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Let's have fun with this but keep it as realistic as possible. Feel free to ask for any medication, treatement, or assessment tool you want, with the caveat that 1) you need to actually know how to use/do/administer it without checking Google, and 2) it's routinely carried on a 911 ambulance (though there'll be exceptions for that). You are working on a primary 911 ambulance with a partner of the same skill level as you. Other than a helicopter there is no intercept with a higher level of care available. You are authorized by your medical control to perform any intervention/give any med that you feel is appropriate (as long as you follow the 2 rules above). You are currently working in an area that goes from urban to very rural, and are currently 60 minutes away from the nearest hospital by ground. A medic/RN helicopter with blood products and a few more advanced interventions/meds is available and will decrease your transport time by 20 minutes but will take 15 minutes to reach you. The first responders are minimally trained to the EMT level and there are as many available as you want. There is a Level 1 Trauma Center/Academic Hospital 75 minutes away, Level 3 Trauma Center/Stroke Center 70 minutes away, and a Level 3 Trauma Center/Community Hospital 60 minutes away. All have cath labs with interventional cardiologists, fully staffed ICU's, and are capable of at least general emergency surgery. You are dispatched for an unconscious female with the local fire department and arrive on scene as the same time as an engine company with 3 FF/EMT's. The house is generally rundown and unkempt with no apparent danger. You are met by an unhurried adult male who tell's you that "my girl isn't feeling good and I can't wake her up." He leads you down a long narrow hall filled with junk to a back bedroom. Upon entering you see a adult (early 50's by appearance) female laying in bed not moving. Go.

This, and unknown med history makes getting there to assess a priority. That doesn't mean balls to the wall flooring it, but have some urgency. If this patient was on blood thinners, very likely in that setting, had facial fractures that could compromise airway, and several other possible circumstances, why wouldn't you have some sense of urgency? L&S doesn't mean flooring it and swerving in and out of traffic. Especially at rush hour, it just helps you not waste time sitting in traffic.

I work for the same service as cprted and yes we would go to this call L&S but it seems that maybe some things have been overlooked, Fell face first out of his wheel chair = rule in/out C-spine. His age alone could rule this in. (Did have a call where a pt fell from standing face first and was unable to get her hands out in time to break the fall, she was dead on arrival) Good size hematoma = Possible brain injury (just had a call 28 female fell from standing, got up and said she was fine. Next day being medevac for a possible subdural hematoma) It always amazes me that when people run L&S they think it means they have drive faster to get to the hospital, when in fact it is designed to make other drivers pull over so you can proceed. Here we are allowed to go 25 km over the posted speed limit while running L&S but that is only if it is safe to do so. It is always better to be safe than sorry, and I think in this particular case you should have gone L&S because of all the factors that this particular pt could deteriorate quickly.

Your patient is already in a state of altered mental status, might not be able to voice concerns or location of other pains. Me? due to that uncertainty, I'd do my best running L&S to the scene, and decide if the trip to the hospital is also going to be L&S, dependant on V/S and S&S observed when with the patient. Remember, all bleeding stops...eventually.

"Do you?" and "Should you have to?" are two distinct questions in this. If your service's policy is that you do, then it probably would be wise to follow that (while also trying to prompt change). In terms of whether this should be the policy, I think it is clear that driving lights and sirens is something that adds significant risk (often with little benefit) and should not be taken lightly. It seems unlikely this patient would benefit from the time saved.