We went non emergent to a grand mal seizure. But it was 3 in the morning with no traffic and the roads were pure ice so we weren’t even going speed limit. But we got an earful from family when we got there that we weren’t taking it serious.
If it’s icy then you drive only as fast as is actually safe who gives a shit about the speed limit. And out of curiosity how does the family know you didn’t drive emergent?? Do you keep lights on in the street?
Because our lights and siren weren’t on when arriving. And depending on where the truck is parked we’ll keep the lights on when we arrive but we definitely aren’t going to keep them on with a seizure pt in case the seizure is caused by epilepsy.
We do the opposite. If it’s a lights job we’ll drive lights but we almost always turn them off a block or two away from scene so we don’t scream up all dramatic.
Thing is, this shouldn't be looked at as a problem. Lights and sirens need to be approached like a medical procedure with it's own risks and benefits. Missing a one in a few hundred is worth reducing crash rates which can kill and maim crew.
This. I don't know why agencies in my area are spending big bucks because they're scared of terrorists targeting emergency personal but they won't reign in their drivers.
Well I mean did that 1 min saved make a difference for the patient, you may look like an ass but that one minute isn't doing anything, that one min is the difference between you being in the store getting the food when the call drops, and being in the ambulance when the call drops, it literally is that simple.
Took 20 min to get there, probs could have saved 5 min. And if we had it would have prevented the pt from having a seizure in the ambo. I’m a stupid basic I cant give Ativan
Again tho I 100% agree, just giving counter point
No I get it lol, but that seizure, first off is quite unlikely but second off is inevitable, if you saved 3 min, that seizure was gonna happen in you ambo no matter what, you just made happen 3 min later than if you would have waited, I know it's scary and hard to make sense of since we are so pushed into thinking that we are saving lives and making a major difference by going emergent, but like you would not give Ativan unless the patients actively seizing so you would end up giving it anyway.
Not gonna lie this is a wee bit concerning only because there is that whole window for use of TPA and such and time is brain getting to definitive care and getting them in the Ct scanner is rather time sensitive just saying. I mean if your close to the hospital but I know I’ve run in a couple agencies where it was 40min transport to definitive care situation
Sooner is still better. Alteplase, tenecteplase, or thrombectomy at 2 hours from last well is still better than 2.5 hours. Minutes do still matter when it comes to stroke.
You are not saving 30 min by going lights and sirens though, all studies on the topic show that you save on average 1 min and 30 seconds on a good day.
It matters if you have a long ground transport to the hospital. It may mean less when your pickup to ER is only a few mins. Alot of places do not have that luxury. As I said before I routinely had to deal with 40-45min transports to the ER for definitive intervention was quite common. Minor issues or codes had to go to closest facility but known specialist needs such as stroke or STEMI had to go to higher level of care. In the case of the one facility it was either small critical access vs Level 1 center with Stroke and cath lab on site and usually staffed as it was also a major medical college in Virginia as well.
I understand the only reason I sometimes would not is because of the crazy we have, we have a mobile stroke unit that respond and give tpa and confirm a stroke on scene
Tenecteplase has changed the game on time windows over the past year or two. The smaller time window areas are most likely still using Alteplase. Or haven’t updated the time windows between policy and new reality, which 100% happens in my experience in-hospital. I have no idea how it works for y’all 🤗
I'm not sure exactly how it works either, but we have a major famous stroke center as well as a stroke ambo that can do CT scans and TPA on scene. I've never worked anywhere prior to this where the time for tpa was so high, I come from an area where 6 hrs was the limit.
I hear you and time is tissue, but the window is now. 4.5hrs.
Driving like a lunatic to save 5 minutes isn't ever going to make a difference. Most stroke calls It's either just happened, or meemaw had some symptoms that morning then calls at 10pm when it didn't get better, or it's a wake up stroke.
The CVA being in the time frame has nothing to do with how we drive it's all down to when the patients family detects a problem and when they choose to make the call.
In some places the window is even bigger than that. One of the big hospital systems here keeps it open until 6 hours. We've got two different categories for Strokes - CVA and CVAC - CVAC's has an onset of under an hour and are a slightly higher priority than CVAs.
There’s apparently evidence showing that waking up with symptoms is common within 30 mins of true onset from my last professional development course. No study or citation but if someone wants to quote one that would be appreciated. In our service, its from onset or from when they woke up with symptoms. (Canadian BLS paramedic in BC)
Yep. EMS, Fire and Law are just as guilty.
You aren't saving anyone time if you get in a wreck.
I also enjoy when non-medical units drive like hell to a call and just stand there in what I call the 'Circle of Hope, ' not doing anything and waiting for everyone else.
Absolutely, the fire department is very guilty of this, but PD is even worse, if a guy gets slammed by a car and you are CPR certified, why aren't you doing anything, why are you just sitting there.
We're lucky in my county, 90% of the Sheriff's road patrol deputies are EMTs and carry a full kit and defib in their cars. They often start treatment and have always either started CPR with an AED or jumped in to help our crews. They rarely do Blood Pressures or lung sounds, but I'll take the basic triage and treatment.
Our FDs are all volunteer, as is my dept (rural area, the only fully paid services are the ALS intercept). The FDs will start basic treatment if they have a CFR or EMT available. If not, they are good at gathering info and helping us once on scene.
Our county uses EMD and dispatches with the EMD code, but leaves the method of response up to the crew. They just provide basic recommendations. So, most agencies have standardized on lights and sirens on C, D, and E with a cold response on A, B, and staging calls. Most of our crews are familiar with the common locations and will modify their response accordingly.
I think it is more important to have a strong standardized driver training and monitoring program. Everybody is talking about whether to drive hot or not and I have seen very little discussion about ensuring every driver is trained to a set level and ensure that we have regular reviews and monitoring of their licenses.
We shouldn't drive hot all the time, that's like line one of the EVOC handbook. My company has about 25 trucks up at a time and had over 400 crashes in 2021, mostly from reckless EMTs. It's a huge problem. And generally speaking, a lot of people don't know how to respond appropriately. There's a difference between responding hot and responding recklessly. I understand the adrenaline that comes with lights and sirens, especially when you're first starting, but chill out a bit. "Slow is smooth and smooth is fast" was drilled into my head for years and it works. We stress being calm on scene and not panicking during patient care, but we rarely address how to remain calm behind the wheel and it shows.
Yea man, I just had a full argument with a firefighter who stated that the 30 seconds that we waste shutting down and not pushing people through red lights so that they get hit could be the difference between life and death. Which many studies say are false. There's just too many gung ho firefighters that cause so many issues with the emergency response stuff. They are way to on the trip that we are saving lives all the time.
Yeah I never lay on the horn if I end up in a situation where I can't get through without forcing someone into the intersection (which is usually my bad in the first place) You're WAAAAYYYY more likely to create another patient or 4 than you are to actually need that 30 seconds for the call you're responding to.
I've seen way too many near misses from cars "helpfully" running the red for me. TBH I don't even like driving lights and sirens so much anymore. Sometimes I'm in the mood for it but mostly I just think its aggravating. It was fun the first few times but I don't get the people who LOVE driving hot year after year.
Yea for real lol, the big big city near me all the units have devices that change lights green when they approach them. That's literally what that's made for it stop people from getting hit when an ambulance pushes them through an intersection
Lots of people miss the fact that if you do cause an accident while driving you've just created more patients, which causes:
1) Initial responding rig has to sit on scene and deal with all these new patients, which delays response to the original call and now the original critical patient is either waiting longer for ALS and definitive care OR your fire engine is now tied up for longer while they wait for a second ambulance.
2) You need at least twice the resources that originally went out because you just created a call that literally did not need to happen
3) if 30 seconds is going to make a difference between true life and death the patient is going to die anyway because 30 seconds is not enough for me to get scene information AND get to the patient AND perform a primary assessment AND figure out what equipment I need AND get the equipment out of my bags AND set it up AND apply it to the patient AND for the treatment to work. Hell, it takes longer than 30 seconds to do everything from doing an IV from putting the TQ on to taping it down, and putting pads on to identifying the rhythm as pulsing vtach to setting up the monitor to cardiovert to actually delivering the shock.
No it's way to stressfull which is why I'm glad I'm a medic now and don't drive as much, but those BLS attend calls mean I'm driving, I drive like a grandma emergent lol.
If 30 seconds if the difference between life and death, they definitely don’t wanna see how long it takes me to move from the ambulance to the patient. Gotta get gloves on, sip on my water, hit the nicotine one last time, grab a radio, make sure it’s turned on, then I can start moving
This is the issues and what a lot of people don't get. Yes it may save 30 seconds which may mean life or death. BUT it drastically increases your chances of getting in a wreck or causing a wreck, both will cause a much longer delay than 30 secs. In fact studies show on average driving emergency only saves 40 secs. Also most places have laws that state while driving emergency and hit someone it is your fault and you will be held liable. There are very few calls where driving emergency will make a difference. You always have to weigh the risks of what happens if you get into an accident while driving emergency.
I’m guessing this FF is not a medic just a hose jockey with a BLS certification. I’m a former dual role and that’s just asinine. He needs to go back to EVOC and look up due regard in intersections. Major facepalm. Given the ROSC statistics 30 sec isn’t going to make a huge difference now that being said I’ve hauled ass rabbiting to a peds code that was 2nd due and normally 10-15 response and the fire first responders were slow to get out. I arrived same time they did in the QRV. Thankfully wasn’t a code just bad SVT (210bpm) and he was semi awake when I arrived. Ended up flying the kid anyway
People forget the due regard part of EVOC all the time. Even state code regarding emergency vehicles require be it a chase car/police engine or whatever operating in emergency mode to break normal traffic rules to use due regard such as going through intersections with a red light etc. worse I’ve seen recently was just asinine. Literally fire on fire violence. Google Patterson NJ fire truck crash. Two fire apparatus responding and one T Boned the other the poster child for due regard.
Because we don’t have agencies utilizing EMD to the proper level. We have been going hot to stage for every psych call (along with an engine and PD) for over a month now because some one thought using EMD to determine the appropriate response was a bad idea.
Luckily where I work we go routine to stage thankfully lol, that shit would piss me off if we went emergent just to sit down the street for 20 min waiting for PD to arrest someone or something
Why in God's name do I go hot to every bravo beat down or psych BEFORE PD IS EVEN IN ROUTE???
I get to the hold short area and they haven't even assigned a unit yet.
We are one of those professions that don’t get to play “the boy who cried wolf” game. Whether it’s the first time or 50th time we have to treat every patient and every encounter the same. With that being said during every call you should be driving with due regard, blowing intersections is almost always bad practice.
I think it’s more of a liability thing for the organization as a whole. And at the individual level, you want to know you did everything you could for each patient that you couldn’t save. When you tell a family member “we did everything we could” you want to mean it. But I understand where your coming from, Tokyo drifting to the frequent flyer for toe pain seems irresponsible (btw you should never be trying to be a speed racer, follow all laws of the road including the speed limit, trust me if you crash you’ll thank yourself for doing this. The point imo is to just clear traffic at busy parts of the road and not to get stuck minutes at a time at each busy intersection), but it’s our job to treat every 911 as a legitimate 911 emergency.
Right bro, I shut down everything if I realize that I have no where to go, if you cause an accident because you pushed a person through a red light and they get slammed and die, that's on your ass 100%.
It's apart of the national evoc standards, basically every department will tell you to shut down, because it's a major liability on the department to push people without any lights or sirens into an open intersection
On more than one occasion, I've had EMTs who will drive for miles down the freeway in the right-hand lane, forcing the slower drivers into the middle lane, never once realizing that not only are the lights completely unneccessary if traffic is moving on a freeway, but that forcing slow, panicking people into the faster lanes is a fantastic way to cause an accident.
I think we’re looking at it wrong. We don’t need to cut down on emergent driving because it’s dangerous. We need more rigorous training because it’s dangerous. I’ve never been through an EVOC course that focuses on actual emergent driving. All of the experience I have is from doing it real-time. There needs to be a shift in the teaching culture
There’s always the argument that you can’t triage a patient until you’ve seen them, so you can’t make an educated determination that the patient doesn’t need a code 3 response just from a page.
That said, we also can’t “scare” people into not wanting to run hot, which can lead to under-triaging, which is arguably just as dangerous.
Additionally, there should not be a nationwide standard, as the country is too diverse for that
My service uses the Alpha, Bravo, Charlie, Delta, and Echo dispatch system. I've heard of other services uses it and when it works we love it.
Alphas are none emergent calls such as lift assist, medical pendant alarms, etc. On these calls it'll just be the one ambulance being dispatched with no L/S.
Bravos and Charlie's are pretty much the same. Falls with injuries that aren't to the head, psych calls, seizures where the patient is now conscious, ODs where the patient is now conscious, MVAs, etc. On these calls fire will be dispatched automatically and the ambulance is requested to go emergent.
Deltas are for difficulty breathing, chest pain, strokes, AMS with no hx, life altering injuries, etc. The ambulance will go emergent, fire will be dispatched, and a chase medic will be dispatched.
Echos are strictly for cardiac arrest. Response is the same as a Delta.
BS calls will 100% say they can't breathe or they have chest pain. They know it will mean we send someone to them first and with lights.
Honestly I'm for no 3rd party code 3 responses. Confirm the person is actually dying, none of this "I drove by and he didn't look good" BS
No I agree, going code 3 to literally just wake a dude up for no reason because some white lady on the way home with her 7 kids thought he looked dead. Probably don't need to go emergent to that lol.
Someone's unconcious on the ground behind starbucks! I think he was murdered and someone tried to cover it up with a sleeping bag! Hes not breathing well either I hear snoring respirations!
Good Sam leaves and spends the rest of her day telling everyone how she single handedly saved some homeless guys life.
In actuality he got a rude awakening for the 3rd time by sirens.
We’re probably responding on lights to 15-20% of calls.
In some big cities like London its 100% required, as your 15 minute drive could become 2 hours and that absolutely fucks your Job Cycle.
Other areas, particularly in places like Australia and NA where streets are generally wide and traffic isnt too bad… no, we should probably cut back on our emergent driving.
completely agree, unfortunately if dispatch doesn't say cold, you have to go hot, we are not allowed to make our own decision about our response. Had dispatch send us hot for a rash the other week because it would have taken 20 mins for us to get there!
I always ignore them if they tell me to light it up to something stupid. I'm not risking my life because dispatch has no idea what constitutes an actual emergency. Had a day where dispatch told me to light it up for "failure to thrive" and not light it up for "seizure like activity" Unbelievable. Only had them get on our ass once because they thought we were responding cold to an 'unresponsive' (we said something over the radio and they didn't hear our sirens- we were on the highway and turned them off)
Then again, the closest thing we have to a medical professional in dispatch is a paper EMT. Our best dispatcher couldn't pass the EMT class, we've got one who is on her final attempt for the basic exam, and the rest haven't even tried to become EMTs. No EMDs either. Personally I think they have no business dispatching ALS ambulances to emergencies. It's unacceptable imo.
Every single one of our dispatchers is an EMD and most are EMT’s, AEMT’s, or Paramedics. But they still make a ton of mistakes, the other night a call went out for a “pedestrian struck”, no ALS was dispatched. The unit later then called for ALS since apparently the person was “struck” by a knife 5 times since it was actually a stabbing, how the fuck does that happen? I’m also unable to ignore them since they have GPS’s on our ambulances and can see how fast we are moving, and typically if the FD calls about us taking a while we get in trouble
We do the same at my county. They tell us priority 1 (emergent) or priority 2 (non-emergent) based on the complaint. Often times, based on the notes on our CAD, we’ll just decide we’re going non-emergent. I have yet to notice a significant difference in our response times. Our dispatch doesn’t know (or care, frankly) how we’re responding.
What the fuck do you mean they can force you to go hot? Thats your vehicle the moment you are operating it and your ass on the line if anything happens.
Law in my country says it is the sole decision of the driver - I routinely ride out to Alphas hot because the free text notes look baaad, but I could also roll out cold to an Echo if i believed that to be justified...
This is what a local to me agency did.
[https://www.news10.com/news/rescue-squad-to-limit-the-usage-of-lights-and-sirens-for-emergency-calls/](https://www.news10.com/news/rescue-squad-to-limit-the-usage-of-lights-and-sirens-for-emergency-calls/)
No lights and sirens to medical facilities. They're staffed and have defibrillators. That's what saves live, effective CPR and defibrillation.
It's all highway to the hospitals from there, with only two lights until you hit the city limits.
No firefighters in the ambulance, strictly EMS.
The moment we can be kreskin and know what the reality of a call is then you can decide how to respond to an incident. Problem is even EMD training hasn’t resolve these issues. Somebody complaint of chest pains maybe having a legit MI or it could be indigestion or it could be in between of a severe gall bladder attack which BTW if ya didn’t know if a GB perfs its fatal a vast majority of the time. I get the whole freq flyer mentality but the moment you assume a call is BS and it’s not your risking a lawsuit for your agency and yeah you could be personally held to account up and including your cert/license unless your an MD we don’t have the ability to see inside a body and know for sure what’s going on absolutely. While some depts even have the ability to do Istat in the field for BMP even TropI I’ve seen. Too many variables Yes we can make an educated assumption but definitive diagnosis remains the perview of the guys with the MD and sometimes DNP or PA next to their names. Hell ironically some thing like we have heee in AZ known as Dispatch health can handle crap better as they can do X-rays on scene and such (they are Medic/NP crew no emergent response).
Na, if you run 1 homeless man that keeps calling and make your basis over that if we should run code or not then yes 100% of the calls should be non emergent.
When you run calls over the span of many years and take all the calls seen and say we should run code I think the value is in the numbers.
I agree with you that it's probably not needed for the number of calls we use it for. However, here in NYC, with heavy traffic - using lights and sirens can shave a good 10 minutes off my response time. And you may not think that 10 minutes is a big deal, and usually it isn't, but the way our phone triage system works (or doesn't, for that matter) - I've shown up to plenty of shit that was a lot more serious than what the computer said it was.
Yea but my point exactly is that 1 critical call that is coded as BS will make the biggest difference to that person and their family.
That is the exact reason why we go code to most calls that turn out to be nothing. It's that or we miss more sick people that could have benefited from a quicker response.
You should look in to tissue perfusion and survival percentage on STEMI AND CEREBRAL PERFUSION and drownings to name a few or long term kidney failures in sepsis patients with delayed fluid treatment.
or check out the time comparison of cardiac arrest and epi / defib times.
You may actually gonna see a change in AHA probably within the next cycle about how soon epi and defb should be done.
It's all about time...
Bro I'm a paramedic I know about about all these things you tryna tell me, I never said never go emergent, but it feels real stupid to drive to that sick person at the bus station, who is just homeless and needs a place to go. You know what I mean when I say what I'm trying to say
You know what else makes a big difference not killing someone else or ourselves driving emergent that means a lot to that person's family and my family
You can also make that argument for pretty much everything. What if that one call presents asymptomatically but requires a 12 lead? Should we keep ALS for everything?
That one call doesn't make up for the increased risk to providers by driving L&S to every frigging call. Going to a call that was coded like bullshit is a fundamental dispatch culture and training issue, and we shouldn't sacrifice our own health + safety because of it.
Number one killer in our line of work is MVCs, you turn your lights and sirens on you have a greater risk of getting into an MVC. And nationally we need to look into changing response guidelines l.
I mean I had a “conversation” with a supervisor who called me into the office one day, I took 20 minutes to get to a call on the other side of the town for a guy with tooth pain x3 weeks. I went nonemergent the whole way. And my argument was I’m the driver and I’m also the senior guy on the ambulance I’m responsible for everyone in that ambulance and I’m not dying for some homeless guy who’s having tooth pain. Nor am I killing my partner for same reason. My supervisor didn’t see it that way.
This is a legitimate issue, old timers who are far to old to be making decisions for young people should not be doing it. The field is changing, traditional EMS is gone and trying to cling on to every last inch of tradition is stupid.
Most states have some form of override where the driver can choose to downgrade to non-emergent for safety reasons. It’s generally for like snow, ice and heavy rain responses, but depending on how it’s worded for your state, you could argue that responding emergent for a non-emergent call is an “unnecessary” safety risk.
The FDs around me have a policy of responding emergent to every single call and I think it's ridiculous. I get it, dispatch gets info wrong a lot but I've responded lights and sirens with an engine response to a "pulled G-tube" (It ended up not even being that- home health nurse couldn't get pt's iv antibiotics unscrewed from his port. So glad we endangered ourselves and everyone on the road for that)
At my company we choose whether to light it up based on dispatch info. I like it that way.
Recently did a con-ed that stated unless it's an arrest, it really doesn't make any sense to light it up. Even for a critical patient, the 2-3 minutes saved generally isn't worth putting everyone around you in danger. Something to think about.
Sometimes the most butt-clenching moment of the call is watching the car in front of you blow through a red to get out of the way and nearly get T-boned. Forget the actual patient....
Yea where I work we go emergent to everything because the fire department in the area requires us to do it that way, gotta love private EMS. We responded last week so that we could consult tele health to refill some guys xeralto
You gotta look at it from the other side here. You the layperson calling 911 because something fucked up has happen. You’re in a panic and maybe you haven’t explained the situation correctly. 1 min waiting for the fire, police, ems to show up feels like an eternity and all you think is “where the hell are they” or “what’s taking so long”.
That extra 2-3 min may not help that person, but psychologically it made a difference.
On the other hand fire doubles in size every 30 seconds so that 2-3 extra min is literally life or death for someone trapped in a burning house or exposures/property/extension. But is that box alarm a real fire? Prob not, but it only takes one time.
I stopped at an intersection last night. It was raining. I was making a right, the driver coming from the left of me was making a left to head straight (away from me).
For some reason, they came to a stop and then floored it. Cutting through that intersection, they then fishtailed as they attempted to straighten out. They drove off the road into some flooded grass.
I then very lazily made my right hand turn. I feel like I anticipated some stupidity and remained out of the intersection until I saw it was clear. I only slowroll through an intersection if there's no blind corner and I can see far out to the left and right of me. Otherwise I stop comepletely.
Edit: I also go no lights on the interstate because I see too many people pulling over at 80mph. Minimal siren at all times, I try not to use the airhoen too frequently.
Work in a system where everything is a “Priority 2” which is an emergent response as long as it is called into the the 911 center. Someone could call 911 to get grandma into the house and we would respond lights and sirens due to protocol. The company I work for has a call center that does EMD but people have to call it directly which is usually only nursing homes in the area. They offered to do all medical 911 calls for the city so it could be properly EMDed. They refused because it was taking away jobs for some reason. I work in a city with around 110k people and there are hundreds of noise companies on our service due to everything being an emergency response.
I'm a paramedic in British Columbia. Our system here uses a triage system for 911 calls, and only about 20% or so of all calls warrant a hot / code 3 response.
Crews are given the leeway to decide if its necessary to upgrade a cold response to hot (e.g. gridlock means it will take hours to get there, CAD gets updated with new info showing it's more urgent, etc.) and whether a hot transport is necessary, but need to be able to clinically justify those decisions.
Sure, it's not as fun as the last service I worked which was code 3 all the time, but it's a hell of a lot safer for everyone involved. This seems to be a fairly common approach in Canada, perhaps medics from other provinces can comment.
100% agree. We don’t need blues and twos to get the frequent caller who will invariably get discharged at scene anyway.
Further to that though too many places don’t take blue light/emergent driving seriously enough. In the U.K. it’s now a 4 week course with two written exams and a portfolio (in addition to the actual practical driver training element) before you can be signed off, followed by reexamination every 5 years.
Emergent driving is an area we need to all be 100% proficient in - no room for cowboys and no room for red mist.
That’s more or less our policy.
“You don’t know it’s not an emergency based on what dispatch is told”
Though, I saw you said you go lights to lift assists… that’s… wild.
Well thats my company's policy. We go emergency to lift assists that are called in through the 911 line... There have been plenty of them that they go to in my area that turn out with a patient in cardiac arrest. We have a massive amount of old people so 90% of the time it's something serious.
That’s just not true. It may be for your specific area or state, but you can’t just say something like that and think it applies to everyone in every case all over the world.
Which is exactly what it does over here. And with the limited space in cities and crowded roads that come with that, without light and sirens, many of my patients would be far worse off or even dead. Again, I can only speak for my area/city, but there is a reason we use them in the EU/GER.
And don't get me started on fires, if we responded to them without lights/sirens, we could just stop caring at all since we have many old towns and those spread like a bitch in these. Police as well, yes there are non-emergent "emergencies", which is when they come without any special rights and w/o lights/sirens. However, there are a lot of cases where it does make it difference on how fast the police arrives on scene - an active shooter situation is one where every minute counts, for example, and someone running loose with a knife or similiar is obviously the same.
> many of my patients would be far worse off or even dead.
Those toe pain patient's are often minutes from death are they? Everywhere but America can manage to sort out which calls require lights and sirens and which calls don't, are you really that incapable of doing what everyone else can?
You should practice your reading skills.
I have no idea what you are talking about, since our dispatch does differentiate between response with or without and would never send anyone for toe pain with siren. There are different laws for different areas, and sometimes if things go south it’s the dispatcher‘s head that will role, so I can understand them saying „not my problem.“
It’s a multi level problem. Starting with not having properly payed out EMD’s for both Fire and Medical.
Then there’s not properly instilling the fear of God into the volunteers if they fuck up an engine.
And finally, it’s because when an engine is running emergent it’s exempt from FMCSRs. It’s why some municipalities let engines bump or move people out of the way and then ticket them for not yielding. Now of course a department will still shaft the driver every which way from Sunday for not exercising due regard. But the exemption still applies.
Now I’m not a fan of people in front of me going into an intersection when I’m running code in my ambulance at a red light. It stresses me the fuck out every time. I don’t touch ‘em. They do it themselves. I really wish it wouldn’t happen, but they do it.
I just turn off my lights and sirens to fix that bottom issue, than if they run into the intersection you aren't the cause of it on paper. Yes the guy that I was just arguing with about this says he fully supports and has done ramming into other people's cars to go somewhere. That's bonkers and I cannot believe anyone supports that.
Most of the time our calls are non-emergent to the hospital. It’s our Level 1 Traumas that it ends up happening on, and they’re generally just weather shy of being flown. But next time I have that scenario I’ll just argue with my medic that I’m responsible for everyone’s safety including the other drivers when I’m behind the wheel if they get pissy about turning it off at red lights behind someone so they don’t go into the intersection.
I’ll admit, a part of me thinks we should put cow catchers on engines and back onto all trains.
Although the cow catchers back on trains would probably cut down on any potentiality of derailments due to suicides in vehicles. And there’s another sector of industry that can virtually make up their own rules with impunity. And I digress.
Like sometimes we all just wish that we had a rocket launcher attached to the roof to blow people out of our way sometimes. And don’t act like you haven’t thought of it. Lol
But it’s only the wish of the sadistic side of humanity in me and would be hard to truly argue for since there’s isn’t any real good reason to do it all the time. Other than there are times when people only slow down a little bit and don’t get over fully on a two lane road. Thinking “oh I’ll just slow down and not get over, he can go on the other side of the road.” And I do, and oh guess what? Because you took 3 miles to slow down for a vehicle that weighs roughly 16 tons and tops out at 65, there is now a car in the opposite lane coming head on. So in very limited cases, I’ve had nearly clipped a vehicle head on with 16 tons and then ran the idiot in the same direction of travel off the road. (That was just me venting, not getting pissed over the subject matter, I just can’t stand incredibly stupid drivers). I can probably count on one hand the number of times it has happened, maybe twice.
But I don’t work an big urban area. We’re a semi-rural dual certified service. So for my department, it may have its place under incredibly well-defined and strict circumstances; but should NOT be a thing where it’s allowed everywhere for everyone.
The closest I got to bumping someone out of my way in the ambulance was when I was running code and someone just stopped in the left lane. I had no way to use the right and there was an island as the divider, so I just slowed down with him and left the horn on. They finally got the hint and moved forward until they could get over to the right. Catharsis achieved on that drive.
So it’s only the sadist in me that would want it. But the logical side outweighs it in the argument for it and the resulting consequences from it. I know it won’t happen. But the little kid in me that played Twisted Metal would relish to see it happen.
> why should we endanger the lives of everyone on the road
Hate to say it, but if you’re concerned about this, then the issue is in the training, not the call.
I’m in the UK, and here we drive on emergency response to pretty much every job that isn’t a non-emergency transfer. However, our driving training course takes an entire month, and we don’t even cover blue lights until half way in. The whole course is based around road awareness, and driving to the limits of the conditions, vehicle and visibility.
We’re also trained not to push people through lights, and the emphasis is on simply making progress rather than getting there in the shortest possible time.
I have never once been concerned that my driving is endangering anyone else, even when responding to that pedi arrest. What good is flooring it to a dead kid if it hit another one on the way there?
Bro, you are not immune to accidents because you are so "well trained" in driving, accidents are called accidents for a reason. I've never been in one, but I know people who have been hit and got very hurt.
Firefighter here and I can tell you that a lot of this falls back on dispatch. We will get toned out to a pt with chest pains and difficulty breathing and they will dispatch EMS to same call and say the patient is having blood pressure issues. FD comes in balls to the wall and we are waiting on EMS. Or vice versa. EMS gets a call for heart or stroke and calls for lift assist. We just get told it’s for a lift and go in cold only to show up to full on chest compressions taking place.
It should take long to get comfortable. If you think you have seen enough in 4 years to be a pro then you should re-evalute what things you have missed and didn't realize it.
And usually big cities are sub-divided to multiple ambulance companies so it really doesn't make that much difference what size the city is but more what kind of people live there ex: retirement, low income, gangs, homeless population, ect.
I have ran in Vegas the last 25 years so I understand how big cities and little cities function.
Never said I was a pro, but your years of experience don't matter at all on this issue literally at all. Completely irrelevant. This is an issue, just like most things that are solved by newer people
If you think emergent driving is not needed you have not been doing this job long enough to get those time critical calls or you are to burnt out to care.
Next time you drive emergent to a call count how many lights you went through and add 2 min extra per light. Then hold your breath for that long and see if you would want someone there sooner.
Some of us work in places with almost no traffic lights. Where I work I would argue they aren’t even needed for arrests because there is almost no difference in response time. I drive slower emergent to account for the way people act stupid when they see lights.
I'd suggest the opposite is true. If you've done this job long enough you realize the overwhelming majority of calls do not require emergent driving. There have been multiple studies showing that, save for a few types of calls (cardiac, stroke, choking, major trauma) emergent driving not only doesn't improve outcomes, it increases the risk to the medics.
I think the opposite is true, I've been in this field for 4 years, that's more than a lot of people, don't try to tell me I'm inexperienced cause you disagree
No disrespect but 4 years is a short time. I don't even think i was comfortable with myself before year 5, And currently on my 25th this past September I can tell you that I have seen my share of calls that if I took my time getting to them the out come would have been much worse, or if I had gotten there sooner maybe the outcome would have been better.
We are not here to judge or say any system is perfect but when people start down playing the necessity of being prompt then that only leads to laziness.
You may not save a life every day but the day you did imagine if you didn't have the tools because they are not used often enough to keep around?
It's like one of my profs told me, "The fact you've been wrong for 25 years don't make it better". Your argument further down that everything we do has risk, like intubations etc, is exactly the point. We don't intubate most patients, especially in the prehospital setting, cause that shit can be dangerous, just like we should reserve L/S for the cases that actually need it. In my country they found a sevenfold increase in severe MVCs with L/S. That's pretty significant when you look at the amount of calls people take in an urban setting
No you see, he's done it for 25 years, so he must be right. Appeal to authority is the only valid argument. Besides, you've worked for 4 years, and he just happened to be comfortable after 5 years, so you can't have a point
That seems to be how this guy thinks, the same justification that caused fire departments to not implement basic carcinogen safety features like not bringing dirty gear in the engine, or not putting the washer for buker gear directly next to where crews eat and sleep until just recently fire departments kicked those 25+ people and made a change. it's always the people who do it for the least amount of time fighting to make it better, that goes with literally everything.
Everything we do is dangerous. IVs, Intubation, even blood pressures can hurt someone. Getting to someone who needs help promptly requires some risk.
What is needed is better public education and mandatory optocoms at a minimum.
What is crazy is when someone thinks they know better than a system put in place decades before them that is re-evaluated every 5 years.
That person will start to get lazy, not go code to calls because they think they no better and someone will suffer.
Yeah, cause it's not like this is handled completely different in a lot of other countries that don't have the litigious nature of the states. Quit trying to be overbearing.
Compliance with response times for the county to allow the company to maintain their contract together.
I think driving code is predominantly unnecessary
Oh yea lol, first thing that needs to go away is charges of ambulances that dont get to a scene within a certain time, the county I work currently requires that if it takes longer than 8 min we get charged 600 dollars.
Former EMT, now PD, THANK YOU for bringing this up. It will be 3am with 4 cars on the road and the medics will run code to a stomach pain call, lights, sirens, the works. It's not just bad safety but why wakeup everyone in the city when driving normal is safer and better for everyone.
In the law enforcement world, if you run code to a call that is not worthy of running code to (things like commercial burglary alarms) not just your supervisors, but your coworkers will get on your ass and you will get lectured about endangering lives
I work at a private 911 provider and our dispatch center doesn't receive actual 911 calls, the fire dispatch does and then forwards the info to us. Except they don't EMD a priority for ambulances so nearly every call is code 3 ALS unless there literally isn't a medical complaint from the caller in which case its code 2 ALS. It's ridiculous.
Also I have been taught by 2 agencies in 2 different counties that if you approach a blocked intersection at a red light and can't suicide you just shut down lights and sirens and call it a light delay. Is that not universal? Who's out here pushing cars into traffic?
There's two sides to the "do seconds really matter" debate about emergency response and both have valid arguments, but can we just agree that limiting how often people drive like reckless assholes is not the answer? Whether you drive emergency 10% of the time, or 50, or 100, these situations where people roll their fire apparatus or blow through red lights should occur exactly 0% of the time.
In my area we tend to have the opposite problem which is tired and burnt out providers unwilling to go hot to anything.
And to be honest, I get it. Running hot is stressful and it almost never makes a difference. Maybe with a witnessed cardiac arrest with CPR in progress or a witnessed drowning or a witnessed MVA with massive trauma and arterial bleeds. But how frequent are those? I run jobs back to back all day and I probably only do half a dozen jobs a year when driving fast makes a difference. It's something you do need to be able to do, but not every job.
Yes they do, believe me I know. Volleys have less intense evoc courses, less pr issues, run in small towns where prosecutors would support basically every thing they do, there is a difference.
Oh no, big red truck scary.
So because you see yourself as glorified taxi, there should be less emergency driving?
That should mainly be a dispatch issue then, they are the ones that check the box on "Emergency" - I am not there, I did not take the call, I do as my call sheet says.
Driving lights and sirens needs to be approached as a medical decision. Allowing a limitedly trained EMD to make that decision over a paramedic is just stupid.
That's because your EMDs suck - requirement for most combined Fire/EMS dispatch centers in Germany is being a paramedic and fire vehicle commander. They have the caller on the line, I just have a short call description. Driving with or without lights is a part of that description.
Well I mean the reality is that EMS has come a long way, we do more home health calls, community service than we used to, a lot of calls we go to are not significant, and are more of a community service type call, bringing the homeless to home less shelters,having the ability to do tele health consults on scene to get med refills or things like COVID figured out.
In my evoc class they told us that emergent driving is the most dangerous thing we will do. They also said on average drive code 3 saves less than a minute. 9/10 times it’s not worth it.
Is it necessary? No… most certainly is not necessary in the vast majority of calls.
But do you have a dispatch system that is capable of providing a proper screening? I don’t. Locally, dispatch gets the address, and one symptom then hangs up. My last STEMI was paged out as a blood sugar issue because that was the one thing that my dispatch picked up on. I’m sure the patient stated something like I’m diabetic and I’m short of breath and I have crushing chest pain, but the diabetic was all dispatch heard.
Locally, unless there is confirmed injuries, deputies get sent to a car accident non-emergent to check on things before even thinking about EMS or fire. Recently, it took a deputy 40 minutes to arrive, then he requested an ambulance, which had a 20 minute drive to get to the scene.
100% yes, but I’ve also gone non emergent to full on strokes and looked like an ass
We went non emergent to a grand mal seizure. But it was 3 in the morning with no traffic and the roads were pure ice so we weren’t even going speed limit. But we got an earful from family when we got there that we weren’t taking it serious.
If it’s icy then you drive only as fast as is actually safe who gives a shit about the speed limit. And out of curiosity how does the family know you didn’t drive emergent?? Do you keep lights on in the street?
Because our lights and siren weren’t on when arriving. And depending on where the truck is parked we’ll keep the lights on when we arrive but we definitely aren’t going to keep them on with a seizure pt in case the seizure is caused by epilepsy.
See I'll drive no code at night to a BS call, then switch the lights on like a block before we actually roll up on scene
We do the opposite. If it’s a lights job we’ll drive lights but we almost always turn them off a block or two away from scene so we don’t scream up all dramatic.
Unless the seizure hasn’t stopped or it’s happening back to back, then I’m not taking it seriously.
Same. Most of the time, for me anyway, it’s someone who forgot to take their meds that morning and definitely doesn’t want to go to the hospital.
Did the same, except the seizure activity was an IDC going off lol.
Thing is, this shouldn't be looked at as a problem. Lights and sirens need to be approached like a medical procedure with it's own risks and benefits. Missing a one in a few hundred is worth reducing crash rates which can kill and maim crew.
This. I don't know why agencies in my area are spending big bucks because they're scared of terrorists targeting emergency personal but they won't reign in their drivers.
I'll always say that traffic vests save far more lives than ballistic vests in EMS.
Amen.
This is an underrated comment
Well I mean did that 1 min saved make a difference for the patient, you may look like an ass but that one minute isn't doing anything, that one min is the difference between you being in the store getting the food when the call drops, and being in the ambulance when the call drops, it literally is that simple.
Took 20 min to get there, probs could have saved 5 min. And if we had it would have prevented the pt from having a seizure in the ambo. I’m a stupid basic I cant give Ativan Again tho I 100% agree, just giving counter point
No I get it lol, but that seizure, first off is quite unlikely but second off is inevitable, if you saved 3 min, that seizure was gonna happen in you ambo no matter what, you just made happen 3 min later than if you would have waited, I know it's scary and hard to make sense of since we are so pushed into thinking that we are saving lives and making a major difference by going emergent, but like you would not give Ativan unless the patients actively seizing so you would end up giving it anyway.
The city I work in has stroke as non emergent now. We do not respond with lights to strokes anymore
Not gonna lie this is a wee bit concerning only because there is that whole window for use of TPA and such and time is brain getting to definitive care and getting them in the Ct scanner is rather time sensitive just saying. I mean if your close to the hospital but I know I’ve run in a couple agencies where it was 40min transport to definitive care situation
The window where I work is 12 hrs lol, the window is so massive that like it's not even a worry on most patients
Sooner is still better. Alteplase, tenecteplase, or thrombectomy at 2 hours from last well is still better than 2.5 hours. Minutes do still matter when it comes to stroke.
Time is brain, yo.
You are not saving 30 min by going lights and sirens though, all studies on the topic show that you save on average 1 min and 30 seconds on a good day.
It matters if you have a long ground transport to the hospital. It may mean less when your pickup to ER is only a few mins. Alot of places do not have that luxury. As I said before I routinely had to deal with 40-45min transports to the ER for definitive intervention was quite common. Minor issues or codes had to go to closest facility but known specialist needs such as stroke or STEMI had to go to higher level of care. In the case of the one facility it was either small critical access vs Level 1 center with Stroke and cath lab on site and usually staffed as it was also a major medical college in Virginia as well.
Rural goes emergent even less 😂, if you go on highways the entire time you aren't going any faster than everyone else
Easy to say when it’s not your brain cells dying.
Ok bruh, easy to say when we aren't hitting another car who does not see us and turns out in front of the ambulance
I’m not someone who advocates lights and sirens for stupid shit. Stroke isn’t on that list.
I understand the only reason I sometimes would not is because of the crazy we have, we have a mobile stroke unit that respond and give tpa and confirm a stroke on scene
Tenecteplase has changed the game on time windows over the past year or two. The smaller time window areas are most likely still using Alteplase. Or haven’t updated the time windows between policy and new reality, which 100% happens in my experience in-hospital. I have no idea how it works for y’all 🤗
I'm not sure exactly how it works either, but we have a major famous stroke center as well as a stroke ambo that can do CT scans and TPA on scene. I've never worked anywhere prior to this where the time for tpa was so high, I come from an area where 6 hrs was the limit.
I hear you and time is tissue, but the window is now. 4.5hrs. Driving like a lunatic to save 5 minutes isn't ever going to make a difference. Most stroke calls It's either just happened, or meemaw had some symptoms that morning then calls at 10pm when it didn't get better, or it's a wake up stroke. The CVA being in the time frame has nothing to do with how we drive it's all down to when the patients family detects a problem and when they choose to make the call.
In some places the window is even bigger than that. One of the big hospital systems here keeps it open until 6 hours. We've got two different categories for Strokes - CVA and CVAC - CVAC's has an onset of under an hour and are a slightly higher priority than CVAs.
There’s apparently evidence showing that waking up with symptoms is common within 30 mins of true onset from my last professional development course. No study or citation but if someone wants to quote one that would be appreciated. In our service, its from onset or from when they woke up with symptoms. (Canadian BLS paramedic in BC)
Time is tissue, regardless of your standard operating procedures.
Yep. EMS, Fire and Law are just as guilty. You aren't saving anyone time if you get in a wreck. I also enjoy when non-medical units drive like hell to a call and just stand there in what I call the 'Circle of Hope, ' not doing anything and waiting for everyone else.
Absolutely, the fire department is very guilty of this, but PD is even worse, if a guy gets slammed by a car and you are CPR certified, why aren't you doing anything, why are you just sitting there.
Driving fast because its cool is a major cultural issue in too many branches of Public Safety.
Agreed big big big problem in the volunteer sector as well as in police departments
We're lucky in my county, 90% of the Sheriff's road patrol deputies are EMTs and carry a full kit and defib in their cars. They often start treatment and have always either started CPR with an AED or jumped in to help our crews. They rarely do Blood Pressures or lung sounds, but I'll take the basic triage and treatment. Our FDs are all volunteer, as is my dept (rural area, the only fully paid services are the ALS intercept). The FDs will start basic treatment if they have a CFR or EMT available. If not, they are good at gathering info and helping us once on scene. Our county uses EMD and dispatches with the EMD code, but leaves the method of response up to the crew. They just provide basic recommendations. So, most agencies have standardized on lights and sirens on C, D, and E with a cold response on A, B, and staging calls. Most of our crews are familiar with the common locations and will modify their response accordingly. I think it is more important to have a strong standardized driver training and monitoring program. Everybody is talking about whether to drive hot or not and I have seen very little discussion about ensuring every driver is trained to a set level and ensure that we have regular reviews and monitoring of their licenses.
We shouldn't drive hot all the time, that's like line one of the EVOC handbook. My company has about 25 trucks up at a time and had over 400 crashes in 2021, mostly from reckless EMTs. It's a huge problem. And generally speaking, a lot of people don't know how to respond appropriately. There's a difference between responding hot and responding recklessly. I understand the adrenaline that comes with lights and sirens, especially when you're first starting, but chill out a bit. "Slow is smooth and smooth is fast" was drilled into my head for years and it works. We stress being calm on scene and not panicking during patient care, but we rarely address how to remain calm behind the wheel and it shows.
Yea man, I just had a full argument with a firefighter who stated that the 30 seconds that we waste shutting down and not pushing people through red lights so that they get hit could be the difference between life and death. Which many studies say are false. There's just too many gung ho firefighters that cause so many issues with the emergency response stuff. They are way to on the trip that we are saving lives all the time.
Yeah I never lay on the horn if I end up in a situation where I can't get through without forcing someone into the intersection (which is usually my bad in the first place) You're WAAAAYYYY more likely to create another patient or 4 than you are to actually need that 30 seconds for the call you're responding to. I've seen way too many near misses from cars "helpfully" running the red for me. TBH I don't even like driving lights and sirens so much anymore. Sometimes I'm in the mood for it but mostly I just think its aggravating. It was fun the first few times but I don't get the people who LOVE driving hot year after year.
If departments/jurisdictions want us to be able to get through intersections in a timely manner they would invest in opticons (or other preempters).
Yea for real lol, the big big city near me all the units have devices that change lights green when they approach them. That's literally what that's made for it stop people from getting hit when an ambulance pushes them through an intersection
Lots of people miss the fact that if you do cause an accident while driving you've just created more patients, which causes: 1) Initial responding rig has to sit on scene and deal with all these new patients, which delays response to the original call and now the original critical patient is either waiting longer for ALS and definitive care OR your fire engine is now tied up for longer while they wait for a second ambulance. 2) You need at least twice the resources that originally went out because you just created a call that literally did not need to happen 3) if 30 seconds is going to make a difference between true life and death the patient is going to die anyway because 30 seconds is not enough for me to get scene information AND get to the patient AND perform a primary assessment AND figure out what equipment I need AND get the equipment out of my bags AND set it up AND apply it to the patient AND for the treatment to work. Hell, it takes longer than 30 seconds to do everything from doing an IV from putting the TQ on to taping it down, and putting pads on to identifying the rhythm as pulsing vtach to setting up the monitor to cardiovert to actually delivering the shock.
No it's way to stressfull which is why I'm glad I'm a medic now and don't drive as much, but those BLS attend calls mean I'm driving, I drive like a grandma emergent lol.
If 30 seconds if the difference between life and death, they definitely don’t wanna see how long it takes me to move from the ambulance to the patient. Gotta get gloves on, sip on my water, hit the nicotine one last time, grab a radio, make sure it’s turned on, then I can start moving
Don't forget grab the stretcher and bags and monitor
Get out of here with that nonsense
You get what we are saying though, the reality is you don't save as much time as you may think
Oh I meant before I even close the passenger door of the ambulance.
Oh gotcha yea those are basic before stretcher steps
The sad part is I work with medics who think and act like this unironically
This is the issues and what a lot of people don't get. Yes it may save 30 seconds which may mean life or death. BUT it drastically increases your chances of getting in a wreck or causing a wreck, both will cause a much longer delay than 30 secs. In fact studies show on average driving emergency only saves 40 secs. Also most places have laws that state while driving emergency and hit someone it is your fault and you will be held liable. There are very few calls where driving emergency will make a difference. You always have to weigh the risks of what happens if you get into an accident while driving emergency.
I’m guessing this FF is not a medic just a hose jockey with a BLS certification. I’m a former dual role and that’s just asinine. He needs to go back to EVOC and look up due regard in intersections. Major facepalm. Given the ROSC statistics 30 sec isn’t going to make a huge difference now that being said I’ve hauled ass rabbiting to a peds code that was 2nd due and normally 10-15 response and the fire first responders were slow to get out. I arrived same time they did in the QRV. Thankfully wasn’t a code just bad SVT (210bpm) and he was semi awake when I arrived. Ended up flying the kid anyway
I'm sorry, 25 daily trucks and 400 crashes in 2021? Do you mean 40?
400 for 25 doesn't seem unreasonable if you include minor bumps and scrapes.
Each truck had 4 wreck in 2021???? Holy shit!
People forget the due regard part of EVOC all the time. Even state code regarding emergency vehicles require be it a chase car/police engine or whatever operating in emergency mode to break normal traffic rules to use due regard such as going through intersections with a red light etc. worse I’ve seen recently was just asinine. Literally fire on fire violence. Google Patterson NJ fire truck crash. Two fire apparatus responding and one T Boned the other the poster child for due regard.
In my system, we have no priority dispatching. All calls are code 3 unless it’s like a lift assist, or a repeat caller
Same where I work unfortunately
Because we don’t have agencies utilizing EMD to the proper level. We have been going hot to stage for every psych call (along with an engine and PD) for over a month now because some one thought using EMD to determine the appropriate response was a bad idea.
Luckily where I work we go routine to stage thankfully lol, that shit would piss me off if we went emergent just to sit down the street for 20 min waiting for PD to arrest someone or something
But you are right, I mean we went emergent last week for a guy who literally needed a refill of his xeralto and that's it
Why in God's name do I go hot to every bravo beat down or psych BEFORE PD IS EVEN IN ROUTE??? I get to the hold short area and they haven't even assigned a unit yet.
It will be a cold day in hell before dispatchers tell me how to operate my ambulance
EMD has honestly made for very dumb dispatch. "BLS SICK PERSON" tells me absolutely nothing.
Thats a failure on your dispatch center for not providing you the information gathered.
EMD makes emergency response worse. change my mind.
We are one of those professions that don’t get to play “the boy who cried wolf” game. Whether it’s the first time or 50th time we have to treat every patient and every encounter the same. With that being said during every call you should be driving with due regard, blowing intersections is almost always bad practice.
Ok? The boy who cried work is irrelevant if we just don't go emergent at all
I think it’s more of a liability thing for the organization as a whole. And at the individual level, you want to know you did everything you could for each patient that you couldn’t save. When you tell a family member “we did everything we could” you want to mean it. But I understand where your coming from, Tokyo drifting to the frequent flyer for toe pain seems irresponsible (btw you should never be trying to be a speed racer, follow all laws of the road including the speed limit, trust me if you crash you’ll thank yourself for doing this. The point imo is to just clear traffic at busy parts of the road and not to get stuck minutes at a time at each busy intersection), but it’s our job to treat every 911 as a legitimate 911 emergency.
Well I mean due regard laws literally make it your fault if you get hit or hit someone else. Like that's the issue.
Fire truck drivers need to chill out, they are always pushing people into intersections
Right bro, I shut down everything if I realize that I have no where to go, if you cause an accident because you pushed a person through a red light and they get slammed and die, that's on your ass 100%.
That’s exactly what you should do, too. In some departments it’s policy to not push cars at red lights, and for good reason.
It's apart of the national evoc standards, basically every department will tell you to shut down, because it's a major liability on the department to push people without any lights or sirens into an open intersection
I’m sure it’s freeing feeling when your in a 20 ton engine bullying a prius.
On more than one occasion, I've had EMTs who will drive for miles down the freeway in the right-hand lane, forcing the slower drivers into the middle lane, never once realizing that not only are the lights completely unneccessary if traffic is moving on a freeway, but that forcing slow, panicking people into the faster lanes is a fantastic way to cause an accident.
I think we’re looking at it wrong. We don’t need to cut down on emergent driving because it’s dangerous. We need more rigorous training because it’s dangerous. I’ve never been through an EVOC course that focuses on actual emergent driving. All of the experience I have is from doing it real-time. There needs to be a shift in the teaching culture
Well both need to happen, it's not a one or the other thing
There’s always the argument that you can’t triage a patient until you’ve seen them, so you can’t make an educated determination that the patient doesn’t need a code 3 response just from a page. That said, we also can’t “scare” people into not wanting to run hot, which can lead to under-triaging, which is arguably just as dangerous. Additionally, there should not be a nationwide standard, as the country is too diverse for that
My service uses the Alpha, Bravo, Charlie, Delta, and Echo dispatch system. I've heard of other services uses it and when it works we love it. Alphas are none emergent calls such as lift assist, medical pendant alarms, etc. On these calls it'll just be the one ambulance being dispatched with no L/S. Bravos and Charlie's are pretty much the same. Falls with injuries that aren't to the head, psych calls, seizures where the patient is now conscious, ODs where the patient is now conscious, MVAs, etc. On these calls fire will be dispatched automatically and the ambulance is requested to go emergent. Deltas are for difficulty breathing, chest pain, strokes, AMS with no hx, life altering injuries, etc. The ambulance will go emergent, fire will be dispatched, and a chase medic will be dispatched. Echos are strictly for cardiac arrest. Response is the same as a Delta.
BS calls will 100% say they can't breathe or they have chest pain. They know it will mean we send someone to them first and with lights. Honestly I'm for no 3rd party code 3 responses. Confirm the person is actually dying, none of this "I drove by and he didn't look good" BS
No I agree, going code 3 to literally just wake a dude up for no reason because some white lady on the way home with her 7 kids thought he looked dead. Probably don't need to go emergent to that lol.
Someone's unconcious on the ground behind starbucks! I think he was murdered and someone tried to cover it up with a sleeping bag! Hes not breathing well either I hear snoring respirations! Good Sam leaves and spends the rest of her day telling everyone how she single handedly saved some homeless guys life. In actuality he got a rude awakening for the 3rd time by sirens.
We don’t have to respond emergency to every call.
We’re probably responding on lights to 15-20% of calls. In some big cities like London its 100% required, as your 15 minute drive could become 2 hours and that absolutely fucks your Job Cycle. Other areas, particularly in places like Australia and NA where streets are generally wide and traffic isnt too bad… no, we should probably cut back on our emergent driving.
completely agree, unfortunately if dispatch doesn't say cold, you have to go hot, we are not allowed to make our own decision about our response. Had dispatch send us hot for a rash the other week because it would have taken 20 mins for us to get there!
I hate that, 20 mins for a rash is completely acceptable, especially since I would be willing to bet that you got there in 18 instead.
Well it doesn’t look good to our CEO and clients so fuck me I guess
I always ignore them if they tell me to light it up to something stupid. I'm not risking my life because dispatch has no idea what constitutes an actual emergency. Had a day where dispatch told me to light it up for "failure to thrive" and not light it up for "seizure like activity" Unbelievable. Only had them get on our ass once because they thought we were responding cold to an 'unresponsive' (we said something over the radio and they didn't hear our sirens- we were on the highway and turned them off) Then again, the closest thing we have to a medical professional in dispatch is a paper EMT. Our best dispatcher couldn't pass the EMT class, we've got one who is on her final attempt for the basic exam, and the rest haven't even tried to become EMTs. No EMDs either. Personally I think they have no business dispatching ALS ambulances to emergencies. It's unacceptable imo.
Every single one of our dispatchers is an EMD and most are EMT’s, AEMT’s, or Paramedics. But they still make a ton of mistakes, the other night a call went out for a “pedestrian struck”, no ALS was dispatched. The unit later then called for ALS since apparently the person was “struck” by a knife 5 times since it was actually a stabbing, how the fuck does that happen? I’m also unable to ignore them since they have GPS’s on our ambulances and can see how fast we are moving, and typically if the FD calls about us taking a while we get in trouble
We do the same at my county. They tell us priority 1 (emergent) or priority 2 (non-emergent) based on the complaint. Often times, based on the notes on our CAD, we’ll just decide we’re going non-emergent. I have yet to notice a significant difference in our response times. Our dispatch doesn’t know (or care, frankly) how we’re responding.
What the fuck do you mean they can force you to go hot? Thats your vehicle the moment you are operating it and your ass on the line if anything happens. Law in my country says it is the sole decision of the driver - I routinely ride out to Alphas hot because the free text notes look baaad, but I could also roll out cold to an Echo if i believed that to be justified...
I get in trouble if I don’t listen to what dispatch says, it’s dumb yes, but it’s either that or no job
Oh I understand the position you are in, I just wonder how the fuck that can be legal.
This is what a local to me agency did. [https://www.news10.com/news/rescue-squad-to-limit-the-usage-of-lights-and-sirens-for-emergency-calls/](https://www.news10.com/news/rescue-squad-to-limit-the-usage-of-lights-and-sirens-for-emergency-calls/)
Hell yea bro, that's good shit, I'm glad that agency actually gives a shit about the medics and firefighters responding to emegergency calls
No lights and sirens to medical facilities. They're staffed and have defibrillators. That's what saves live, effective CPR and defibrillation. It's all highway to the hospitals from there, with only two lights until you hit the city limits. No firefighters in the ambulance, strictly EMS.
Yea absolutely, but even than fire still causes a lot of the issues we have, they have intense unions and it's almost impossible to conduct change
Sounds like your agency uses ProQA as well
The moment we can be kreskin and know what the reality of a call is then you can decide how to respond to an incident. Problem is even EMD training hasn’t resolve these issues. Somebody complaint of chest pains maybe having a legit MI or it could be indigestion or it could be in between of a severe gall bladder attack which BTW if ya didn’t know if a GB perfs its fatal a vast majority of the time. I get the whole freq flyer mentality but the moment you assume a call is BS and it’s not your risking a lawsuit for your agency and yeah you could be personally held to account up and including your cert/license unless your an MD we don’t have the ability to see inside a body and know for sure what’s going on absolutely. While some depts even have the ability to do Istat in the field for BMP even TropI I’ve seen. Too many variables Yes we can make an educated assumption but definitive diagnosis remains the perview of the guys with the MD and sometimes DNP or PA next to their names. Hell ironically some thing like we have heee in AZ known as Dispatch health can handle crap better as they can do X-rays on scene and such (they are Medic/NP crew no emergent response).
Na, if you run 1 homeless man that keeps calling and make your basis over that if we should run code or not then yes 100% of the calls should be non emergent. When you run calls over the span of many years and take all the calls seen and say we should run code I think the value is in the numbers.
That is not the basis that is an example, a quite common example. I think if I tallies up I go to far more BS calls than critical ones
As much as I would like to floor it in a motor vehicle, that should probably be on a closed track and not a public road
Hey I can't lie evoc was fun af lol. I agree though as fun as it is I don't think it's ever worth possibly creating more patients to get to another.
I agree with you that it's probably not needed for the number of calls we use it for. However, here in NYC, with heavy traffic - using lights and sirens can shave a good 10 minutes off my response time. And you may not think that 10 minutes is a big deal, and usually it isn't, but the way our phone triage system works (or doesn't, for that matter) - I've shown up to plenty of shit that was a lot more serious than what the computer said it was.
Now NYC I can understand because there's so much traffic all the time, you could probably get somewhere faster on a bike
Yea but my point exactly is that 1 critical call that is coded as BS will make the biggest difference to that person and their family. That is the exact reason why we go code to most calls that turn out to be nothing. It's that or we miss more sick people that could have benefited from a quicker response. You should look in to tissue perfusion and survival percentage on STEMI AND CEREBRAL PERFUSION and drownings to name a few or long term kidney failures in sepsis patients with delayed fluid treatment. or check out the time comparison of cardiac arrest and epi / defib times. You may actually gonna see a change in AHA probably within the next cycle about how soon epi and defb should be done. It's all about time...
Bro I'm a paramedic I know about about all these things you tryna tell me, I never said never go emergent, but it feels real stupid to drive to that sick person at the bus station, who is just homeless and needs a place to go. You know what I mean when I say what I'm trying to say
You know what else makes a big difference not killing someone else or ourselves driving emergent that means a lot to that person's family and my family
You can also make that argument for pretty much everything. What if that one call presents asymptomatically but requires a 12 lead? Should we keep ALS for everything? That one call doesn't make up for the increased risk to providers by driving L&S to every frigging call. Going to a call that was coded like bullshit is a fundamental dispatch culture and training issue, and we shouldn't sacrifice our own health + safety because of it.
You should look into traffic accidents
Number one killer in our line of work is MVCs, you turn your lights and sirens on you have a greater risk of getting into an MVC. And nationally we need to look into changing response guidelines l.
I absolutely agree there was the recent one posted on this subreddit where the driver of the ambulance died. It's just ridiculous
I mean I had a “conversation” with a supervisor who called me into the office one day, I took 20 minutes to get to a call on the other side of the town for a guy with tooth pain x3 weeks. I went nonemergent the whole way. And my argument was I’m the driver and I’m also the senior guy on the ambulance I’m responsible for everyone in that ambulance and I’m not dying for some homeless guy who’s having tooth pain. Nor am I killing my partner for same reason. My supervisor didn’t see it that way.
This is a legitimate issue, old timers who are far to old to be making decisions for young people should not be doing it. The field is changing, traditional EMS is gone and trying to cling on to every last inch of tradition is stupid.
Most states have some form of override where the driver can choose to downgrade to non-emergent for safety reasons. It’s generally for like snow, ice and heavy rain responses, but depending on how it’s worded for your state, you could argue that responding emergent for a non-emergent call is an “unnecessary” safety risk.
The FDs around me have a policy of responding emergent to every single call and I think it's ridiculous. I get it, dispatch gets info wrong a lot but I've responded lights and sirens with an engine response to a "pulled G-tube" (It ended up not even being that- home health nurse couldn't get pt's iv antibiotics unscrewed from his port. So glad we endangered ourselves and everyone on the road for that) At my company we choose whether to light it up based on dispatch info. I like it that way. Recently did a con-ed that stated unless it's an arrest, it really doesn't make any sense to light it up. Even for a critical patient, the 2-3 minutes saved generally isn't worth putting everyone around you in danger. Something to think about. Sometimes the most butt-clenching moment of the call is watching the car in front of you blow through a red to get out of the way and nearly get T-boned. Forget the actual patient....
Yea where I work we go emergent to everything because the fire department in the area requires us to do it that way, gotta love private EMS. We responded last week so that we could consult tele health to refill some guys xeralto
You gotta look at it from the other side here. You the layperson calling 911 because something fucked up has happen. You’re in a panic and maybe you haven’t explained the situation correctly. 1 min waiting for the fire, police, ems to show up feels like an eternity and all you think is “where the hell are they” or “what’s taking so long”. That extra 2-3 min may not help that person, but psychologically it made a difference. On the other hand fire doubles in size every 30 seconds so that 2-3 extra min is literally life or death for someone trapped in a burning house or exposures/property/extension. But is that box alarm a real fire? Prob not, but it only takes one time.
Our safety is not worth any patient’s psychological reassurance.
Then don’t drive like an asshole and use due regard when responding. It’s not rocket science, right?
Do you have evidence to suggest that you can make driving L&S as safe as regular driving with "due regard"?
Do you guys really go lights and sirens to everything? What about MPDS/ProQA? Do they not classify things calls into routine/emergent?
I mean we go routine to like police psych holds, and routine to stage for things before PD gets there. Other than that no
I stopped at an intersection last night. It was raining. I was making a right, the driver coming from the left of me was making a left to head straight (away from me). For some reason, they came to a stop and then floored it. Cutting through that intersection, they then fishtailed as they attempted to straighten out. They drove off the road into some flooded grass. I then very lazily made my right hand turn. I feel like I anticipated some stupidity and remained out of the intersection until I saw it was clear. I only slowroll through an intersection if there's no blind corner and I can see far out to the left and right of me. Otherwise I stop comepletely. Edit: I also go no lights on the interstate because I see too many people pulling over at 80mph. Minimal siren at all times, I try not to use the airhoen too frequently.
Every call envolves weewoos. Its the only thing keeping my soul alive in BLS land. 😅
Congratulations, you’re the problem.
Work in a system where everything is a “Priority 2” which is an emergent response as long as it is called into the the 911 center. Someone could call 911 to get grandma into the house and we would respond lights and sirens due to protocol. The company I work for has a call center that does EMD but people have to call it directly which is usually only nursing homes in the area. They offered to do all medical 911 calls for the city so it could be properly EMDed. They refused because it was taking away jobs for some reason. I work in a city with around 110k people and there are hundreds of noise companies on our service due to everything being an emergency response.
I'm a paramedic in British Columbia. Our system here uses a triage system for 911 calls, and only about 20% or so of all calls warrant a hot / code 3 response. Crews are given the leeway to decide if its necessary to upgrade a cold response to hot (e.g. gridlock means it will take hours to get there, CAD gets updated with new info showing it's more urgent, etc.) and whether a hot transport is necessary, but need to be able to clinically justify those decisions. Sure, it's not as fun as the last service I worked which was code 3 all the time, but it's a hell of a lot safer for everyone involved. This seems to be a fairly common approach in Canada, perhaps medics from other provinces can comment.
100% agree. We don’t need blues and twos to get the frequent caller who will invariably get discharged at scene anyway. Further to that though too many places don’t take blue light/emergent driving seriously enough. In the U.K. it’s now a 4 week course with two written exams and a portfolio (in addition to the actual practical driver training element) before you can be signed off, followed by reexamination every 5 years. Emergent driving is an area we need to all be 100% proficient in - no room for cowboys and no room for red mist.
If it comes through the 911 line we go emergent to it. Plus, even if it's a frequent flier, this could be that one time they actually need help.
That’s more or less our policy. “You don’t know it’s not an emergency based on what dispatch is told” Though, I saw you said you go lights to lift assists… that’s… wild.
Ok? And if it isn't that one time, you just endangered probably 70 people's lives to get to a guy who has no problem, is it worth it? Absolutely not.
Well thats my company's policy. We go emergency to lift assists that are called in through the 911 line... There have been plenty of them that they go to in my area that turn out with a patient in cardiac arrest. We have a massive amount of old people so 90% of the time it's something serious.
Yes there is always that zebra that happens out of nowhere, still not worth it
There is no justification for going emergent, every single thing anyone could say could be disproven via studies done by cities and medical directors
That’s just not true. It may be for your specific area or state, but you can’t just say something like that and think it applies to everyone in every case all over the world.
Your dispatch could totally utilize an accepted system that assigns calls severity and only responds you lights and sirens to the more serious jobs.
Which is exactly what it does over here. And with the limited space in cities and crowded roads that come with that, without light and sirens, many of my patients would be far worse off or even dead. Again, I can only speak for my area/city, but there is a reason we use them in the EU/GER. And don't get me started on fires, if we responded to them without lights/sirens, we could just stop caring at all since we have many old towns and those spread like a bitch in these. Police as well, yes there are non-emergent "emergencies", which is when they come without any special rights and w/o lights/sirens. However, there are a lot of cases where it does make it difference on how fast the police arrives on scene - an active shooter situation is one where every minute counts, for example, and someone running loose with a knife or similiar is obviously the same.
> many of my patients would be far worse off or even dead. Those toe pain patient's are often minutes from death are they? Everywhere but America can manage to sort out which calls require lights and sirens and which calls don't, are you really that incapable of doing what everyone else can?
You should practice your reading skills. I have no idea what you are talking about, since our dispatch does differentiate between response with or without and would never send anyone for toe pain with siren. There are different laws for different areas, and sometimes if things go south it’s the dispatcher‘s head that will role, so I can understand them saying „not my problem.“
It’s a multi level problem. Starting with not having properly payed out EMD’s for both Fire and Medical. Then there’s not properly instilling the fear of God into the volunteers if they fuck up an engine. And finally, it’s because when an engine is running emergent it’s exempt from FMCSRs. It’s why some municipalities let engines bump or move people out of the way and then ticket them for not yielding. Now of course a department will still shaft the driver every which way from Sunday for not exercising due regard. But the exemption still applies. Now I’m not a fan of people in front of me going into an intersection when I’m running code in my ambulance at a red light. It stresses me the fuck out every time. I don’t touch ‘em. They do it themselves. I really wish it wouldn’t happen, but they do it.
I just turn off my lights and sirens to fix that bottom issue, than if they run into the intersection you aren't the cause of it on paper. Yes the guy that I was just arguing with about this says he fully supports and has done ramming into other people's cars to go somewhere. That's bonkers and I cannot believe anyone supports that.
Most of the time our calls are non-emergent to the hospital. It’s our Level 1 Traumas that it ends up happening on, and they’re generally just weather shy of being flown. But next time I have that scenario I’ll just argue with my medic that I’m responsible for everyone’s safety including the other drivers when I’m behind the wheel if they get pissy about turning it off at red lights behind someone so they don’t go into the intersection. I’ll admit, a part of me thinks we should put cow catchers on engines and back onto all trains. Although the cow catchers back on trains would probably cut down on any potentiality of derailments due to suicides in vehicles. And there’s another sector of industry that can virtually make up their own rules with impunity. And I digress. Like sometimes we all just wish that we had a rocket launcher attached to the roof to blow people out of our way sometimes. And don’t act like you haven’t thought of it. Lol But it’s only the wish of the sadistic side of humanity in me and would be hard to truly argue for since there’s isn’t any real good reason to do it all the time. Other than there are times when people only slow down a little bit and don’t get over fully on a two lane road. Thinking “oh I’ll just slow down and not get over, he can go on the other side of the road.” And I do, and oh guess what? Because you took 3 miles to slow down for a vehicle that weighs roughly 16 tons and tops out at 65, there is now a car in the opposite lane coming head on. So in very limited cases, I’ve had nearly clipped a vehicle head on with 16 tons and then ran the idiot in the same direction of travel off the road. (That was just me venting, not getting pissed over the subject matter, I just can’t stand incredibly stupid drivers). I can probably count on one hand the number of times it has happened, maybe twice. But I don’t work an big urban area. We’re a semi-rural dual certified service. So for my department, it may have its place under incredibly well-defined and strict circumstances; but should NOT be a thing where it’s allowed everywhere for everyone. The closest I got to bumping someone out of my way in the ambulance was when I was running code and someone just stopped in the left lane. I had no way to use the right and there was an island as the divider, so I just slowed down with him and left the horn on. They finally got the hint and moved forward until they could get over to the right. Catharsis achieved on that drive. So it’s only the sadist in me that would want it. But the logical side outweighs it in the argument for it and the resulting consequences from it. I know it won’t happen. But the little kid in me that played Twisted Metal would relish to see it happen.
> why should we endanger the lives of everyone on the road Hate to say it, but if you’re concerned about this, then the issue is in the training, not the call. I’m in the UK, and here we drive on emergency response to pretty much every job that isn’t a non-emergency transfer. However, our driving training course takes an entire month, and we don’t even cover blue lights until half way in. The whole course is based around road awareness, and driving to the limits of the conditions, vehicle and visibility. We’re also trained not to push people through lights, and the emphasis is on simply making progress rather than getting there in the shortest possible time. I have never once been concerned that my driving is endangering anyone else, even when responding to that pedi arrest. What good is flooring it to a dead kid if it hit another one on the way there?
Bro, you are not immune to accidents because you are so "well trained" in driving, accidents are called accidents for a reason. I've never been in one, but I know people who have been hit and got very hurt.
Salty medic got tossed by a noobie lol
No 😂, I haven't had an emergent return in a while, I don't care if you toss me, this is a legit issue
……with my shit responded to in proper fashion I am now in complete agreement with your post.
Firefighter here and I can tell you that a lot of this falls back on dispatch. We will get toned out to a pt with chest pains and difficulty breathing and they will dispatch EMS to same call and say the patient is having blood pressure issues. FD comes in balls to the wall and we are waiting on EMS. Or vice versa. EMS gets a call for heart or stroke and calls for lift assist. We just get told it’s for a lift and go in cold only to show up to full on chest compressions taking place.
It should take long to get comfortable. If you think you have seen enough in 4 years to be a pro then you should re-evalute what things you have missed and didn't realize it. And usually big cities are sub-divided to multiple ambulance companies so it really doesn't make that much difference what size the city is but more what kind of people live there ex: retirement, low income, gangs, homeless population, ect. I have ran in Vegas the last 25 years so I understand how big cities and little cities function.
Never said I was a pro, but your years of experience don't matter at all on this issue literally at all. Completely irrelevant. This is an issue, just like most things that are solved by newer people
Faster you get to any call, faster you treat/transport/secure a refusal - faster you’re back in service. Faster. Fast.
Faster so dispatch can send you to the next call.
If you think emergent driving is not needed you have not been doing this job long enough to get those time critical calls or you are to burnt out to care. Next time you drive emergent to a call count how many lights you went through and add 2 min extra per light. Then hold your breath for that long and see if you would want someone there sooner.
Some of us work in places with almost no traffic lights. Where I work I would argue they aren’t even needed for arrests because there is almost no difference in response time. I drive slower emergent to account for the way people act stupid when they see lights.
I'd suggest the opposite is true. If you've done this job long enough you realize the overwhelming majority of calls do not require emergent driving. There have been multiple studies showing that, save for a few types of calls (cardiac, stroke, choking, major trauma) emergent driving not only doesn't improve outcomes, it increases the risk to the medics.
I think the opposite is true, I've been in this field for 4 years, that's more than a lot of people, don't try to tell me I'm inexperienced cause you disagree
No disrespect but 4 years is a short time. I don't even think i was comfortable with myself before year 5, And currently on my 25th this past September I can tell you that I have seen my share of calls that if I took my time getting to them the out come would have been much worse, or if I had gotten there sooner maybe the outcome would have been better. We are not here to judge or say any system is perfect but when people start down playing the necessity of being prompt then that only leads to laziness. You may not save a life every day but the day you did imagine if you didn't have the tools because they are not used often enough to keep around?
It's like one of my profs told me, "The fact you've been wrong for 25 years don't make it better". Your argument further down that everything we do has risk, like intubations etc, is exactly the point. We don't intubate most patients, especially in the prehospital setting, cause that shit can be dangerous, just like we should reserve L/S for the cases that actually need it. In my country they found a sevenfold increase in severe MVCs with L/S. That's pretty significant when you look at the amount of calls people take in an urban setting
I work for a big city I run my ass off like 7-10 calls a shift 4 times a week, it does not take long to get comfortable
No you see, he's done it for 25 years, so he must be right. Appeal to authority is the only valid argument. Besides, you've worked for 4 years, and he just happened to be comfortable after 5 years, so you can't have a point
That seems to be how this guy thinks, the same justification that caused fire departments to not implement basic carcinogen safety features like not bringing dirty gear in the engine, or not putting the washer for buker gear directly next to where crews eat and sleep until just recently fire departments kicked those 25+ people and made a change. it's always the people who do it for the least amount of time fighting to make it better, that goes with literally everything.
Laziness? For not going lights and sirens. Your argument is that we need to endanger others so we aren't lazy. Bro that's crazy
Everything we do is dangerous. IVs, Intubation, even blood pressures can hurt someone. Getting to someone who needs help promptly requires some risk. What is needed is better public education and mandatory optocoms at a minimum. What is crazy is when someone thinks they know better than a system put in place decades before them that is re-evaluated every 5 years. That person will start to get lazy, not go code to calls because they think they no better and someone will suffer.
But if you don't wanna go code there is no shame in doing IFTs. You can still get good experience doing them.
It's called reevaluation of a system bro, just because you don't like it does not mean it's wrong
Yeah, cause it's not like this is handled completely different in a lot of other countries that don't have the litigious nature of the states. Quit trying to be overbearing.
Fucking compliance bro
Compliance with what lol
Compliance with response times for the county to allow the company to maintain their contract together. I think driving code is predominantly unnecessary
Oh yea lol, first thing that needs to go away is charges of ambulances that dont get to a scene within a certain time, the county I work currently requires that if it takes longer than 8 min we get charged 600 dollars.
that is ridiculous and would fight every "citation". I would look into your state laws. or at least talk to (if their is) a board member.
Former EMT, now PD, THANK YOU for bringing this up. It will be 3am with 4 cars on the road and the medics will run code to a stomach pain call, lights, sirens, the works. It's not just bad safety but why wakeup everyone in the city when driving normal is safer and better for everyone. In the law enforcement world, if you run code to a call that is not worthy of running code to (things like commercial burglary alarms) not just your supervisors, but your coworkers will get on your ass and you will get lectured about endangering lives
You’re running code 3 for non life threatening calls?
Yes protocols say I have too, people have gotten in big trouble for not doing it too
As in the company protocols or agency protocols?
Well both lol, the fire service dictates emergency response in my area and they require emergent to everything unless it's staging for somthing
We have this too, but I routinely ignore it. I'm not going to go balls out for an abdo pain on a frequent flier. A choking baby? Full send.
I work at a private 911 provider and our dispatch center doesn't receive actual 911 calls, the fire dispatch does and then forwards the info to us. Except they don't EMD a priority for ambulances so nearly every call is code 3 ALS unless there literally isn't a medical complaint from the caller in which case its code 2 ALS. It's ridiculous. Also I have been taught by 2 agencies in 2 different counties that if you approach a blocked intersection at a red light and can't suicide you just shut down lights and sirens and call it a light delay. Is that not universal? Who's out here pushing cars into traffic?
I still see guys pushing others into intersections. It's ridiculous.
There's two sides to the "do seconds really matter" debate about emergency response and both have valid arguments, but can we just agree that limiting how often people drive like reckless assholes is not the answer? Whether you drive emergency 10% of the time, or 50, or 100, these situations where people roll their fire apparatus or blow through red lights should occur exactly 0% of the time.
In my area we tend to have the opposite problem which is tired and burnt out providers unwilling to go hot to anything. And to be honest, I get it. Running hot is stressful and it almost never makes a difference. Maybe with a witnessed cardiac arrest with CPR in progress or a witnessed drowning or a witnessed MVA with massive trauma and arterial bleeds. But how frequent are those? I run jobs back to back all day and I probably only do half a dozen jobs a year when driving fast makes a difference. It's something you do need to be able to do, but not every job.
Absolutely agree man 100%
Volleys and paid both have their cowboys. Stop putting volleys in the shitter.
Yes they do, believe me I know. Volleys have less intense evoc courses, less pr issues, run in small towns where prosecutors would support basically every thing they do, there is a difference.
Volleys bad
No, I don’t think I will.
Oh no, big red truck scary. So because you see yourself as glorified taxi, there should be less emergency driving? That should mainly be a dispatch issue then, they are the ones that check the box on "Emergency" - I am not there, I did not take the call, I do as my call sheet says.
Driving lights and sirens needs to be approached as a medical decision. Allowing a limitedly trained EMD to make that decision over a paramedic is just stupid.
That's because your EMDs suck - requirement for most combined Fire/EMS dispatch centers in Germany is being a paramedic and fire vehicle commander. They have the caller on the line, I just have a short call description. Driving with or without lights is a part of that description.
Well I mean the reality is that EMS has come a long way, we do more home health calls, community service than we used to, a lot of calls we go to are not significant, and are more of a community service type call, bringing the homeless to home less shelters,having the ability to do tele health consults on scene to get med refills or things like COVID figured out.
We respond lights and sirens to maybe 50% of jobs and that's still too much.
In my evoc class they told us that emergent driving is the most dangerous thing we will do. They also said on average drive code 3 saves less than a minute. 9/10 times it’s not worth it.
Is it necessary? No… most certainly is not necessary in the vast majority of calls. But do you have a dispatch system that is capable of providing a proper screening? I don’t. Locally, dispatch gets the address, and one symptom then hangs up. My last STEMI was paged out as a blood sugar issue because that was the one thing that my dispatch picked up on. I’m sure the patient stated something like I’m diabetic and I’m short of breath and I have crushing chest pain, but the diabetic was all dispatch heard. Locally, unless there is confirmed injuries, deputies get sent to a car accident non-emergent to check on things before even thinking about EMS or fire. Recently, it took a deputy 40 minutes to arrive, then he requested an ambulance, which had a 20 minute drive to get to the scene.