Arrive alive

[kohlerrf]

Why dont we take all the lights and sirens off all the ambulances and just drive with the flow of traffic. I realize that there are some situations where you are in grid lock and lights and a siren might help but generally I have found gridlock is grid lock. More often than not the call we are dispatched to is not time critical such as a sprained ankle or a sick call or even in the case of an MI or CVA. It has been proven time and time again that driving with Lights and Sirens is not that big of a time savings over planning a smart route to the patient avoiding known traffic delays and in the late evening or early morning hours there is virtually no time saving. Does it really matter if we get there 30 seconds or a minute earlier? Just because we wont have lights and sirens does not mean on the odd occasion we need to clear traffic we cant have a police escort.

Now lets think of the cost savings on and ambulance with no emergency lights inverters power packs and dual alternators or on board power management computers and in addition how the ambulance insurance costs would go down. Maybe with these cost savings we could add additional ambulances to cover the area that would cut down response time even further? Lastly, having not just suffered a harrowing ride screaming through the streets at the hand of another would we be calmer and think more clearly on the call and in turn more accurately diagnose and treat the patient?

I think its worth a try.....

[Richard B the EMT]

Just because we wont have lights and sirens does not mean on the odd occasion we need to clear traffic we cant have a police escort.

Here in New York City, the majority of EMS calls do not need the NYPD on the scene with us. Admittedly taken out of context, but would not having, in no particular order, a combination of proper medical training for the personnel, driving techniques for the vehicle operator, and the lights and siren available for use by that trained vehicle operator, instead of delaying transport awaiting a LEO vehicle fot it's Lights and Siren, be a better thing?

I think I have the correct paraphrased quote, applicable here, from Theodore Roosevelt, that one can get better results with a carrot and big stick, than just the carrot.

Also, while I don't believe I know you, I have to think you've never seen any Emergency vehicles being operated in Emergent mode in New York City, especially on the city's highways. Too many times, I have seen drivers almost in collisions, and actually colliding, trying to force or bluff their way through the traffic, by trying to appear that they are convoying with the ambulance.

I'll reopen some of my old strings re vehicles following ambulances, and the dangers of Emergency vehicles convoying under L&S, in the near future.

Edited November 19, 2010 by Richard B the EMT

[TJZ]

Emergent transport can make an 75 minute hospital transfer 45 minutes. It may not save much time in urban areas but over rural countryside it is a life saver.

[DwayneEMTP]

Emergent transport can make an 75 minute hospital transfer 45 minutes. It may not save much time in urban areas but over rural countryside it is a life saver.

Do you do a lot of emergent hospital transfers?

I gave the + to the original post as I think the logic is sound with the exception of the police escorts. Rarely are lights and sirens needed. Perhaps we could use them only when they actually were, and if they were gone, or severely limited we could get every yahoo in the friggin' country to stop trying to do our jobs for free...

Thanks for sharing your thoughts...

Dwayne

[zippyRN]

A lot of it is attitude of both crews and management and also system design

If you have a system which sets a response standard with a tight time frame for all calls there is a pressure to gain every second, especially if funding is dependant on meeting the response standard ( as seen i nthe Uk with the Orcon standards where failure to meet the time standards regardless of clinical outcomes attracted 'fines' from the commissioning body )...

At this point the AMPDS wallahs will come in and say that AMPDS has it's place here - which to some extent it does in that you can triage some calls down to a less pressured response - such as the 30 min or 1 hour standards that some places in the UK have for the AMPDS codes that fall into Orcon cat C ... - this is where the marginal differences in response time but substantial risk profile changes can come around ... exactly how far can you drive from station in 8/10/ 15 minutes under normal driving conditions ?

At this point the SSM wallahs are also jumping up and down with their powerpoint presentations of predicting where the next call is and response isochrones from standby points and 'order of merit' of standby points ... SSM has positive impacts but equally the ssystems where SSM is implemented on the cheap i.e. standby points which are literally a pin in a map you upset crews, local populations and the treehuggers ...

This is all response side issues the next issue is to risk assess the benefits of transporting patients under emergent conditions, there are some occasions in which this is arguably a clinical necessity but in other scenarios is this the case ? what is the clinical need for the rapid transport ? why are crews transporting dead bodies on lights and siren for the ED doctor to call in in the back of the vehicle or after a curory round or two of ALS in the ED ....

[fiznat]

I work in a city with highways and I can say that lights and sirens saves a significant amount of time depending on the time of the day and the traffic. At rush hour, a 45 minute trip across town can turn into 10 minutes with the lights and sirens. I think that is a huge difference, and one that can be critical for a certain population of patients. I agree that as an industry we do tend to overuse the lights and sirens, but I would never advocate that they be entirely removed.

[uglyEMT]

Ok first to Dwayne: Love ya brother! Not so much take the vollies away take the wackers away LOL No need for Johnny Speedracer in his Pickup to have more lights and sirens then the entire fleet of rigs including heavy rescue just to get to the station or scene 1 minute ahead of everyone else just to sit in the rig awaiting a "driver" because he is 17 and cant LOL

Nexct, on to the OP. I like what you are implying but I dont think entierly removing them is the answer. What I think is needed is better education for the drivers (guys hold off the - Im not calling us ambulance drivers, Im using driver generically) of the ambulances. I think a big problem is folks get minimal training. Yes one course of EVOC is not enough training. I think more training is necessary in the PROPER use of L&S.

My take is somewhat different then most folks, but hey Im from NJ and we just do things differently I go Lights TO every call, sirens only at the 2 blind intersections (basically just pulsed once or twice to announce), after 11pm I dont use sirens unless absolutly necessary. Hey some people are blind to my lights even in total darkness. Once at the call just my safety lights are on because I am blocking a street. Once we have determined the patient's need of transport (emergent, non emergent) my decision on L&S is made.

We have protocols per my squad that 2 major intersections on our route to primary care will NOT be crossed at anytime unless we have the green light. The only stipulation is if paramedics are onboard and want us to due to patient need (CPR in progress sort of thing) During our trip down the highway to the hospital we cross about 7 intersections that have traffic lights. Very few times will we run a red, we usually shut the lights down and wait at the light for the green. Then put the lights back on to clear traffic but not at break neck speeds. If we feel the patient is really in need of nothing more then a ride then we are all off and just a regular vehicle.

I have seen other companies run L&S wailing and blarring passing us all the way down to the hospital and getting there no faster then us. Plus who wants to hear the damn siren for 30 minutes.

What Richard talked about is a big problem that I try to educate everyone I get a chance to about. DONT FOLLOW MY DAMN RIG!!!!!!!!! I hate having either a family member or just Johnny Comelately get on my rear step and follow me through traffic and such. Bad enough folks dont yeild for us most times but if they do they are not expecting a POV to be right behind me. Also I may have to hit my brakes for whatever reason be it a deer in the road, errant car pulling out a driveway or side street, bus coming head on with me (dont ask). If I need to apply the stop pedal liberally and your on my ass you now become additional patients. Please don't. I try and get family members to leave ahead of us if possible that way its one less thing to worry about. ALS do what you want in the chase truck, your trained too LOL

[fiznat]

Very few times will we run a red, we usually shut the lights down and wait at the light for the green. Then put the lights back on to clear traffic but not at break neck speeds.

It seems to me that this would be confusing to other drivers on the road.

[JPINFV]

Emergent transport can make an 75 minute hospital transfer 45 minutes. It may not save much time in urban areas but over rural countryside it is a life saver.

I'm curious to know how you can cut travel time down by half if rural areas are supposed to have less traffic and traffic lights. Is it that the drivers feel like they're allowed to speed* with lights and sirens or something similar?

*Note: I take a pragmatic look at speeding, especially since a lot of speed limits are set to generate revenue, not increase safety.

Edited November 22, 2010 by JPINFV

[rock_shoes]

I'm curious to know how you can cut travel time down by half if rural areas are supposed to have less traffic and traffic lights. Is it that the drivers feel like they're allowed to speed* with lights and sirens or something similar?

*Note: I take a pragmatic look at speeding, especially since a lot of speed limits are set to generate revenue, not increase safety.

I suspect you just answered your own question. Rules/regulations vary by jurisdiction as to the priviledges/responsibilities involved when running L/S. Most jusrisdictions I'm aware of include exceeding the posted limit as allowable.