Trauma Docs with lights and sirens?? What do you think?

[akflightmedic]

WOW!!

Is that an Ace post??

I am impresssed! I think that is the shortest, nicest and to the point post ever posted by Ace. Me thinks someone is shooting for different nominations in 2007...lol.

How funny is it that a newbie called out Rid...some people have no clue..that gave me a good laugh as well. Not only can the nebie NOT defend his flawed argument, he can not even spell EVOC correctly.

I would like to touch on the comment he made with due regards to safety. He said look right, look left and proceed.

I think he is the one viewing it from a narrow perspective. How many accidents ocurred that you did not see? They do not have to involve you. You can not control what other drivers will do. I have had people pull over or in front of other cars because they thought they were being helpful and trying to get out of my way. I felt bad for them, because only if they knew I was repsonding to total BS, they would think differently about L n S. For the record this was an old system that required L n S on everything. My last system was great with priority dispatching..and the strange thing was..it worked!!! Very rarely was something more serious than what we thought. But I hate the argument of what if it was your family, what would you want or do? You know what? It doesnt matter..IT IS NOT MY EMERGENCY!! Say it again, IT IS NOT MY EMERGENCY!!..Yes it may be a loved one, and I would be sad, but who are we to think first, that we are entitled to instant EMS, and secondly to think that we could and should cheat death at every opportunity. Death is natural, it is an integral part of living. Get over yourself and your heroics....

[JoelEMT]

very well said AK.

Seems to me that while reading through the mountain of posts in this thread and others that it doesn't matter what the truth is or what the studies say, people are going to disagree. Everyone sees things differently, whether by choice or through ignorance, there are people that will disagree just to piss you off.

MY take on it is: L&S generally mean higher speeds. (not to mention, the "adrenaline rush" that the newbies get causing among other things: poor/irrational thoughts/judgement, tunnel vision etc. (some would counter - increased reflexes but yeah, whatever) High speeds have been CONSISTENTLY proven to cause an increase in the number of collisions as well as an increase in the severity of the damage and injuries sustained in those collisions when compared to the collision/damage/injury rates of those that followed the speed limits ( speed limit being the maximum SAFE speed for IDEAL conditions) We have all seen the confusion and panic and resulting poor judgment of people on the road that hear/see an emergency vehicle. Do we really need to further aggravate the problem by allowing everyone (including vollies) to have L&S??? I would rather see a decrease in OVERALL vehicle related trauma by properly educating the public as well as educating/training those that currently use L&S on how and why to drive safely. Prevention, rather than allowing everyone to respond hot to deal with problems that proper education/mentality (a.k.a. Prevention) could have prevented in the first place is ideal.

Of course, all too many people THINK that they are better than most people, that they already do drive safely or "don't worry I can handle it" IT'S B.S. You may be in control of your own vehicle but you don't control nature, nor the other drivers on the road.

It's time that people (aka EVERYBODY) takes our heads out from our rears and starts practicing safe and curteous driving. Collisions will still happen but that's why there is EMS to begin with.

We just need to get over the "oh, WOW, SHINY!!!" mentality

[Ace844]

I have a question on the data from the "Only 43 seconds difference" w/ lights and sirens. A few years ago when my service went to the NAEMD dispatch cards/system and we began running some emergencies No Lights & Siren we did a study( Not really scientifically supervised). We found that inside our largest city (pop. @ 70,000, increasing during working hours to approx. 100,000) that L/S response got us there 2.2 minutes faster. Granted there were times when it was close to the 43 seconds i.e. "Rush Hours", but during "Waking hours of 0700 to 2100 was the major time difference. In the rural areas there was no difference in the times.

I would like to know the population(s) of those areas and the time of day in the studies.

I have seen these numbers for 20 years but never read a study on it.

"Beagle,"

Any of this sound familiar to you?? ..The studies are here, just follow the links, and the data will be clear to you...

You can present the material, but you can't make me care.-- Calvin

Miss Wormwood: What state do you live in?

Calvin: Denial.

Miss Wormwood: I don't suppose I can argue with that...

Calvin: Can you make a living playing silly games? His Dad: Actually, you

can be among the most overpaid people on the planet.

"That's the whole problem with science. You've got a bunch of

empiricists trying to describe things of unimaginable wonder."

--- Calvin

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[chazmedic]

Actually, Beagle is right. The EMS, FD, and PD have all done surveys on response times. The city has had 2 studies conducted in regards to response times for the PUM process. The 43 second rule has never really applied in Northwest Arkansas. It is more like 2 minutes in time saved. This is not exceeding the speed limit by 15 mph as conditions warrant. This is accordance to state law. When we went to Priority Dispatch with EMS, the city about had a stroke over the 2 minute time difference between hot (L&S) and cold (no L&S). In fact, as a result, we were told at Fire we had to respond to all calls hot (EMS is a private nonprofit company here, I work for both). We have since got a new chief and dropped this rule.

Each area is different. Little Rock, which has a larger population and more traffic, the 43 second number does hold truth. People here do actually pull over for a L&S vehicle. However, the city we are in does not allow any POV's with L&S to respond, except for the detectives (not really POV's, yet unmarked). EMS has strict rules to responding. I can have my driver sent home if he is driving in what I feel to be a dangerous manner. I usually do not let my driver go over the speed limit. We are not supposed to drive 5 miles over in the fire truck. The cops are the most dangerous. They are little land rockets.

As to the idea of a trauma doc on scene, our ER docs all say the same thing: "see you in the ER". Trauma requires getting the patient to the ER quickly and safely. Research that is being done with the armed forces in Iraq seems to be supporting the idea of aggressive ALS and PHTLS care with limited scene times and rapid transport with the care continuing while en route. However, limiting your scene time is probably easier when being shot at. If the doc was actually in the ambulance maybe things would be different.

[Ace844]

"Chaz,"

Please post these studies so that we can all see them please. I'm not saying I disagree, as I have posted about 10 previously here that support those types of claims...Still if you have recent data, it'd be nice to see it to have a comparision...

out here,

ACE844

[chazmedic]

I'll try to locate where they ended up. All the PUM data was supposed to go onto the county's web site but hasn't yet. I'll check and verify. I'll post the links when I find them. Right now, AMR has walked into the area so all information has just gone "top secret" at where I work.

[chazmedic]

I'll have to see if I can find them on my computer at Job#1 next time I'm on shift. I can't find it now on the county site. The city or more specifically, the former fire chief had the city study done because he was looking for data to use in an attempt to regulate EMS in the city. Not take over, just regulate. One of the things he didn't like was cold responses. Everyone doubted him on his findings. However, imagine the surprise when his finding actually mirrored our in house findings at EMS (job#2) of a 2 minute difference. It was surprising to management because they had always used the 43 second thing with us in staff meetings about safe driving. It really surprised us when they actually admitted it to line staff.

Of course, none of this matters right now since I can't find any of the studies on line.

[Beagle189]

"ACE"

Thanks for the links to the studies. What I read in them is that 1 city of 46,000 population got the 43 seconds. One study. I am sure there is others out there that will show the same. The same goes for my service's informal study that found 2 minutes were saved (and the City's study that Chaz refers). Anyway I was not making a point that RLS was better or necessary. I just wanted to see the info to compare. As stated in others postings here - What does 2 minutes really save? Depends on the call. My service uses NAEMD Dispatch and we still run RLS to "real emergencies" and guess what? We still run RLS to calls that shouldn't be run RLS.

[n5iln]

"ACE"

Thanks for the links to the studies. What I read in them is that 1 city of 46,000 population got the 43 seconds. One study. I am sure there is others out there that will show the same. The same goes for my service's informal study that found 2 minutes were saved (and the City's study that Chaz refers). Anyway I was not making a point that RLS was better or necessary. I just wanted to see the info to compare. As stated in others postings here - What does 2 minutes really save? Depends on the call. My service uses NAEMD Dispatch and we still run RLS to "real emergencies" and guess what? We still run RLS to calls that shouldn't be run RLS.

The 43-second item, believe it or not, is quoted in the National Safety Council CEVO-II course manual, which is the EVOC my employer has selected to put everyone through. I work in a city of somewhere around 90,000 covering something like 60 square miles (I'll admit I'm guessing here), so our mileage is going to vary a great deal, especially in winter when we get our typical snow loads on the streets. How much do we really save? I wouldn't care to hazard a guess.

The point, though, is that when I'm responding to a P1 call, I'm in a big moosy truck with a lot of lights and reflective tape and things on all sides. And I've been trained and qualified to drive it running RLS in adverse conditions. If a doc wants to do the same thing, he needs to go through the same qualifications, and do his responding in an "authorized emergency vehicle" and not just a POV that he's put a Gall's Special light on top of.

[Asysin2leads]

The problem with the study about warning lights and sirens is that it is flawed logic. For one, it takes an average, where the use of lights and sirens should be looked at on a pinpoint, case by case basis. In other words, there can be 500 calls that someone only saved 20 seconds with l/S, and 3 calls where someone saved 10-20 minutes, and you'd get the same average. I didn't do the math and that probably doesn't work out to 43, I was trying to make a point, get off my back and go find some goofs in a Star Trek movie or something.

Anyway, my esteemed colleague from Texas hit what I was getting at. I liked this program because in my opinion it looked at emegency medicine as a whole, instead of looking at ambulances and EMT's. EMS does not save lives, we may provide critical interventions, we may pull off some great work sometimes, but it is a continuum of care that saves the patient. There are those who want to have lights and sirens so they can play Dragnet, and there are those who view them as a means to expedite emergent care when necessary. I like to think in the latter.