Lights and sirens

[croaker260]

So why are the paramedics, who have more than 100 times the medical education hours than I, putting call priority in to my hands?

As a forerly certed EMD and EMD-Q I can answer that.

1- because you are answering the call and they arnt.

2- Because weather you use MDs, RNs, EMTs, or medics, they all spend more time and what if and double guess the protocols because of their additional training. Give me a civilian with no medical experiance, and reinforce protocol compliance....and you will have a better dispatcher than a 20 year medic. Not saying that the 20 yer medic isnt an excellant street provider, but it is two different jobs tackinging a single commonality.

The protocols are not perfect, but they work 95% of the time with out major issue, and 99% of the time with out critical issue.

Dispatchers establish the priorities (Alpha , bravo, etc) and obtain vital information, then provide Dispatch Life Support (Telephonic instructions) if needed.

The System administrators determine how to use those priorities in their system (example: Alpha equals cold responses, bravo equals 1 hot and 1 cold, etc)

The medic/EMT on the street takes these policies and guidelines and and translate them into daily operations and make them work. Exceptions to policies should be just that...exceptions....not every day occurances.

Otherwise you have 10 different medics who would respond to the same call 20 different ways...chaos. You cant run a system thaat way.

[brentoli]

Thats how it works here, and there are no issues. We don't give priorities out when we dispatch.

"Ambulance 1 - Trouble breathing - 500 Main St - 81 year old male trouble breathing taken treatment with no relief cardiac history RD 50-01"

Thats your normal dispatch here.

[ErinCooley]

we go "code 3" to all calls, but hardly ever into the hospital.

[tskstorm]

It is moronic protocols that add to the problem. ~~ it isn't an EMS protocol it is an NYPD protocol

So you drove red lights and siren to an officer and then took the officer with a boo-boo to the ED to be checked?

It is this wasteful nonsense which is driving us bankrupt. ~~not driving us bankrupt when we got paid for the call.

Horse falling on top can be very severe. ~~Point was sometimes its insignificant sometimes it isn't

But minor problems they should be able to take themselves. ~~ Why shouldn't they receive the same standard of care as anyone else, everyone else has the right to call an ambulance for a hangnail, they deserve it too, anything different would be a deviation from standard of care.

Ugh I hate this topic...

I had a discussion similiar to this with a probie once, wanting to know why we didn't respond priority to every call because after all "Dispatch could be wrong..."

I can tell you for a fact that the vast majority of calls in New York State are BLS calls, : http://www.health.state.ny.us/nysdoh/ems/stat.htm

I can't attest for all other states, but I'm betting the statistics are similar. Why put yourself at risk for a basic call?

So...in short...if someone has a hangnail, I'm not responding priority...I refuse to. I refuse to put the lives of myself, my crew, and the other motorists in jeopardy because someone can't afford a bottle of Motrin or use their digits unaffected by a hangnail to call a taxi.

Please take note of the response already which was stated, are those numbers based on how it was dispatched, what the call should have been after a review of the ACR? and regarding who transported. How many were 10-94's where the ALS rides on the BLS unit and the BLS unit gets credit for the call and gets to send the bill.

Secondly If it was left to me how to respond I would choose the most appropriate, however here in NYC for the 9-1-1 system you are dispatched with a priority, and any deviation of that is ignorance, neglect of duty, and just horrible. The point here, is If you get to choose how you respond then that's okay, but here we are stuck following the rules if we want to keep our job.

[rat115]

Here we respond as our EMDs dispatch us. Normally, because we first have to respond to our ambulance location, we respond emergent. We're told either "emergent" or "non-emergent" when we're toned for the call.

On the way to the ER, it's our call. In 3 yrs, I've only used both lights and sirens about 10 times that weren't auto accidents.

We do a LOT of ground transfers out of here. We're ONLY allowed to use lights/sirens when there is an issue. The last time I went emergent was for a pre-term OB who had the Tributaline start wearing off during the 2.5 hr transfer.

[Richard B the EMT]

FDNY EMS, and all ambulances dispatched by the FDNY EMD, when given the assignment, the type call has been previously prioritized by the Medical Director. The call takers can upgrade, if and when they think it appropriate, per our guidelines (they better be ready to justify the upgrade).

Policy currently is, except for the call-types that are above a certain level of priority, L&S will be on for the initial response, and used as felt needed by the crews for getting to the hospital.

We also have pounded into us by the EVOC instructors, to follow New York State Vehicle and Traffic Law #1104, no matter if L&S are on or not, to operate the department vehicles "With due regard to any and all other traffic on the road" (if not actual wording, it is to that effect).

[firedoc5]

This is where experience, well trained dispatchers, crews, good communication skills, and good old fashion common sense from all comes into place. There's no way you are going to ba able to sit down and put into polocies and / or procedures that you must/must not use L&S.

I'm not going to go on a rant and rave on it here. All I'd be doing is repeating and going in circles.

I will mention that when I first started there was an unusual "unwritten" policy in place. Where it came from I had no idea. You have to remember it was a very small volunteer service. And no one had honestly worked with or got first hand knowlege from an actual EMS professional. But there were a few that talked of how much they did know. And one of those facts was that "it was the law that anytime you had a patient on board, emergency or not, you had to have at least flashing lights on." This was actually practiced for awhile. We'd be sitting in traffic at a stop light with flashing lights on waiting for the traffic light to turn green. All it did was cause confusion. People with the green light wouldn't go waiting for the ambulance with "emergency lights" on to go, others trying to get out of the way of the ambulance to give them room to get through traffic. It was a true mess.

Finally the coordinator and a couple of others asked the right people (which they should have done in the first place) and got it straightened out. I was there and I felt embarrased for the "verterans" I was running with. Come to find out that the guy who came up with the 'rule", who tended to sound important was just trying to think of an excuse to use the lights. And of course he started backing up saying he was misquoted.

[robert gift]

... "it was the law that anytime you had a patient on board, emergency or not, you had to have at least flashing lights on." We'd be sitting in traffic at a stop light with flashing lights on waiting for the traffic light to turn green. All it did was cause confusion. People with the green light wouldn't go waiting for the ambulance with "emergency lights" on to go, others trying to get out of the way of the ambulance to give them room to get through traffic. It was a true mess. ...

Wow! How ridiculous.

Amazed no one challenged such a stupid policy and had the guts to refuse to follow it.

Maybe he meant, 'keep headlights on' while patient is on board. That is reasonable and was practiced for many years.

Is the moronic tradition of police leading an ambulance to the hospital in OB cases, still done?

Edited April 11, 2009 by robert gift

[zippyRN]

Don't encourage him. He is *cough, cough* special.

My English friends agree

you referring to mr Gift there scott ? - without replaying the original thread, his lack of understanding and appreciation of the different working practices and legal precedents was stunning, and also seemed to fail to appreciate the safety record of Uk emergency services drivers vs those elsewhere i nthe world.

to the thread in hand...

when doiing Ambulance support work with SJA in the locality i do most of it in - we don't run on lights and noise to calls becasue they are calls which have been priortised and/or health Professional triaged to be suitable for a response time somewhere between send the next suitable resource but cold response and 4 hours from the call ... there's a handful of calls in the 8 years i've been doing this kind of work that were definitely wrongly categorised, and the majority of those were ones where primary care physicians had seen the patient but failed to assess them properly.

even on 999 work the number of patients transported to hospital on lights and noise is a small fraction of responses.

in terms of interfacility transfers unless the patient is an ITU transfer or has a definite clinical need to be transferred as an emergency they are transferred under normal road conditions ...

[robert gift]

you referring to mr Gift there scott ? - without replaying the original thread, his lack of understanding and appreciation of the different working practices and legal precedents was stunning, and also seemed to fail to appreciate the safety record of Uk emergency services drivers vs those elsewhere i nthe world.

to the thread in hand...

when doiing Ambulance support work with SJA in the locality i do most of it in - we don't run on lights and noise to calls becasue they are calls which have been priortised and/or health Professional triaged to be suitable for a response time somewhere between send the next suitable resource but cold response and 4 hours from the call ... there's a handful of calls in the 8 years i've been doing this kind of work that were definitely wrongly categorised, and the majority of those were ones where primary care physicians had seen the patient but failed to assess them properly.

even on 999 work the number of patients transported to hospital on lights and noise is a small fraction of responses.

in terms of interfacility transfers unless the patient is an ITU transfer or has a definite clinical need to be transferred as an emergency they are transferred under normal road conditions ...

Can anyone intrepret?