Do you emergent transport base off of mechanism?

[Just Plain Ruff]

I rarely run hot to the ER unless the patient is crashing.

I see more and more in cities I visit a disturbing trend.

Case in point. I have spent time in a town in florida and our office is right above the ER. I spend time day dreaming at times and looking out the window.

I one time this week counted 18 ambulances coming to the ER with patients. Of those 18 ambulances in that hour 11 of them came emergently, lights and sirens. Did they have 18 critical patients? NOPE as a matter of fact I went down to the ER and asked about the patients in the past hour. I asked how many were critical. They said 2 which were the trauma alerts that came in.

So why the emergent transport?

I also spent some time a number of years ago in New York at the New York Hospital Queens and every ambulance that arrived to their ER came with lights on, rarely with sirens.

What is this trend I'm seeing. It occurred in Jacksonville when I was there, I saw it in Springfield Mass, I saw it in Detroit and also in Patterson New Jersey.

Are these isolated places that just do this to do it or is there something else going on? Is it to save time because we on this forum surely know that running hot does not save time.

Just some observations. Nothing more.

[Fox800]

I rarely run hot to the ER unless the patient is crashing.

I see more and more in cities I visit a disturbing trend.

Case in point. I have spent time in a town in florida and our office is right above the ER. I spend time day dreaming at times and looking out the window.

I one time this week counted 18 ambulances coming to the ER with patients. Of those 18 ambulances in that hour 11 of them came emergently, lights and sirens. Did they have 18 critical patients? NOPE as a matter of fact I went down to the ER and asked about the patients in the past hour. I asked how many were critical. They said 2 which were the trauma alerts that came in.

So why the emergent transport?

I also spent some time a number of years ago in New York at the New York Hospital Queens and every ambulance that arrived to their ER came with lights on, rarely with sirens.

What is this trend I'm seeing. It occurred in Jacksonville when I was there, I saw it in Springfield Mass, I saw it in Detroit and also in Patterson New Jersey.

Are these isolated places that just do this to do it or is there something else going on? Is it to save time because we on this forum surely know that running hot does not save time.

Just some observations. Nothing more.

Ooh they rolled their SUV! Now I get to practice my EVOC driving, yo!

[Just Plain Ruff]

Ooh they rolled their SUV! Now I get to practice my EVOC driving, yo!

No We need to give them a diesel bolus. Woo hoo.

Does anyone else think that's a silly statement.

Although I did have a nurse friend of mine tell a doctor that the reason why he upped the oxygen from 2lpm nasal cannula to 15lpm NRB was he was giving the patient an oxygen bolus.

[Chief1C]

No We need to give them a diesel bolus. Woo hoo.

Does anyone else think that's a silly statement.

Although I did have a nurse friend of mine tell a doctor that the reason why he upped the oxygen from 2lpm nasal cannula to 15lpm NRB was he was giving the patient an oxygen bolus.

I'm gonna use that... A bolus of oxygen.

[armymedic571]

I think when you look at "MOI", the only one that through really suggest serious injury through case study and research is "ejection from a vehicle". As stated in previous trauma guidelines, ejection from a vehicle increases mortality by .......( I think 25%)...... The point is Mechanism by it self is an assessment tool for what "could" be wrong with the patient, not what is wrong.

The exception to this is MOI plus significant physical finding.

I personally feel that transporting emergently based off of mechanism is just as ridiculous as transporting CPR in progress. But that is just my opinion.

Not to mention, why are we transporting emergently? If they are (the patient) that critical, why not call for aeromedical if in the appropriate setting. Obviously, I wouldn't call for them if I could get them there faster while being safe.

[tskstorm]

I also spent some time a number of years ago in New York at the New York Hospital Queens and every ambulance that arrived to their ER came with lights on, rarely with sirens.

In NYC we tend to drive with our lights on, and sirens selectively, we wont always force traffic through a light if its too dangerous for them to do so. To many cares into a major intersection for example. If we're driving 50/60 on a highway there is no point either. For the most part we use a few siren blasts at the intersection to make sure all traffic is stopped and we roll through at a slow speed. In NYC there are 3 times when sirens are used full blast, 1 you work for HATZOLAH they drive everywhere full lights full sirens, whats wrong with the patient is irrelevant, 2, you get a "lights and sirens job" and you work for a transport company (read get an assignment for a misplaced peg tube or chronic pneumonia you are 2 hours late to pick up) or for the NYC EMS/911 Units a pediatric arrest or similar.

So lights on is as good as saying they came in lights and sirens.

whether how we do it is good or bad isn't the point just clarifying.

As a rule unless I am giving a notification to the hospital I will not use lights and sirens. No point in shaving seconds off a transport time to sit in triage for 25-30 min. If we're going to go right into a trauma slot or similar, then yes.

I wouldn't use mechanism alone if it was up to me. However policies dictate otherwise certain mechanisms require a notification and emergent transport.

Falls greater 2 times height, pedestrians/bicyclist struck over 5 mph etc...

[aussiephil]

I think I have detected yet another difference betweeen our countries.

To transport a patient her, emergent if you will, does not involve lights & sirens. You can run emergent with a patient at 10 mph. It does not mean you travel at speed.

Paramagic, when you said

Mechanism (in relatoin to motor vechicle collisions) is a poor predictor of injury. Mechanism alone is not sufficient to warrant the risk of running emergent to a trauma center. Mechanism should be used as a cue to alert you to look for specific patterns of injuries, not as a reason to not treat appropriately.

can i ask you to look at my comments in regards to this. I said

The MOI should indicate to you what potential injuries the patient may have. It is reason to transport to a Trauma Centre. Last time I looked, we were not carrying X-ray, CT & Ultrasound for FAST in the ambulances. (If you dont know what FAST is, click here.)

further

The MOI is the single most important piece of info you have to indicate the injury that may present in time.

I have spent time discussing with doctors the MOI more than the exisiting, presenting injuries because they want to focus their radiological survey to specific areas, not waste time with whole body CT. They want to use a FAST scan now not wait to have the PT into X-Ray.

Dwayne, i think our disagreement is over the definition of emergent transport. I agree we should be continnually monitoring our patients looking however, there is no reason why we cannot be expediante with out patients, based on the MOI, looking at the Potential for serious or severe injury, this does not mean we have to expidite!!

[speedygodzilla]

So it sounds like my reasoning is reasonable. Turn out to be an interesting discussion. Feel free to add more.

[CBEMT]

So why the emergent transport?

For us, it's department policy. Right, wrong, or indifferent, that's the rule. And by state law we are not afforded emergency vehicle privileges unless both are activated.

So at 3am when I don't use them rolling down a sleepy side street looking for the house number, or on the highway because I'm outrunning the siren anyway, I'm breaking the law. Or at least, have no legal recourse if suddenly a car materialized in front of me and I hit it.

The only agencies around here that don't transport emergent are the privates, unless they have something they think warrants it. The peg tubes, Foley replacements, most transfers from urgent care centers, etc are hauled normal traffic. But none of them are doing 911 calls, so its not that big of a percentage.

Edited June 6, 2010 by CBEMT

[Richard B the EMT]

To transport a patient her, emergent if you will, does not involve lights & sirens. You can run emergent with a patient at 10 mph. It does not mean you travel at speed.

Phil, I think I need a clarification from you. When I say "Emergent", that means to me, traveling under engaged lights and siren, possibly at speeds over the roadway's posted speed, but with due regard for other traffic on the road (FDNY regs forbid anything more than 10 over posted, and never over 50 MPH). As always, I'd be balancing the "Need for the Speed", with the "Ride that's a Glide".

If not the same, what does "Emergent" mean on your end of the world?

Due to a severe "S" turn, there's a roadway that, even on a fast run to the Trauma Center, I feel safer going below the posted speed. The L&S will remain on, even with me traveling slower than the rest of the traffic on that "S" turn. It's gotten me some funny looks from motorists I would be becoming a rolling roadblock to, but If I keep safe, my partner safe, the vehicle safe, then the patient will be safe, too.