Arrive alive

[brentoli]

I just want to point out here one thing:

You may think 95mph is needed/acceptable. Your partner may think 95mph is needed/acceptable. Your patient may think 95mph is needed/acceptable. But your eventual victims lawyer will think 95mph is a few million in the bank.

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[JPINFV]

I just want to point out here one thing:

You may think 95mph is needed/acceptable. Your partner may think 95mph is needed/acceptable. Your patient may think 95mph is needed/acceptable. But your eventual victims lawyer will think 95mph is a few million in the bank.

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That argument can be made for any collision when using lights and sirens. If you're going 10 MPH and using the legal exemptions allowed by the use of lights and sirens, you're going too fast.

[brentoli]

That argument can be made for any collision when using lights and sirens. If you're going 10 MPH and using the legal exemptions allowed by the use of lights and sirens, you're going too fast.

Yes. However, a low speed L&S crash brings about much less negative emotions than an excessively high speed crash of any type.

A witness always adds 20mph when you turn your lights on anyway.

Google "David Bisard IMPD" and see what attention high speed L&S crash gets you. Ignore the fact he was drunk, I've watched the case from the beginning and that only added fuel to an already raging fire.

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Edited November 24, 2010 by brentoli

[Richard B the EMT]

OK but it says "everyone will always drive 5 mph over the speed limit" so to me it says that the speed limit will always be set to make revenue no matter what it is, safe or not.

As a conspiracy theorist, unfortunately, that makes sense.

[TJZ]

I just want to point out here one thing:

You may think 95mph is needed/acceptable. Your partner may think 95mph is needed/acceptable. Your patient may think 95mph is needed/acceptable. But your eventual victims lawyer will think 95mph is a few million in the bank.

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Sometimes I am not as good with words as I would love to be. I was trying to show that there are instances where 95 is safe. They are very few but having the option is a good thing. There are situations where 2mph is not. The trick is knowing the difference and not letting your emotions get the better of you.

Picture a rural WI highway, newly repaved, dry with no cross roads, flat with the tree line a quarter mile back from the road. Here with no cars in sight you can push it with a well kept rig having tires that you and mechanic checked that morning. Once I get into town it is entirely different. I never approach any intersection with my foot on the gas, not even on a green light. I always cover the brake. When there are cross roads this speed is not acceptable. You must be able to stop safely without banging your medic head at all times. I could tell stories of stupid people tricks all week (wanna hear some )

Never count on them to yield, never count on them continuing to yield. Do not think they see you, or hear you. Do not think they care about the red light they have, or the green that is for you. That small child does not have a mother nearby. That college student's friend thinks it is funny to push him in the road as you go by emergently.

I used my best numbers to make a point of how big the time saving can be but there were only 2 times I was able to do this. As soon as one thing changes it is no longer a viable option to go that fast. Sometimes it is hard to accept that conditions are rarely like that and I have had to deal with the fact that a few minutes I could not make up safely did cost a life. Even if it is true that he may have made it had we delivered him slightly sooner the focus MUST be on arriving safely NO MATTER the nature of the illness or injury. We are not on the road to take risks. Our patients usually have the quota covered on that.

Legally, I see where you are coming from. I may have come off as a risk taker, but I assure you I am so much the opposite. My partners learned not to ever tell me to go faster just advise me of patient condition and I will do what I can. I learned to drive with a ceramic, uncovered coffee cup on the dash, if it splashes you are not doing it right. (thanks Mom)

On the opposite of this, I have driven lights and sirens to be able to go slowly (5mph) along the lane lines avoiding the bumps of a very rough piece of road so as not to jolt my patient with a bulging, barely leaking AAA.

[brentoli]

I don't think patient condition should be any buisness of the drivers. There is a reason helicopter pilots as a general rule aren't medically trained and kept out of the patient condition loop.... it clouds judgement.

Seal the driving compartment off... hire a professional driver who doesn't know anything but CPR, and put the two crewmembers in back, with 100% seatbelt useage.

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[TJZ]

I don't think patient condition should be any buisness of the drivers. There is a reason helicopter pilots as a general rule aren't medically trained and kept out of the patient condition loop.... it clouds judgement.

Seal the driving compartment off... hire a professional driver who doesn't know anything but CPR, and put the two crewmembers in back, with 100% seatbelt useage.

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This I would love to see! All the driver should know is emergent or non for ideal, across the board safety. I have seen risks far too great taken because of this clouded judgment. I have also met MANY in EMS that really should be in Nascar as their heart is not there to heal it is there to go fast. They do not even need a crashing patient to be foolish and reckless. Some I have compared their ego driven driving to the impairment of being totally drunk. It terrifies me from all aspects. As a person on the road, EMT in the back or the patient.

I must admit that after my time served in EMS I really don't have as much faith as I should... knowing many of those that will come if I call 911 has changed me, I have lost much faith. I guess you could equate it to working in a restaurant and not ever wanting to eat there again lol

[kohlerrf]

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.

Ricard, I started My career with the NYC Health and hospitals Corp in 1979 as 21-E out if Lincoln hospital got my medic in 1980 and I left in 1995 after working 35-W out of Woodhull hospital to work for the voluntary hospitals for the next 5 years...they paid better as for NYC bin there done that and believe me its not the bright center of the universe.

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.

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.

TJZ you drive way too fast brother

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

Your right i agree but I had to put that in for the yahoos

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 ....

Zippy great post thanks. I need to make this absolutely clear, I think type of thinking is the crux of the issue. RED LIGHTS AND SIRENS only request the right of way they do not demand it. There use does not absolve you of responsibility and you can be found libel if you cause injury to another while using light and sirens. regardless of their use you can only disobey traffic regs when conditions permit. There are no companies that can compel you to pass a red or run a stop sign at any time for any reason. the only reason you do is because every one else does. If your service has a slow response time they have to put on more units with shorter distances to travel, not to tell the existing units to speed up, think about it for a minute how ridiculous is that?

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

I admit the escort thing is a bad idea I just put that in for the yahoo's but let me ask what is it your problem if someone is following you thorough traffic shouldn't you be looking in front of you while moving forward? If it really bothers you just pull over and stop and let them pass you and then proceed on your way.

[Richard B the EMT]

Ricard, I started My career with the NYC Health and hospitals Corp in 1979

My apologies, as I didn't know that. We overlapped, as I started HHC EMS in 1985, although "for the needs of the service", I went from the QGH EMS Academy directly into Communications Bureau as a "CRO", and was there until just after the FDNY Merger.

By the years mentioned, unfortunately, you might have known one or both of the idiots from the "Two One Deli" incident.

[uglyEMT]

I admit the escort thing is a bad idea I just put that in for the yahoo's but let me ask what is it your problem if someone is following you thorough traffic shouldn't you be looking in front of you while moving forward? If it really bothers you just pull over and stop and let them pass you and then proceed on your way.

I watch all directions around my rig. Foward, back and sides. I also look in my mirror to see whats going on in the patient compartment. Do I need to adjust driving to allow my partners to do something?

I know some say just to concintrate on whats infront of me but I feel total awarness is key.

As for pulling over because someone is on my back step. Maybe, depends on circumstances. I could care less about Joe Somebody I didn't tell not to. I was more talking about the patient's family. They are the ones sometimes that try following me through things they shouldn't. I don't want them to be patients too.

Its all good though, good comments and posts