes are going away both in fire and EMS.

[antiquefirelt 994]

Thinking a little more about the incoming truck company. Telling him to "expedite, we've got people on the fire escape on the floor above" also tells other incoming companies that they should leave room for the truck. Everybody responding in will know what is going on. This only works, however, if your people are well trained and professional. Then they won't go into semi-panic mode and drive recklessly to get there.

Would the above situation have any different if the truck company officer, while responding, heard a "Mayday, Mayday, Firefighter is on the floor above and his egress is blocked.?" Would he abandon all caution or would he act the same as the fire escape situation?

Would it be different again if the radio message was "First due truck...front of the building...get your stick up forthwith."

My point is that if you are poorly trained, poorly disciplined, etc, you may abandon all caution at the word "expedite" but you probably are also the guy who responds to a reported "Trash can fire on a street corner" with reckless abandon also.

I think the real message here is everything said after the word "Expedite". Using it as the OP noted "Expedite the medic" or Expedite the truck" merely indicates someone feels you need to come as quick as possible, as if you weren't already. By adding in actual useful information after the word, you've turned it from sounding like a chaos to a controlled decision making process that allows incoming units to modify their decisions with updated information. To me it's nothing to do with the word and everything about how to provide useful information to ensure units respond as efficiently as possible (not always faster!)

Edited November 8, 2013 by antiquefirelt

[Hudson61 11]

The term, "expedite" really does not tell me what is going on at the scene. I would rather the IC say something like, I have two patients one is conscious with severe bleeding the other unresponsive with shallow respiration. That give me a better idea of what I am getting into. Plus knowing my resources, I can decide to ask for addition resources if needed,

All the term expedite does is get incoming crews into trouble by causing them to drive a little faster then they normally would. Hardly a few weeks goes by when we all learn about another firefighter or EMS technician is killed responding to an alarm. We have already lost way too many young and promising responders to dangerous driving.

I agree with all of you who stated we need to drop the term expedite.

Drive safe, stay safe. For the best way to help the folks who rely on our skills, is for us to arrive on scene safely.

[Bnechis 3,961]

Then lets teach the to say it into the radio WITHOUT pressing the PTT button.

What it really means is this.

There is nothing I can do, but people are watching, so I will say something meaningless into my radio so that the public thinks I am in complete command and control of the situation.

Correct me if I'm wrong, but the old addage is still being taught. Priority 1 is your own safety, 2nd is your partner, 3rd is by-standers, and 4th is the patient.

The patient is #7

#1 is my safety

#2 is my family

#3 is my partner (some switch 2 & 3)

#4 is by-standers

#5 is the dept. (because if I screw up it costs them)

#6 is all the lawers who will be litigating the case if I get past #5

#7 is the patient

[antiquefirelt 994]

I Correct me if I'm wrong, but the old addage is still being taught. Priority 1 is your own safety, 2nd is your partner, 3rd is by-standers, and 4th is the patient.

If this were reality, ambulances wouldn't have lights and sirens. Responding to an EMS calls RLS puts your #4 up front and endangers the other three. Amazingly if you're there as a firefighter/EMT then suddenly your safety or your partners may not be #1, we often find ourselves accepting significant risks for the benefit of a patient/victim.

I would re-align the prioritization to place by-standers first (once we arrive we need to stop further harm), and then depending on your oath determine who's risking what for whom, and I'd add that your partner should be on the same line as yourself if you're a team.