ALS using Lights and Sirens back to the hospital

[zmedic]

One big reason for the discrepancies between places is policies. I worked for a private company that said statistically only about 5% of our patients should be brought in L/S. Every emergent run was QA/QI, and while that was mainly to check medical care, if you were running hot when the patient didn't have any idications you would hear about it. So most patients didn't get run LS, and those that did were the really sick ones who needed it. I thought it worked well.

[AnthonyM83]

Traumaking, I don't think anyone in this topic is questioning fire engines going LS to fires....

[DwayneEMTP]

In Pueblo, it seems almost everything is responded to Code 3, but I've never been on a call that was transported that way.

Here (so I was told by the Medical Director) Every Code 3 return must be reviewed and justified by the medic, in person, with the medical director and the "Code 3 committee."

I don't know what happens at the committee...But I've heard it can be rough if you can't justify your rationale for a "hot" transport.

I can see good and bad to that...But mostly it seems to be a good thing...

Dwayne

[Just Plain Ruff]

You can say that the ems uses lights and sirens for the most b/s reasons like the drunk parked is butt on the sidewalk that you know is going to be a fun and BUMPY ride to the hospital.But when you say lights and sirens about fire department using llights and siren at three am for a stupid dumpster fire 100 ft from and building ,well I have to say we as a responding unit to that b/s fire call dont realize what it is until the first unit gets on scene so yes even three am light and siren down the road due to the civilian the just reported that stupid fire is prob trying to get to dunkin donuts to buy coffee and not paying attention to the fire truck or ambulance responding to that bullshit call that it was just dispatched too.

Anthony I used that as an example of what makes me chuckle.

Traumaking, I was working with the red cross and I knew the dispatcher who took the call. I called in on their non-emergency number and said I told him there was a dumpster on fire and then we shot the sh*t for a bit. I heard him dispatch the call. As a matter of fact it was the same crew that I just finished working a fire with and helping the fire victims out with red cross assistance.

He dispatched the call as a non-emergency run for a small dumpster fire. They still ran emergency.

It made me chuckle, I wasn't criticising them at all. Don't get your knickers all in a bunch.

Plus, your paragraph was really hard to read.

[Just Plain Ruff]

You can say that the ems uses lights and sirens for the most b/s reasons like the drunk parked is butt on the sidewalk that you know is going to be a fun and BUMPY ride to the hospital.But when you say lights and sirens about fire department using llights and siren at three am for a stupid dumpster fire 100 ft from and building ,well I have to say we as a responding unit to that b/s fire call dont realize what it is until the first unit gets on scene so yes even three am light and siren down the road due to the civilian the just reported that stupid fire is prob trying to get to dunkin donuts to buy coffee and not paying attention to the fire truck or ambulance responding to that bullshit call that it was just dispatched too.

what makes you think that the drunk who has parked his car on the sidewalk is a BS call?

I'm not sure what else to make of your single sentence other than the fact that dumpster fires are more important than the drunk.

[flight-lp]

@Traumaking - We also don't know about the drunk until on scene either, so your comparison holds no correlation. This discussion pertains to EMS use of L/S, not what the fire department does.

@Ventmedic - I absolutely believe you have sound justification to challenge the experience and qualifications of your transfer crew if they are wooin' everywhere they go. An educated critical care team provides a calm, collaborative effort, one that rarely need extra illumination on the road.

My agency rarely utilizes emergency response to the hospital. The few pts. that do include our trauma's that go downtown, our CVA with confirmed onset of less than three hours, AMI's (direct to Cath Lab, current time of 911 cal to revascularization is under 90 minutes), and post resuscitations. Just about everything else can be handled proficiently going non-emergency.

[akflightmedic]

Please be kind to traumaking...he has 20 years as FF/EMT and is looking for a supervisor position.

Anywho, I agree with you Ruff. LnS are heavily abused in EMS Land in general. When I first started, remember I was 18 and working for the county, there were times I used LnS just because I could. Ignorant, undereducated and unprepared I was, but so were a majority of my "mentors".

I worked fo rmany years in a high volume, dense traffic tourist area. Many times, we ran hot to the ER simply to be clear for the next call. Such dedicated fools we were...risking our lives and other peoples lives, instead of abiding by the rules and letting the response times be what they may be. How could this have been good you may ask? Simply put, if our times suffered long enough, then they would be forced to put on more units instead of us sucking it up, overworking ourselves and endangering people on the road as well as the EMS crew and patient.

Now that I am older and wiser, all these thoughts enter my brain constantly. One county service in particular in FL that I loved working for had a wonderful system. First they were dual medic, ahem. Second, they dispatched calls by priority which informed us on how to respond. If they felt no indication for LnS, then we did not use them. That could always change while en route by any of us, as long as we had justification for it.

Once on scene, very rarely ever did we go LnS to the ER. This conversation got me thinking really hard, and I am very taxed trying to think of how often LnS were utilized. It just did not happen that often. On occassion during a peak holiday week, or during a few hours block where traffic was increased for whatever reason, he would give us authority to utilize LnS if needed to expidite. Even on those occassions there just was not a need for it. And yes this was a very busy service with high call volume and a very diverse population, with a high percentage of it being elderly with a ton of medical history.

But something else I recall, is even if we used LnS to get to the ER, very rarely did it involve higher speeds. The LnS were merely a way to move traffic as you were approaching but you still had to slow way down, and taking turns at high speeds does nothing for the person in back.

I think it seriously boils down to education and competence. Being able to step back and critically analyze the big picture and know what needs to be done for this individual care wise. If you have no clue what treatments are required after you drop them off at the ER, and you really do not care, then you do not belong in EMS. You should be able to anticipate their future needs, even though "it is not my job". I think many lack this understanding and they wish to get to the ER before they run out of tricks up their sleeve, so to speak. I think a lack of understanding of the whole disease process, AnP, leads to much worrying and feeling overwhelmed, thereby increasing their need to turn over to someone else quick.

Hope my ramblings made some sense...

[Traumaking07]

When it comes to where we are yes I do agree with what you are saying als and also bls units are using l/s way to many time and even alot of bls calls with out als can be and should be down graded to a normal responce(no Light or siren to the hospital).

[spenac]

When it comes to where we are yes I do agree with what you are saying als and also bls units are using l/s way to many time and even alot of bls calls with out als can be and should be down graded to a normal responce(no Light or siren to the hospital).

Dang you make long sentences. I still have not caught my breath from reading it yet. Have a nice night.

[Just Plain Ruff]

ok let me ask a controversial question. Which I'm sure will bring some wildly heated and probably angry responses.

Should bls ever be dispatched emergency?