Driver training

[VentMedic]

Right on Brother!

Lets take this situation for you gotta get there nubes still out there. You are 2 cars back behind a car stopped at a red light of a busy intersection. Mommy and baby are belted in waiting for the light to turn green. Your truck is over hanging their rear bumper blasting your air horn lights and sirens! Terrified and distracted by you, mommy wants to get her baby away from you and sees the car in front of her went through the intersection and made it. Mommy, being distracted by you a screaming baby and cross traffic in the intersection creeps into the busy intersection to get her terrified and screaming child away from you and SLAM, is broadsided by an 18year old blasting snoop dog on his base woofer in his low rider. What happens now?

Wow! That jolted a memory.

Many years ago before the Children's hospital got their own transport vehicles and drivers (non-EMT), they used the local privates and it was often the luck of the draw for what crew you got. The Neo/Pedi teams only need a truck so they hired BLS for each transport since the team supplied all the equipment and were a rolling NICU/PICU. Unfortunately, some EMTs did not realize they didn't need L&S or speed and the teams preferred just a nice ride back to the Children's hospital with the child especially after they spent 2 -4 hours stabilizing the child at the other hospital which may even have been somewhere in the islands for a 12 hour transport. 2 more minutes were not going to matter.

Anyway, the team had just picked up a 3 day old infant at a hospital just across town and the parents were going to follow in their POV. The EMT driver was freaked over having a very sick child in his truck and started driving L&S and rolling through the red lights even against the protests of the neo team. What they didn't realize was at the first light he rolled through, the parents also rolled through only to be struck broadside by one large truck and then another vehicle hit them. They were dead at scene. The baby recovered but to not have parents.

Now, we prefer to have a driver (non-EMT) from the transport pool and one who does not need to know anything about the patient except what we tell them and to give us a professional limo ride with no L&S or speed to and from our destinations. The same goes for our pilots. We never yell out something stupid like "they're coding" because their focus should only be on the aircraft and not what is happening in the back unless there are other options. Part of being a Paramedic or on a Specialty team is that you know what your own capabilities are and are able to provide care to the fullest for your job title. Usually we are the higher level of care for miles around.

Edited December 14, 2009 by VentMedic

[Kiwiology]

... What they didn't realize was at the first light he rolled through, the parents also rolled through only to be struck broadside by one large truck and then another vehicle hit them. They were dead at scene. The baby recovered but to not have parents....

Aw snap, or in this case, crunch!

[CBEMT]

Wow! That jolted a memory.

Many years ago before the Children's hospital got their own transport vehicles and drivers (non-EMT), they used the local privates and it was often the luck of the draw for what crew you got. The Neo/Pedi teams only need a truck so they hired BLS for each transport since the team supplied all the equipment and were a rolling NICU/PICU.

I used to be that crew- my private had the transport contract for the PICU team, only difference was it had to be an ALS crew- their monitors didn't have defib capability, so they wanted someone who knew how to work the monitor on the truck. Plus state protocol required an ALS provider onboard any ambulance being used for SCT.

Anyway, the team had just picked up a 3 day old infant at a hospital just across town and the parents were going to follow in their POV. The EMT driver was freaked over having a very sick child in his truck and started driving L&S and rolling through the red lights even against the protests of the neo team. What they didn't realize was at the first light he rolled through, the parents also rolled through only to be struck broadside by one large truck and then another vehicle hit them. They were dead at scene. The baby recovered but to not have parents.

Did anyone talk to the parents about transport issues before leaving? Our transport nurse would always take the parents aside and make it clear that they were to take their time and not follow the truck. They were given printed directions to the destination hospital and told of the dangers involved in following the truck. If it would keep them both calm and rational, they'd offer to take one of them with us in the front of the truck (I wasn't crazy about that either, but it wasn't my decision).

I know what the EMT did on that call was wrong, but I also have a hard time pinning two deaths on him when it was their decision to follow the truck through the light.

L+S was always "up to the team," which meant the nurse- the MD onboard was a resident on rotation, and thus hadn't been on very many transports, and wouldn't be before it was someone else's turn. And since many RTs refused transport runs unless the patient was already on a vent, they didn't have the experience either.

So sometimes we used the lights, and sometimes not. What got aggravating was when we were asked to use the lights "just to get through the red lights." We tried explaining that it didn't work like that, but usually to no avail.

[WolfmanHarris]

Did anyone talk to the parents about transport issues before leaving?

I do this any time there's family planning on coming to the hospital right away. If we're going L&S (which is rare) I am very firm and clear on not following and driving safely. If we're not going L&S I tell the family not to rush, because we won't be and to drive as normal. If I have doubts on the family member being able to drive safely due to their emotional state and there is no alternative driver, I will consider having them come along in the truck (which I am not usually fond of).

One other technique I found works well for keeping family from tailgating us to the hospital is after telling them not to rush and drive safe I let them know that triage and registration will take a few minutes to complete and that they may not be able to come back into the ED during that time. We'll take good care of their loved one and they should take the time to take care of anything they need to at home. Feed pets, call children, gather up some belongings to make their loved one's stay more comfortable, lock-up their home and then by the time they get that done and get to the hospital, things will have settled.

[VentMedic]

Did anyone talk to the parents about transport issues before leaving? Our transport nurse would always take the parents aside and make it clear that they were to take their time and not follow the truck. They were given printed directions to the destination hospital and told of the dangers involved in following the truck. If it would keep them both calm and rational, they'd offer to take one of them with us in the front of the truck (I wasn't crazy about that either, but it wasn't my decision).

I know what the EMT did on that call was wrong, but I also have a hard time pinning two deaths on him when it was their decision to follow the truck through the light.

This was a dedicated neo team that had no reason to run L&S. The RN and RRT knew the parents were going to follow and told the parents that it would be a gentle ride to the Children's hospital. The trip started out that way but the EMT hit the L&S to go through a red light before the team could stop him. Of course that freaked out the parents who didn't know what to think when the truck lit up and darted. The EMT's excuse "he wasn't running code 3 but just didn't want to wait at the light". This is essentially what you stated in the following paragraph.

This was a sad lesson to be learned by all specialty teams which eventually got their own trucks and their own drivers.

L+S was always "up to the team," which meant the nurse- the MD onboard was a resident on rotation, and thus hadn't been on very many transports, and wouldn't be before it was someone else's turn. And since many RTs refused transport runs unless the patient was already on a vent, they didn't have the experience either.

So sometimes we used the lights, and sometimes not. What got aggravating was when we were asked to use the lights "just to get through the red lights." We tried explaining that it didn't work like that, but usually to no avail.

It sounds like that was not a dedicated Peds transport team but rather something like "who wants to ride in the ambulance situation?" This is truly the most dangerous situation since they are not a "team".

Our teams are RN/RRT or RN/RN with a doctor used only for ECMO transports. If you are on the team you go.

Our attorneys have also told us about the liability of running L&S to and from the airport or even to a local hospital. If we spend 4 hours in the hospital stabilizing a child, 2 more minutes will not make a difference.

Edited December 14, 2009 by VentMedic

[Richard B the EMT]

I missed the terminology. What is/are "PAMI"?

As for a vehicle with friends/family following the ambulance, I have simple instructions for that driver. I tell them, when in a stable patient condition, that I am not going to use the L&S, and will be stopping at traffic lights, they should not be freaked out that I am going slow, I'm giving a "Ride that's a Glide" trip, and the smooth ride will benefit the patient.

When it is a L&S run, I tell them not to chase me, leave before I do if possible, but not to break any traffic laws. Better they be delayed in arriving at the same ER, then not make it at all due to them being in an accident of their own. Most times they listen.

[CBEMT]

This was a dedicated neo team that had no reason to run L&S. The RN and RRT knew the parents were going to follow and told the parents that it would be a gentle ride to the Children's hospital. The trip started out that way but the EMT hit the L&S to go through a red light before the team could stop him. Of course that freaked out the parents who didn't know what to think when the truck lit up and darted.

Ok, gotcha.

It sounds like that was not a dedicated Peds transport team but rather something like "who wants to ride in the ambulance situation?" This is truly the most dangerous situation since they are not a "team".

Yes and no. Every shift in the PICU has at least one transport-qualified nurse, and an MD (ER resident on Peds rotation) that's on call. They have to go. The doc might be in-house, or at home. So we on the ambulance end sometimes have inexperienced crews running L+S to the hospital to pick up the team, and end up waiting half an hour for the doc to show up. (They usually learn after that.)

If it sounds like Respiratory might be needed, the RT on duty is paged, but has the option of saying no. And they often will, especially because transports are paid at a flat rate, and don't count towards either the RN or the RT weekly hours- they actually badge out on the time clock on the way to the truck. Meaning many an RN/RT have lost money because the 3 hour transport didn't count towards their overtime, and the flat rate didn't match what they would have made. Sometimes we'd end up on back to back transports, which only made it worse.

Unfortunately, the feeling seems to be that although transports requests are common, there isn't enough demand to warrant a full-time dedicated team. In fact, I heard that the MD slot may be getting cut for cost considerations.

The OB/Gyn hospital runs the NICU team; they're always NR/MD/RT. Their staffing situation seems similar, but I don't know as many of the particulars.

[kohlerrf]

Wow! That jolted a memory.

Many years ago before the Children's hospital got their own transport vehicles and drivers (non-EMT), they used the local privates and it was often the luck of the draw for what crew you got. The Neo/Pedi teams only need a truck so they hired BLS for each transport since the team supplied all the equipment and were a rolling NICU/PICU. Unfortunately, some EMTs did not realize they didn't need L&S or speed and the teams preferred just a nice ride back to the Children's hospital with the child especially after they spent 2 -4 hours stabilizing the child at the other hospital which may even have been somewhere in the islands for a 12 hour transport. 2 more minutes were not going to matter.

Anyway, the team had just picked up a 3 day old infant at a hospital just across town and the parents were going to follow in their POV. The EMT driver was freaked over having a very sick child in his truck and started driving L&S and rolling through the red lights even against the protests of the neo team. What they didn't realize was at the first light he rolled through, the parents also rolled through only to be struck broadside by one large truck and then another vehicle hit them. They were dead at scene. The baby recovered but to not have parents.

Now, we prefer to have a driver (non-EMT) from the transport pool and one who does not need to know anything about the patient except what we tell them and to give us a professional limo ride with no L&S or speed to and from our destinations. The same goes for our pilots. We never yell out something stupid like "they're coding" because their focus should only be on the aircraft and not what is happening in the back unless there are other options. Part of being a Paramedic or on a Specialty team is that you know what your own capabilities are and are able to provide care to the fullest for your job title. Usually we are the higher level of care for miles around.

Very good point Vent! Exactly the kind wisdom from experience that is lost on the new guard. In addition I think its a great idea to have "untrained" drivers. When I started, my partner was called an MVO for "motor vehicle operator" all she did was drive and help me carry patient or equipment. Those were the days....

I missed the terminology. What is/are "PAMI"?

As for a vehicle with friends/family following the ambulance, I have simple instructions for that driver. I tell them, when in a stable patient condition, that I am not going to use the L&S, and will be stopping at traffic lights, they should not be freaked out that I am going slow, I'm giving a "Ride that's a Glide" trip, and the smooth ride will benefit the patient.

When it is a L&S run, I tell them not to chase me, leave before I do if possible, but not to break any traffic laws. Better they be delayed in arriving at the same ER, then not make it at all due to them being in an accident of their own. Most times they listen.

PAMI=Primary Angioplasty in acute Myocardial Infarction. When we diagnose and acute myocardial infarction in the field we notify the cath lab at the hospital with a PAMI ALERT. This starts a cascade of events both pre-hospital and in hospital in order to reduce door to balloon time as this is a time sensitive procedure.

Another thing to think about is that there's a difference between an emergency response and an emergency call. It's possible to respond non-emergently (no L/S) to an emergency call (patient going to the emergency room).

Good point. we are often called by PD to an emergent situation and told to respond flow of traffic and stage. meaning, go with the normal flow of traffic and no lights and sirens than stage in th area and wait to be called in by police when the scene is safe. Yes "do nothing until the scene is safe" for all you young Bucks. Oh no!?$?%# I see another thread spawning!

[VentMedic]

I wonder how many would actually consider being an EMT if the ambulances had no lights and sirens? Look at the stigma the transport companies which are just "routine" trucks have. Yet, some wonder why these companies are not more prevalent. Besides all the start up and maintenance costs, could it be that there is a shortage of qualified people who want these jobs? They would much rather drive real fast with L&S than to provide a safe transport for patients to and from appointments and procedures. Thus, there is no shortage of EMT applications at ambulance companies or mills that mass produce EMTs. Some are even to drive an ambulance for free if they can play with the lights and sirens occasionally.

We have actually had some comment to the Specialty Team members when we must use an ambulance service to and from the helicopter in another area that the "baby or kid" can't be that sick if you don't need light and sirens. What they don't consider is that if you know what you are doing and have confidence in your abilities why would one ever run lights and sirens with a patient on board except for a few dire situations or in a few traffic conditions? If the hospitals have confidence in your assessment abilities, they can prepare for whatever you are bringing to them to where very little treatment time is lost. Unfortunately some companies that are ALS still have a "BLS" mentality and the hospitals will also perceive them as such regardless of the patch.

[Kiwiology]

I wonder how many would actually consider being an EMT if the ambulances had no lights and sirens?

The ambo's here are pretty good at screening out people who have "red light fever" and we always have the Patient Transport Service which is exactly as you describe, a bunch of guys who go round in a road vehicle without lights and sirens.

I for one also wonder that about your guys and I think your very low entry to practice standard and very loose laws perpetuation the problem of "whackeritis". Here you have to have at least a Diploma (sort of like an AAS degree) or Bachelors Degree to be an ambo plus any sort of lights on your personal vehicle are illegal except orange and yellow which are what the garbage truck has and nobody pays any attention to!

Personally I absolutely detest these people who want to drive fast with the lights and sirens on all the time. Now having said that, a quick blast of the siren once or twice is fun, hell I'd be lying if I said I didn't have an accident on my first p1 job (maybe not the BEST choice of words given this thread but you get my idea!).