Lights and sirens

[tskstorm]

1) Correct, no matter how good a dispatch center and it's crew are, there is always going to be room for improvement

2) Transit just has a link to send the assignment to the "Relay" position in the EMD. They rarely if at all talk to anyone in the EMD.

3) Even with me being a former call taker in the FDNY EMD, I thought a minor injury was at least a priority 5, which still has a L&S response.

4) That person, while starting out as a seizure call, was hit by a train! Someone dropped the ball, and badly so, as I'd think a person hit by a train would be a Major Trauma, at Pri ONE! BLS, ALS CFR Engine, EMS supervisor, hell, add a truck company. That was a big time call.

4A) Tskstorm, if available, could you provide a link to any newspaper stories on that job?

1 I agree completely there will be holes and we need to do our best to plug them, if this means up triaging en route by going L&S so be it.

2 This job was a major foul up, there wasn't even transit PD, just the conductor and station attendant, and all they cared about was an ACR number

3 Priority 5 is non-critical injury, priority 7 is a minor injury (Gosh I spend too much time on an ambulance to remember all this haha)

4 Should have been a Major trauma, (If memory serves priority 2) and all resources as we both stated seemed necessary

5 I don't follow up on my jobs that closely, I never looked for it in the paper or online. We were able to finish the job with the engine company and my unit. It was a difficult vertical but we accomplished it. I'll take a look around, but the patients last name is escaping me, I will have to ask my partner to see if he remembers.

[wrmedic82]

My feeling on lights and sirens is this. Or me putting my foot in my mouth.

As far as response

Follow department policy as far as the use of lights and sirens. Its just good CYA.

As far as transport

Use common sense and sound judgment. Err on the side of the patient. Alot of times lights and sirens will add stress to everyone involved. As a rule of thumb on our truck if there is no compromise to ABC's and indication of CVA (provided the patient is a possible candidate for fibrinolytic therapy) we will not run hot to the hospital.

As far as driving

Driving to and from the scene should be done with as much sense of urgency that keeps both yourself, and everyone safe.

Be careful, be safe.

[CBFLATLINE]

Personal attack removed...AK

[nremtp]

It is hard to post objectively without attacking what seems to be a very stupid person who seems to completely misunderstand an EMS system he has very little experience in.

Our MPDS categorises calls in one of three categories, A (life threatening) B (serious) and C (neither serious or life threatening.

Only A and B calls get a lights and sirens response, purely and simply because we cannot rely on information from the caller as being reliable enough to determine the seriousness of the patient's condition. Numerous studies have shown that the information provided by the caller is unreliable which is why MPDS exists. It isn't a perfect system but neither was CBD (the predecessor of MPDS).

We do not "run fake calls" on lights and sirens as you claim. We undertake a prescribed course of training in emergency driving and are supervised by a driving instructor under controlled conditions. Just like intubation, cannulation and other skills; we practice them under supervision before doing them for real on a sick patient. It is now a legal requirement to undertake emergency driver training before being permitted to exceed the speed limit on lights and sirens. In a nutshell, our system is much safer than your sheltered little world where people don't need training.

We also have (as zippyRN says) "Urgent" calls which are not run on lights and sirens. This is where a physician has assessed a patient either in person or over the telephone and decided they need to be admitted to hospital but has decided that it isn't life threatening (sometimes wrongly) so we respond under normal road conditions.

We only use lights and sirens where MPDS has identified a potentially life threatening condition. Once we reach the patient, we rarely use lights and sirens to transport them to hospital unless they are time critical (chest pain for example or multi system trauma). In the case of chest pain or obstetrics we don't tend to use sirens as it causes anxiety in the patient but we still respond under lights.

Your whole argument seems to hinge on the fact that you find sirens annoying, well boo hoo; they are there to protect the crew in the vehicle and warn other drivers that we need to make progress.

If I am responding to a call which MPDS has categorised as life threatening then you can bet your last dollar that I will respond with lights and sirens as we are required to get there within 8 minutes and my Paramedic licence is at risk if I don't. I will however drive safely and in accordance with the law and because of this we have an excellent safety record in the UK.

[medicv83]

I work in Buffalo NY, and the use of lights and sirens is determined by the dispatch center in relation to the dispatch code they input. We, as the responding crew ultimately make the decision to go hot to the hospital or not. I will say that there is a dramatic difference in response times here in buffalo when comparing the use of lights and sirens to a scene and when going "cold". Simply because of the traffic and amount of traffic lights. A huge factor in response times w/ and w/o lights and sirens depends on your area and the demographics. Once again, the use of lights and sirens to the scene and from the scene can make a huge difference in time for the pt. Now granted, I rarely use lights and sirens from the scene unless it is a time sensitive pt, however dispatch tells me how to respond to the scene.

[boeingb13]

Though it may of already been said, after reading so many peoples "personal" beliefs on the subject, the fact is your dept/company, whatever sets the sop's, sog's or what have you. When they say they come on they do. And for a good read, research Jacksonville Fire Rescue and sherrifs office, A officer from each is facing serious jail time from not having one or the other on while on a call.

[WolfmanHarris]

Though it may of already been said, after reading so many peoples "personal" beliefs on the subject, the fact is your dept/company, whatever sets the sop's, sog's or what have you. When they say they come on they do. And for a good read, research Jacksonville Fire Rescue and sherrifs office, A officer from each is facing serious jail time from not having one or the other on while on a call.

That makes sense only so far as SOP is that prescriptive. Here use of L&S is at the discretion of the Paramedics. While traditionally Code 4 calls receive L&S response, this is not required and use or not, at any time relies on the judgment of the crew as to their necessity.

[boeingb13]

The problem people could run into is this, your transporting get into a wreck the first thing the dept tries to do is not take blame but blame you, so they say, its in our policy that this person is to drive with or witout L/S. Our rule is all transports are to be run without unless a rapid transport calls for otherwise. We also have the rule that you stop at all intersections even when the light is green, though this one is not always followed, the lights and siren rule is. But I understand that policy changes from dept to dept.

[rock_shoes]

That makes sense only so far as SOP is that prescriptive. Here use of L&S is at the discretion of the Paramedics. While traditionally Code 4 calls receive L&S response, this is not required and use or not, at any time relies on the judgment of the crew as to their necessity.

Does this only apply for scene to hospital trips or is this also the case for scene response? Scene to hospital is entirely at the paramedic crew's discretion for us. Scene responses can be downgraded at the crew's discretion if continuing to run L/S is ill advised for safety reasons (weather, road conditions, traffic etc.).

[WolfmanHarris]

Does this only apply for scene to hospital trips or is this also the case for scene response? Scene to hospital is entirely at the paramedic crew's discretion for us. Scene responses can be downgraded at the crew's discretion if continuing to run L/S is ill advised for safety reasons (weather, road conditions, traffic etc.).

What I mean is that MOH's antiquated and stupud DPCI2 system classifies calls as:

Priority 1: Deferrable; essentially never dispatched, but sometimes a return priority for a BS call

Priority 2: Scheduled transfer; less and less common in EMS thanks to private IFT companies taking on this burden

Priority 3: Prompt; less urgent 911 calls

Priority 4: Urgent

This is how we are dispatched to a call. Traditionally, Code 4 gets L&S and that's it. However, using L&S during a Code 4 is at the discretion of the Paramedic to the scene. We determine our own priority for return along with CTAS. For example, when consolidating, my service area was rural and quiet. During most shifts traffic was limited and L&S would serve little to no purpose. Therefore we often didn't use them at all for a Code 4. Where I'm working now is far more urban and I have used L&S on a Code 3 where they wouldn't otherwise be used as traffic was so congested that a single light could have easily taken 15 minutes without using L&S to request right of way. That being said, judgment is a double edged sword and being allowed to exercise it means facing the consequences of using it poorly.