ALS using Lights and Sirens back to the hospital

[captainstandup]

Patient or crew comfort becomes an issue when you are sitting on the 5 in California or on I-77 in NC every day for 2 or 3 hours just because a bunch of dumbasses cant drive and have a fender bender. The little old lady with a stable hip fracture on your cot deserves better than this. I'm not saying to abuse Lights and Siren but there are situations where even a non-emergency transport to the hospital isn't so routine anymore. And what a waste of resources to sit in traffic. As far your point of an urgent call waiting that makes no sense. We are expected to maintain a state of readiness since EMS is important at the time of need and much less important 20 minutes after the fact. Perhaps it ok to leave a kid choking a a nearby school while the ambulances sit in traffic and obey the traffic rules. There has to be some common sense in this equation but until agencies are properly funded, staffed and deployed we will often find ourselves in a state of crisis.

I vividly remember an article, i think it was in popular science, that warned of future traffic nightmares. Well sportsfans we have arrived in the future they warned of. Even in less populated portions of NC its not uncommon to sit in traffic on the interstates for 40 minutes or longer. We have even resorted to aeromedical at certain times of the day for less severe patients than we would have flown in the past due to gridlock. But unfortunately there are scarce air resources and they are very expensive for the patients.

[JPINFV]

Errr, if traffic is at a standstill, where exactly do you expect the cars to move to clear a path for you're code three dialysis run?

[captainstandup]

Come on, you know exactly what I am referring to. The emergency lanes and easing around stalled traffic, the median if its dry and safe. Im not talking about reckless foolishness but I am saying that sitting in the back of a piece of crap ambulance with shitty AC for 2 or three hours is cruel and if there is any safe manner of escaping this situation through utilizing the warning lights and siren perhaps its the better choice.

[AnthonyM83]

There's usually either room on the side of the road OR you can go down the center/divider lane (often a turn two-way turn lane), unless there's a center divide.

I know CA law allows FF's to return back to their area LS for coverage purposes.

[tniuqs]

Not to start a fight with Dust, who'd win, but I'd like to talk about the idea of not having BLS rigs. I worked in a county where we were contractually obligated to have a medic on every rig, and that seemed really wasteful. A large percentage of our patients, like 80%, could have been managed on the BLS level. They were stable, didn't need drugs/pain control. It costs the system a whole lot more to have a medic on every truck. A well trained EMT should be able to handle a lot and get ALS backup when they are in over their head. (Clearly ALS should be dispatched immediately to certain calls, like chest pain, SOB, etc.) Thoughts?

To quote some famous dood:

Continue to think the way you have always thought.

And continue to get what you have always got.

So Is 11 bucks an hour enought ? .... ok a bit of literary licence.

cheers

[CBEMT]

I will comment on some of the busy Florida BLS teams and L/S because I am not shy about asking a crew about this that is coming in to pick up a routine transfer like the devil is chasing them. They are told to "expedite". This is perceived by some as permission to run Code 3.

Lol, yeah expedite. Because dispatch gave the facility a 20-minute ETA knowing full well they didn't have a truck within 30 minutes of the place. And if they get in a crash dispatcher says "I never told them to do that."

[AnthonyM83]

Our service uses the terms "expedite" and "it's a far one" and "good time" a lot...helps keep ETAs low, but crashes high by perpetuating the mentality that speed is of essence. And if you REALLY get lost, you don't just get retraining, you get suspension (if it's in the area where people pay their bills).

[triemal04]

Patient or crew comfort becomes an issue when you are sitting on the 5 in California or on I-77 in NC every day for 2 or 3 hours just because a bunch of dumbasses cant drive and have a fender bender. The little old lady with a stable hip fracture on your cot deserves better than this. I'm not saying to abuse Lights and Siren but there are situations where even a non-emergency transport to the hospital isn't so routine anymore. And what a waste of resources to sit in traffic. As far your point of an urgent call waiting that makes no sense. We are expected to maintain a state of readiness since EMS is important at the time of need and much less important 20 minutes after the fact. Perhaps it ok to leave a kid choking a a nearby school while the ambulances sit in traffic and obey the traffic rules. There has to be some common sense in this equation but until agencies are properly funded, staffed and deployed we will often find ourselves in a state of crisis.

If that's what you do then that's what you do. If your service doesn't care then go for it. Personally I'd rather treat the pt's pn, pad around them to minimize movement and give them a gentle ride to the hospital, bypassing the areas that I know will be at a standstill. But that's just me, and if that's not possible where you are then keep doing what you're doing I suppose.

I think you're misinterpreting the comment about getting units back in service. Unless you work for the perfect EMS agency, at some point your resources will run low, or all will be in use. (this should not be happening on a regular basis, if it is, then something needs to change fast) When that happens and an ALS call is pending, transporting a non-emergent pt code 3 to the hospital so that you become available for the next call is very appropriate.

[Just Plain Ruff]

I still don't buy the fact that it's justifiable to get a unit back in service so you run lights and sirens to the hospital.

no jury or court in the land is going to side with the ambulance service that goes with that thought process.

You run hot due to needing to get back in service, you go thru a red, you broadside a family on holiday. Two family members are killed and your original patient is now a critical patient, as well as you and your partner are patients. The ONLY defense you and your service can muster up is "we needed to get the patient to the hospital to get back in service."

The plaintiff's attorney says "You ran the red light and killed my clients children just to get back in service"

Jury comes back and gives a clear message to you and your service that just to get a unit back in service is not a reason to run hot so the family gets a cool 10 million or whatever award they ask for. All because your service didn't have enough units to begin with.

So back to the wreck. Now you have one entire crew who is out of service, you have a patient who now might be critical depending on what kind of damage is done to the ambulance and you have injured people in the car. Now your service has to scrounge around for mutual aid to get the help to you that you have caused. Instead of needing one unit back in service you are going to need at least 2 if not 3 or 4 additional ambulances at the scene you caused becuase your service put the public and you at risk to get a unit available.

Sorry guys, I don't buy it.

[mrmeaner]

In the second weekend of November there is a trauma conference I'd like to go to where a former local EMT will be speaking. He was in the back of an ambulance that rolled while L/S back to the hospital a few years ago. The details are a little fuzzy, but I believe transporting a pt. with a broken leg, and there ended up being at least 1 fatality from the accident. He ended up paralized from the waist down.

I'd hate to think that each service has to go through their own tragedy before they look at how they use L/S.