What Does "Expedite The Medic" Mean?

[wraftery 1,275]

So we throw the word "Expedite". It will soon be replaced by another word which implies the same urgency.

Any word like expedite which implies urgency will have the same reaction to those who would put the pedal down and kill or injure people with their reckless abandon.

I used forthwith before. It used to be a word like expedite, but it seemed to wear off and go to the place of adrenaline- producing words that lost their effect This is where expedite will go when the effect wears off. It's not the word that is the problem, it's that squirt of adreninene that gets people to lose control. It looks like a widespread Safety issue. Let's have a stand-down and come up with all the words and phrases that might activate the adrenal glands of the untrained. Throw the squirt-words out.

Here's a starter list:

Expedite, 10-75, CPR commenced, worker, working fire, take a hydrant, smoke showing, shots fired, pin, entrapment

Come on! If you panic over a "word," what are you going to do when you get a "situation"

[v85 212]

For everyone who Is saying that expedite does nothing because everyone is responding as fast as they can already, that might not be the case.

For example, EMS gets called alpha response (no lights or siren) to a sick subject. PD gets on scene and finds CPR in progress.

EMS gets paged to MVA evaluation only(no lights or siren) or minor injuries(lights and siren might be on, but not truly being responded emergency). First responder gets on scene and finds a rollover with partial ejection

[FireMedic049 597]

The term, "expedite" really does not tell me what is going on at the scene. It may not tell you the details, but I think it depends on local factors as to whether or not it tells you what's going on. If the PD in my city are requesting EMS to expedite, that tells us that the patient is significantly ill or injured. In some of the other (small) communities around us, that may or may not be the case.

All the term expedite does is get incoming crews into trouble by causing them to drive a little faster then they normally would.

I disagree. Driving "a little faster than they normally would" to me actually means "a little faster", like 5-10 mph. However, most that oppose the use of the word seem to be saying that it automatically makes incoming units drive significantly faster in a reckless fashion. Assuming you are already responding in a prudent manor, it is possible to drive a little bit faster without being "out of control" and a menace to others on the road.

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, however the term "expedite" probably has little to with why this is happening. I would suspect that the vast majority of agencies provide inadequate driver training for their personnel. Most will probably take you out for a drive around town a few times or a few hours and if you don't crash into anything you're good to go. Most probably do not provide any actual "emergency driving" experience prior to turning you loose on the public. I know that's been my experience.

Maybe we're losing them because we aren't training them good enough? Maybe we're losing them because we are putting them in situations they aren't prepared for yet? Maybe we should change that?

[antiquefirelt 994]

The term, "expedite" really does not tell me what is going on at the scene. It may not tell you the details, but I think it depends on local factors as to whether or not it tells you what's going on. If the PD in my city are requesting EMS to expedite, that tells us that the patient is significantly ill or injured. In some of the other (small) communities around us, that may or may not be the case.

As I've said previously, as a singular word, "Expedite" implies the requesting person person does not think the responding unit(s) are fully aware of the situation and are already travelling to the scene as quickly as safety allows. A better solution would be for the person requesting the "expedite" to give a brief condition report that gives real-world details.

In your scenario you assume that if PD asks you to expedite the pt. is significantly ill or injured (we do the same). Was that not how you were dispatched in the first place? If not, then wouldn't knowing the difference in actual medical concerns be more relevant? If I'm coming to the scene I'l always appreciate as much real time information as I can get, vs. "just get here ASAP". Typically our units travel with the flow of traffic or as fast as the conditions allow using RLS. Just because someone at the scene wants us there faster doesn't change "due regard".

It's really not about the word, but about actual communication.

[Westchester 49]

In my opinion, the reson for requesting Paramedic's to expedite is because the first responding EMT's don't have the experience or are not ready to be in charge of a call. Rivertowns have been spoiled with having Greenburgh ALS. I know that tax payers pay a dollar withing their taxes for this service, but my old Ambulance Corp would have ALS on every call because they were to affraid to handle the call themselves, or they wanted the Paramedic to do their PCR and the BLS agency would write on their PCR " Refer to Greenburgh ALS PCR #.................". Some BLS agencys take advantage of the word " expedite ", not only are the patients and/or family members hearing this, but so are residents with scanners, then they come out of the wood work to see what's going on, or a Volunteer whose not on duty wan't to buff it out. I have seen way too many accidents with the word expedite or with the word proceed with caution. I was on a call where the EMT notified ALS proceed with caution, well the patient wnt into shock and we almost lost the patient. The system is abused! If we can't handle a call or unsure of the treatment we give, then don't do patient care.

[FireMedic049 597]

As I've said previously, as a singular word, "Expedite" implies the requesting person person does not think the responding unit(s) are fully aware of the situation and are already travelling to the scene as quickly as safety allows. A better solution would be for the person requesting the "expedite" to give a brief condition report that gives real-world details.

The reality is that most of the time we are not "fully aware of the situation" while responding and we are not always traveling "as quickly as safety allows". Sometimes we travel at the speed limit even though it would be "safe" to travel faster. In some cases, the request could serve to confirm that the unit traveling "as quickly as safety allows" is the right response.

On the opposite side of this, is the advisement to "slow your response" equally insufficient?

In your scenario you assume that if PD asks you to expedite the pt. is significantly ill or injured (we do the same). Was that not how you were dispatched in the first place? If not, then wouldn't knowing the difference in actual medical concerns be more relevant?

As you should know, how we are dispatched does not always reflect the actual severity of the call. For example, last year I was dispatched to a call with some sort of low budget complaint. We started out NE response. Dispatch asked us to call in for a code to be able to access the residence via the garage because the patient would not be able to let us in. I got some additional information that prompted us to upgrade the response (breathing issue if I recall correctly). Well, I arrived to find the patient laying in bed covered in blood looking like something out of a slasher movie. The patient was in pretty bad shape with an arterial laceration of the wrist and in decomensated shock. No where close to what we were expecting.

I work EMS in a busy, small urban city. Our PD are not medical responders and do not respond with us on most calls. As such, they may not be sufficiently trained to provide a more descriptive update, but most people can tell if somebody looks to be in "bad shape". If we're getting the "expedite" from them, it's likely to be for an MVA of some sort or violent trauma. We run a lot of low budget MVAs, but do get some pretty bad ones too. We run a lot of trauma calls, but a lot of them are not serious. While knowing that the patient was shot in the chest and leg rather than just shot in general is nice, it may not sufficiently convey the seriousness of the patient's condition.

If I'm coming to the scene I'l always appreciate as much real time information as I can get, vs. "just get here ASAP".

I would tend to agree that more information is better, particularly if the situation is unclear at the dispatch.

Typically our units travel with the flow of traffic or as fast as the conditions allow using RLS. Just because someone at the scene wants us there faster doesn't change "due regard". I agree and was making the point that it can be possible to respond faster while still exercising "due regard".

It's really not about the word, but about actual communication.

Right, but as I said, depending on local conditions, the word can be actual communication.

[antiquefirelt 994]

As I've said previously, as a singular word, "Expedite" implies the requesting person person does not think the responding unit(s) are fully aware of the situation and are already travelling to the scene as quickly as safety allows. A better solution would be for the person requesting the "expedite" to give a brief condition report that gives real-world details.

The reality is that most of the time we are not "fully aware of the situation" while responding and we are not always traveling "as quickly as safety allows". Sometimes we travel at the speed limit even though it would be "safe" to travel faster. In some cases, the request could serve to confirm that the unit traveling "as quickly as safety allows" is the right response.

On the opposite side of this, is the advisement to "slow your response" equally insufficient? Nope. We tend to err on the side of caution when it comes to responding, so in most cases being told to slow our response would be sufficient to me. Some times we might question it depending on what we've been dispatched to.

In your scenario you assume that if PD asks you to expedite the pt. is significantly ill or injured (we do the same). Was that not how you were dispatched in the first place? If not, then wouldn't knowing the difference in actual medical concerns be more relevant?

As you should know, how we are dispatched does not always reflect the actual severity of the call. For example, last year I was dispatched to a call with some sort of low budget complaint. We started out NE response. Dispatch asked us to call in for a code to be able to access the residence via the garage because the patient would not be able to let us in. I got some additional information that prompted us to upgrade the response (breathing issue if I recall correctly). Well, I arrived to find the patient laying in bed covered in blood looking like something out of a slasher movie. The patient was in pretty bad shape with an arterial laceration of the wrist and in decomensated shock. No where close to what we were expecting.

You made my point here when you noted you "got some addition information (breathing issues). To me just being told to expedite is reflects a system where multiple disciplines fail to understand each others capabilities, limitations and basic protocols.

I work EMS in a busy, small urban city. Our PD are not medical responders and do not respond with us on most calls. As such, they may not be sufficiently trained to provide a more descriptive update, but most people can tell if somebody looks to be in "bad shape". If we're getting the "expedite" from them, it's likely to be for an MVA of some sort or violent trauma. We run a lot of low budget MVAs, but do get some pretty bad ones too. We run a lot of trauma calls, but a lot of them are not serious. While knowing that the patient was shot in the chest and leg rather than just shot in general is nice, it may not sufficiently convey the seriousness of the patient's condition. Our situations may be somewhat similar though we're too small for me to call urban at all. But like you, our PD doesn't respond on EMS calls outside the drugs, assaults, MVA's, knives and guns. Your point about being shot vs. shot in the leg/chest is valid, but I'd rather have that information follow the word "expedite" vs. just using the single word.

If I'm coming to the scene I'l always appreciate as much real time information as I can get, vs. "just get here ASAP".

I would tend to agree that more information is better, particularly if the situation is unclear at the dispatch.

Typically our units travel with the flow of traffic or as fast as the conditions allow using RLS. Just because someone at the scene wants us there faster doesn't change "due regard". I agree and was making the point that it can be possible to respond faster while still exercising "due regard".

While it is possible to speed up, typically we train personnel to run two ways, with traffic or RLS fast as safely possible while exercising due regard. While reality may have the unit travelling slightly off either mark, I'd prefer to change the response based on actual information.

It's really not about the word, but about actual communication.

Right, but as I said, depending on local conditions, the word can be actual communication.

As was said early on here, yelling "expedite the bus" into the radio smacks of amateurism. Sure anyone can be overwhelmed, but most of the time, some actual useful information would be of more benefit than just being told to speed up (regardless of how you're travelling). I'm in no way advocating dropping the word from our vocabulary, merely asking that it be qualified/quantified with some real information. While our cops are not trained medical providers, they are trained emergency responders who have been faced with numerous intense situations, they understand the need for better information and should be able to display some radio restraint and provide basic information (bleeding badly, not breathing well, color looks bad, seizing, unconscious, etc.)

We had this exact scenario last night with the previous shift. They were on a AFA call and got called to a rollover MVA with ejection. First PD units arrive and request the ambulance "expedite", which they followed with "the victim is losing consciousness." The squad and bus were already enroute RLS and made no change to their response. No harm, no foul, just timely. On the other hand we get numerous calls via PD that we get little or no information on as they radio dispatch with "send me an ambulance", which the dispatcher does without any information of EMD code, thus we must make decisions on how to responed and with whom based on inadequate info. Like everything else, it's about educating people, sometimes each other.

Edited November 11, 2013 by antiquefirelt

[FireMedic049 597]

As was said early on here, yelling "expedite the bus" into the radio smacks of amateurism. Sure anyone can be overwhelmed, but most of the time, some actual useful information would be of more benefit than just being told to speed up (regardless of how you're travelling). I'm in no way advocating dropping the word from our vocabulary, merely asking that it be qualified/quantified with some real information. While our cops are not trained medical providers, they are trained emergency responders who have been faced with numerous intense situations, they understand the need for better information and should be able to display some radio restraint and provide basic information (bleeding badly, not breathing well, color looks bad, seizing, unconscious, etc.)

I would agree that yelling it into the radio is an amateur move, however the message itself stated in a calm fashion isn't necessarily "amateur". Obviously, additional information with it would be more ideal.

We had this exact scenario last night with the previous shift. They were on a AFA call and got called to a rollover MVA with ejection. First PD units arrive and request the ambulance "expedite", which they followed with "the victim is losing consciousness." The squad and bus were already enroute RLS and made no change to their response. No harm, no foul, just timely. On the other hand we get numerous calls via PD that we get little or no information on as they radio dispatch with "send me an ambulance", which the dispatcher does without any information of EMD code, thus we must make decisions on how to responed and with whom based on inadequate info. Like everything else, it's about educating people, sometimes each other.

Yeah, the send me an ambulance, but I won't tell you why thing is ridiculous.

On that note, I had a call along those lines earlier this year. The initial dispatch was for EMS to respond and standby at a funeral service at a church just outside our city, but in a similar area that we cover for EMS. Our supervisor called dispatch about it and was told that there had already been several altercations at the service between attendees and the PD wanted us there "just in case". It was a baptist church and the service was for a young child killed in another case of urban violence.

We started over NE (4 minutes away) and as we're almost halfway there, our dispatch relays to us that PD is asking for us to come in the front door when we get there. I asked if they had a patient. The dispatcher stated that they didn't know and the PD wasn't answering the radio. I stated that "it doesn't sound like the scene is safe if they aren't answering their radios" and that we would not be entering. About a minute out from the scene the dispatcher stated the PD was advising that the scene was safe, but still didn't advise if they had a patient. OK, whatever.

We pull in and see a PD SGT standing near the roadway talking to a guy from the funeral home. We stop and I ask "What's up?" He starts to explain that it's this kid's funeral and it's pretty apparent that he's talking to me as if we just happened to stop by. I told him that you guys (his PD) requested us to respond there. He had no idea that we were coming. There wasn't any patient, however we did get treated to a ridiculous display of over the top drama/grief when this young black girl collapsed onto a grassy area and was swarmed by family/friends.

This grandmother looking lady asked us for a sheet for the girl. I'm like what do you need a sheet for (thinking she needs to stop acting like a fool and get up). She wanted the sheet to cover her, concerned for her modesty. The girl had a good plumber's crack going and her shirt was riding up on her and the sheer bottom half of it was now exposing her upper half. I bit my tongue thinking maybe if she had dressed more appropriately for the occasion and acted like an adult this wouldn't be a problem.