Warning Lights @ Sirens use in EMS

[Richard B the EMT]

Please consider the EMD protocols, working with the agency Medical Director's directives. That assigns priority to call-types, and the priority determines the need for L&S on the way to the call scene. Obviously, an "Arrest" is going to be a Pri One, not so obviously (per the protocols I'm working under), an EDP is a Pri Seven, which requires we respond like we were in a private car, without L&S.

FDNY EMS' protocols require L&S for all Pri One through Pri Six call-types, no L&S for Pri Seven and Eight. An FDNY EMS ambulance placed out of service for not responding to the radio is on a Pri Eight Call, per the paperwork, with the same Pri level for being out of service with a flat tire (surprise, that gets a response "job" number, too).

As an afterthought, I also mention if the caller tells the call taker the patient's age is over 65, or 5 and under, if the normal call-type's priority is 5 or greater, the call taker must change the priority in the Computer Assisted Dispatch system to at least a 4. As the ambulances and crews can be called off of a lower priority call for a higher one, this lessens the chance of that happening, benefiting both the young and the elderly.

[Dustdevil]

I worked for a service that would triage the call. If it was an emergency call but not determined a lifethreat, (eg chest pain, ejection, long fall, cardiac arrest etc etc etc) the closest unit would respond L&S and the farther unit would go non-emergency. Usually the differences in response times would be no more than 2-4 minutes. If the first in unit determined that it was a non-emergent patient then they would say continue non-emerg but if they needed us to upgrade we always could. I found that to be a great idea.

What exactly is great about it? Why would any of those patients need four medics and two ambulances? :?

[Just Plain Ruff]

What was great about it Dust is that it took in to consideration the type of call and the resources needed. Granted, if the call was bls then sometimes only a fire department bls ambulance responded, if it was in the gray area then a bls ambulance and a als ambulance would be called, usually the bls ambulance was closest so if it was deemed a bls call by the crew then the ALS ambulance would be cancelled.

If it was a bonafide life threat or need of ALS the first in unit could upgrade the ambulance. If the ambulance was first and didn't need help on scene they could cancel the Fire unit and vice versa.

Bear in mind, this county is not like any of the other many counties in this state, it has more money than it knows what to do with and can afford to send all these resources to calls. If they didn't have the resources then it would be a different story. But the money is there and they choose to spend part of it that way.

[Dustdevil]

Sweet! I was assuming it was a normal system with too few ambulances to serve the population.

I would love to work in a system that could send another ambo as my backup instead of a fire engine!

But hold it, you're talking about sending another ambo AND a fire engine?

Are the ambos tiered, or all ALS? This is interesting.

[Guest]

I'm sorry i disagree with that. Your county maybe rich but it won't be for long. That is way to many emergency vehicles on the road at once headed to the same location. That is bound to cause a major collision one of these days. Besides that unless it is an MCI what do you need two ambulances and an engine for? To many people to many trucks and to much risk and liability out on one call. Even if you do call them off before they get there, the point is the additional resources are already rolling to you lights and sirens and the danger is already there. Just because you turn off you lights and sirens does not make you any less noticeable in the public. I'm not saying stay at the station until you get called but to turn off your lights and sirens in the middle of a red light or even right after you pass the intersection makes us look like ass's that don't want to play by the same rules as everyone else.

You should feel lucky you have the resources like that, i wish we did.

I understand that it is your counties policy to do this. We are way different. We are ALS with BLS back up. We only call for help if needed it does not come automatically then have to be turned around. Besides we have a staffed ALS fly car. minimal trucks on the road minimizes the risk to us and the public.

[Dustdevil]

That is way to many emergency vehicles on the road at once headed to the same location.

Two is too many? Or do you mean two plus a fire engine is too many?

[Guest]

well lets think about it a typical response the way i understand it, 2 ambulances, a firetruck, 1-2 LEO's. (they have to be everywhere.) What do you need two ambulances there for? unless there are two patients.

On our service we responder one ambulance and usually have at least on LEO. Never does fire respond unless it is hazmat, fire, rescue, or MVA. Even though they are all NREMT-B'b on our dept. the do not run medical calls. I don't need water or an axe. If i do i will call.

However i did go back and review the past posts and must say that i missed where ruff had said the first due truck was the only one with lights and sirens. Unless they advised that they needed additional help. so kinda make my argument pointless. and i apologize.

[Ace844]

Hi All,

In my state there are some communities where responses are like were described in the aforementioned posts. For example:

This takes place In a Major city in Mass: 1 Fire engine, 1-2 PD/LEO cars, Depending on the call-1 BLS, 1-ALS ambulance responding.....So here's in my experience how it brakes down. Fire: because they want the call #'s to justify having a job(they mostly hang out and do little to nothing for the patient), Police (our safety, mostly they watch as well..:roll:), BLS/ALS: depends on the call and "dispatched percieved acuity of the call"...

Out here,

Ace844

[vs-eh?]

So here is how it breaks down here...

We use the Alpha/Bravo/Charlie/Delta/Echo system that many of you may be familiar with. In all of these I'm speaking from an ambulance perspective...

A - no L+S

B - no L+S

C - Too much of a catch all priority. 75 year old with elbow pain, but has a hx of heart? Ummmm charlie...however stroke is often a charlie too, so...It is up to the crew if they want to run it or not. I'd say 80% of the time, they don't.

D - L+S and tiered to fire and police. Crews normally would run this, whoever there are exceptions. If the crew is likely to get there pretty soon anyway, they may not run it.

E - L+S and tiered to fire and police. Probably hard pressed to see a crew that doesn't repsond L+S to these.

Comments...

- We are basically dispatched on a "closest car" system, regardless if a BLS or ALS crew, with some exceptions. Chest pain and a BLS car is 5 minutes away, ALS is further, it will likely go to BLS with no ALS backup. 99% of the time it's not needed in our system anyway. We don't double dispatch here, unless it is an echo and a BLS crew is closer. I'd say 50% of the calls that BLS units get are Charlie or higher, 95% of the time ALS backup is not dispatched/required/asked for...

- Fire usually gets there < 5-6 minutes, I think there are like 80ish fire stations here. Fire functions in a FR role only - AED, basic BLS stuff, O2, etc...They don't do vitals or anything (out side of general impression of a radial pulse). Basically they are there to assist us, imho the system works well like that. No real infighting about tx because well all ambulance (regardless of scope) are the higher medical authority.

- At peak times there are upwards of 20 paramedic response cars in the city, a mix of BLS and ALS. Normally they are only dispatched to Charlie+ calls, but they can go to anything they want. They augment response times and treatment in some cases.

- It is pretty rare that police attend to "normal" higher priority calls, they maybe dispatched, but they are too busy to attend a 98% of the time obvious medical. Psych calls they are often requested and many times a crew has to "stage" and wait for police depending on the call details. ANy kind of violent trauma call (shooting/stabbing) etc...they are there pretty quick and many times before us. Cardiac arrests/obvious deaths they have to attend. Whether a pronouncement or "obvious death" they have to attend and 99% of the time they are left with the body after everyone leaves. They wait for the coroner and such...

[Just Plain Ruff]

Let me try to explain this a little better cause my previous posts were mis-read or I just did a bad job explaining

there are 5 different overall types of response vehicles. We are not talking LEO's here ok.

BLS Ambulances (2 emt ff's)

ALS Ambulances (2 medics or 1 medic/1 EMT)

Supervisor vehicles (1 Medic)

BLS Pumper

ALS Pumper

Call for a fall comes out

Dispatch sends a bls unit and a als unit. Whichever unit is closest goes L&S, the farther unit responds non-emergency

First unit arrives and triages the patient - if the patient is ALS or Life threat - then the further unit is upgraded. If the call is a bls call then the further unit is cancelled unless needed for lifting or other type of support.

At no times are two ambulances and a firetruck sent to a call unless it's determined by dispatch to be needed like a head on collision with significant injuries.

One other example - chest pain or cardiac arrest type call gets a Fire truck or BLS ambulance for manpower and An ALS Ambulance along with a supervisor.

I hope this straightened out the previous info.