I think it may be time to have real conversations about emergent driving

  1. We went non emergent to a grand mal seizure. But it was 3 in the morning with no traffic and the roads were pure ice so we weren’t even going speed limit. But we got an earful from family when we got there that we weren’t taking it serious.

  2. Thing is, this shouldn't be looked at as a problem. Lights and sirens need to be approached like a medical procedure with it's own risks and benefits. Missing a one in a few hundred is worth reducing crash rates which can kill and maim crew.

  3. Well I mean did that 1 min saved make a difference for the patient, you may look like an ass but that one minute isn't doing anything, that one min is the difference between you being in the store getting the food when the call drops, and being in the ambulance when the call drops, it literally is that simple.

  4. The city I work in has stroke as non emergent now. We do not respond with lights to strokes anymore

  5. Absolutely, the fire department is very guilty of this, but PD is even worse, if a guy gets slammed by a car and you are CPR certified, why aren't you doing anything, why are you just sitting there.

  6. I’ve had a sheriff deputy pass me up while responding to the same call. He beat me by like 2 minutes and was just standing outside, didn’t even make patient contact

  7. We shouldn't drive hot all the time, that's like line one of the EVOC handbook. My company has about 25 trucks up at a time and had over 400 crashes in 2021, mostly from reckless EMTs. It's a huge problem. And generally speaking, a lot of people don't know how to respond appropriately. There's a difference between responding hot and responding recklessly. I understand the adrenaline that comes with lights and sirens, especially when you're first starting, but chill out a bit. "Slow is smooth and smooth is fast" was drilled into my head for years and it works. We stress being calm on scene and not panicking during patient care, but we rarely address how to remain calm behind the wheel and it shows.

  8. Yea man, I just had a full argument with a firefighter who stated that the 30 seconds that we waste shutting down and not pushing people through red lights so that they get hit could be the difference between life and death. Which many studies say are false. There's just too many gung ho firefighters that cause so many issues with the emergency response stuff. They are way to on the trip that we are saving lives all the time.

  9. People forget the due regard part of EVOC all the time. Even state code regarding emergency vehicles require be it a chase car/police engine or whatever operating in emergency mode to break normal traffic rules to use due regard such as going through intersections with a red light etc. worse I’ve seen recently was just asinine. Literally fire on fire violence. Google Patterson NJ fire truck crash. Two fire apparatus responding and one T Boned the other the poster child for due regard.

  10. Yup. There is an EMT at my agency who goes code 3 to every call (including medical alarms, unknown medical and general illness) and argues that he should be able to make the decision because he's the driver. He drives with reckless abandon and runs people off the road, tailgates with less than 5 second following distance even when there is no space for them to pull off the road, and starts yelling, cussing people out and mashing on the air horn when they won't get out of the way sitting at a red light with nowhere to go when he just flipped the L/S on 0.2 seconds ago. One of the many, many reasons I am glad I no longer work with or have to interact with that person anymore.

  11. In my system, we have no priority dispatching. All calls are code 3 unless it’s like a lift assist, or a repeat caller

  12. I don't know if all calls in my system are code 3, but I know they'll run code 3 to my hospital for a stable IFT to the big hospital for higher level of care.

  13. We are one of those professions that don’t get to play “the boy who cried wolf” game. Whether it’s the first time or 50th time we have to treat every patient and every encounter the same. With that being said during every call you should be driving with due regard, blowing intersections is almost always bad practice.

  14. On more than one occasion, I've had EMTs who will drive for miles down the freeway in the right-hand lane, forcing the slower drivers into the middle lane, never once realizing that not only are the lights completely unneccessary if traffic is moving on a freeway, but that forcing slow, panicking people into the faster lanes is a fantastic way to cause an accident.

  15. Because we don’t have agencies utilizing EMD to the proper level. We have been going hot to stage for every psych call (along with an engine and PD) for over a month now because some one thought using EMD to determine the appropriate response was a bad idea.

  16. Luckily where I work we go routine to stage thankfully lol, that shit would piss me off if we went emergent just to sit down the street for 20 min waiting for PD to arrest someone or something

  17. Right bro, I shut down everything if I realize that I have no where to go, if you cause an accident because you pushed a person through a red light and they get slammed and die, that's on your ass 100%.

  18. I think we’re looking at it wrong. We don’t need to cut down on emergent driving because it’s dangerous. We need more rigorous training because it’s dangerous. I’ve never been through an EVOC course that focuses on actual emergent driving. All of the experience I have is from doing it real-time. There needs to be a shift in the teaching culture

  19. My service uses the Alpha, Bravo, Charlie, Delta, and Echo dispatch system. I've heard of other services uses it and when it works we love it.

  20. The moment we can be kreskin and know what the reality of a call is then you can decide how to respond to an incident. Problem is even EMD training hasn’t resolve these issues. Somebody complaint of chest pains maybe having a legit MI or it could be indigestion or it could be in between of a severe gall bladder attack which BTW if ya didn’t know if a GB perfs its fatal a vast majority of the time. I get the whole freq flyer mentality but the moment you assume a call is BS and it’s not your risking a lawsuit for your agency and yeah you could be personally held to account up and including your cert/license unless your an MD we don’t have the ability to see inside a body and know for sure what’s going on absolutely. While some depts even have the ability to do Istat in the field for BMP even TropI I’ve seen. Too many variables Yes we can make an educated assumption but definitive diagnosis remains the perview of the guys with the MD and sometimes DNP or PA next to their names. Hell ironically some thing like we have heee in AZ known as Dispatch health can handle crap better as they can do X-rays on scene and such (they are Medic/NP crew no emergent response).

  21. Na, if you run 1 homeless man that keeps calling and make your basis over that if we should run code or not then yes 100% of the calls should be non emergent.

  22. BS calls will 100% say they can't breathe or they have chest pain. They know it will mean we send someone to them first and with lights.

  23. No I agree, going code 3 to literally just wake a dude up for no reason because some white lady on the way home with her 7 kids thought he looked dead. Probably don't need to go emergent to that lol.

  24. completely agree, unfortunately if dispatch doesn't say cold, you have to go hot, we are not allowed to make our own decision about our response. Had dispatch send us hot for a rash the other week because it would have taken 20 mins for us to get there!

  25. I always ignore them if they tell me to light it up to something stupid. I'm not risking my life because dispatch has no idea what constitutes an actual emergency. Had a day where dispatch told me to light it up for "failure to thrive" and not light it up for "seizure like activity" Unbelievable. Only had them get on our ass once because they thought we were responding cold to an 'unresponsive' (we said something over the radio and they didn't hear our sirens- we were on the highway and turned them off)

  26. What the fuck do you mean they can force you to go hot? Thats your vehicle the moment you are operating it and your ass on the line if anything happens.

  27. I agree with you that it's probably not needed for the number of calls we use it for. However, here in NYC, with heavy traffic - using lights and sirens can shave a good 10 minutes off my response time. And you may not think that 10 minutes is a big deal, and usually it isn't, but the way our phone triage system works (or doesn't, for that matter) - I've shown up to plenty of shit that was a lot more serious than what the computer said it was.

  28. Yea but my point exactly is that 1 critical call that is coded as BS will make the biggest difference to that person and their family.

  29. Bro I'm a paramedic I know about about all these things you tryna tell me, I never said never go emergent, but it feels real stupid to drive to that sick person at the bus station, who is just homeless and needs a place to go. You know what I mean when I say what I'm trying to say

  30. You can also make that argument for pretty much everything. What if that one call presents asymptomatically but requires a 12 lead? Should we keep ALS for everything?

  31. I stopped at an intersection last night. It was raining. I was making a right, the driver coming from the left of me was making a left to head straight (away from me).

  32. Work in a system where everything is a “Priority 2” which is an emergent response as long as it is called into the the 911 center. Someone could call 911 to get grandma into the house and we would respond lights and sirens due to protocol. The company I work for has a call center that does EMD but people have to call it directly which is usually only nursing homes in the area. They offered to do all medical 911 calls for the city so it could be properly EMDed. They refused because it was taking away jobs for some reason. I work in a city with around 110k people and there are hundreds of noise companies on our service due to everything being an emergency response.

  33. I'm a paramedic in British Columbia. Our system here uses a triage system for 911 calls, and only about 20% or so of all calls warrant a hot / code 3 response.

  34. Number one killer in our line of work is MVCs, you turn your lights and sirens on you have a greater risk of getting into an MVC. And nationally we need to look into changing response guidelines l.

  35. The FDs around me have a policy of responding emergent to every single call and I think it's ridiculous. I get it, dispatch gets info wrong a lot but I've responded lights and sirens with an engine response to a "pulled G-tube" (It ended up not even being that- home health nurse couldn't get pt's iv antibiotics unscrewed from his port. So glad we endangered ourselves and everyone on the road for that)

  36. Yea where I work we go emergent to everything because the fire department in the area requires us to do it that way, gotta love private EMS. We responded last week so that we could consult tele health to refill some guys xeralto

  37. You gotta look at it from the other side here. You the layperson calling 911 because something fucked up has happen. You’re in a panic and maybe you haven’t explained the situation correctly. 1 min waiting for the fire, police, ems to show up feels like an eternity and all you think is “where the hell are they” or “what’s taking so long”.

  38. If it comes through the 911 line we go emergent to it. Plus, even if it's a frequent flier, this could be that one time they actually need help.

  39. I just turn off my lights and sirens to fix that bottom issue, than if they run into the intersection you aren't the cause of it on paper. Yes the guy that I was just arguing with about this says he fully supports and has done ramming into other people's cars to go somewhere. That's bonkers and I cannot believe anyone supports that.

  40. Bro, you are not immune to accidents because you are so "well trained" in driving, accidents are called accidents for a reason. I've never been in one, but I know people who have been hit and got very hurt.

  41. Lights and sirens use is statistically associated with an increased risk of crashes. I am 100% sure that if similar studies were conducted in the UK you would see similar results. Not all crashes are going to be something you will reduce or stop by your own actions, regardless of training.

  42. Firefighter here and I can tell you that a lot of this falls back on dispatch. We will get toned out to a pt with chest pains and difficulty breathing and they will dispatch EMS to same call and say the patient is having blood pressure issues. FD comes in balls to the wall and we are waiting on EMS. Or vice versa. EMS gets a call for heart or stroke and calls for lift assist. We just get told it’s for a lift and go in cold only to show up to full on chest compressions taking place.

  43. It should take long to get comfortable. If you think you have seen enough in 4 years to be a pro then you should re-evalute what things you have missed and didn't realize it. And usually big cities are sub-divided to multiple ambulance companies so it really doesn't make that much difference what size the city is but more what kind of people live there ex: retirement, low income, gangs, homeless population, ect. I have ran in Vegas the last 25 years so I understand how big cities and little cities function.

  44. Never said I was a pro, but your years of experience don't matter at all on this issue literally at all. Completely irrelevant. This is an issue, just like most things that are solved by newer people

  45. No years of experience counter the data which shows that for the most part, driving lights and sirens is far more dangerous and in most (but certainly not all) cases unnecessary.

  46. If you think emergent driving is not needed you have not been doing this job long enough to get those time critical calls or you are to burnt out to care. Next time you drive emergent to a call count how many lights you went through and add 2 min extra per light. Then hold your breath for that long and see if you would want someone there sooner.

  47. Some of us work in places with almost no traffic lights. Where I work I would argue they aren’t even needed for arrests because there is almost no difference in response time. I drive slower emergent to account for the way people act stupid when they see lights.

  48. I'd suggest the opposite is true. If you've done this job long enough you realize the overwhelming majority of calls do not require emergent driving. There have been multiple studies showing that, save for a few types of calls (cardiac, stroke, choking, major trauma) emergent driving not only doesn't improve outcomes, it increases the risk to the medics.

  49. I think the opposite is true, I've been in this field for 4 years, that's more than a lot of people, don't try to tell me I'm inexperienced cause you disagree

  50. Former EMT, now PD, THANK YOU for bringing this up. It will be 3am with 4 cars on the road and the medics will run code to a stomach pain call, lights, sirens, the works. It's not just bad safety but why wakeup everyone in the city when driving normal is safer and better for everyone.

  51. I work at a private 911 provider and our dispatch center doesn't receive actual 911 calls, the fire dispatch does and then forwards the info to us. Except they don't EMD a priority for ambulances so nearly every call is code 3 ALS unless there literally isn't a medical complaint from the caller in which case its code 2 ALS. It's ridiculous.

  52. There's two sides to the "do seconds really matter" debate about emergency response and both have valid arguments, but can we just agree that limiting how often people drive like reckless assholes is not the answer? Whether you drive emergency 10% of the time, or 50, or 100, these situations where people roll their fire apparatus or blow through red lights should occur exactly 0% of the time.

  53. In my area we tend to have the opposite problem which is tired and burnt out providers unwilling to go hot to anything.

  54. Yes they do, believe me I know. Volleys have less intense evoc courses, less pr issues, run in small towns where prosecutors would support basically every thing they do, there is a difference.

  55. In my evoc class they told us that emergent driving is the most dangerous thing we will do. They also said on average drive code 3 saves less than a minute. 9/10 times it’s not worth it.

  56. Last service I worked for full time did priority dispatching. We probably only ran emergency traffic to 60% of our calls. But I’ve also been sent to non emergency or priority 3 calls that turned out to be stemis etc. time saved running hot is minimal and much more dangerous. I’m all for priority dispatching

  57. I pretty much only run hot with a patient on board if someone is straight up actively dying, and it’s either reversible or I need stuff that the hospital has that I don’t have like whole blood or something. Otherwise we go chill mode to the ER every time.

  58. It annoys me when doing critical care transport when they want us to go emergent for a transport that is not time sensitive (I’m ok for going to the OR, cath lab, ECMO candidate, or IR for a thrombectomy). Sorry but they are in a hospital not waiting in their house or on a street corner.

  59. In my service in Ontario we only have to drive lights to our highest priority calls (Priority 1s). We have the option on Priority 2s but most don’t. Everything else is mandated to drive non emergent

  60. I can remember a blog of a Dutch medic that visited an EMS team in the US. And he was surprised they basically always drove with lights and sirens. And also that when they drove with lights and sirens, it lacked urgency. Like they just drove the speed limit together with other traffic, what is even the point of lights and sirens at that point other than making it more dangerous without the benefit of being quicker?

  61. Completely agree, in my country the majority of calls are done without lights/sirens. The number of patients I see the paramedics bring in with lights/sirens and going probably more quickly than safe, for them to just be left in the hallway to wait for a nurse/physician is ridiculous.

  62. Absolutely, I hate when I go emergent and show up to find a triage appropriate person, me and my partner and possibly a trainee or a student just risked our lives to put a patient in the waiting room. Ain't worth it

  63. I'm on a volunteer squad, and yes, it seems like some of the people are only there for the opportunity to drive the blinky bus the way they always fantasized about. I'm quietly glad we have a speed limiter.

  64. Oh that's nice, atleast that's in place, I don't mean any actual hate to volly firefighters, but there is a trend with them not being medically trained and not understanding the fact that we do not make it to the call that person in far more likely to die than if we are like 1 min late

  65. Where I live we barely go code 1. Our ProQA may tell us code 1, but we are allowed to use our discretion. We don't have the traffic to justify the need.

  66. Right up until you don’t drive emergent to what you think is a lift assist and as l ends up being they’re on the ground for a full blown arrest.

  67. There are many agencies current running hot to all calls, where I work already does not run hot to lift assist, have lift assist become really sick patients, absolutely. Would we really have saved that much time by going emergent, absolutely not, maybe make it 1 min to a min and half faster.

  68. Recently in my city a firetruck was driving erratically on the way to a scene and crashed into a building: killed multiple people. Sad part was the truck had been called off and another department was dispatched. Truck went anyway and barreled through a red light, hit an SUV, then hit a building. Killed 3 people

  69. I think the dispatch protocols in my area need a major overhaul. The triggers for an emergent response are so slight, that going light speed to pick up a tooth ache because he can't get in to their dentist until tomorrow morning and they haven't taken their meds is not necessary. I cut my L&S at the earliest opportunities, but my threshold to use them sees good merit and careful thought as well. I don't flick them on if I think I'll put the traffic around me at risk of one person's stupid idea, but I will nail the horn if needed. Many newbies are surprised what a quick double tap does to move traffic instead of laying it on thick.(especially if there are pedestrians walking puppies)

  70. I see both sides of this argument. I 100% agree the use of emergent response is over utilized, and the majority of our calls don’t require them. Looking at it from a liability side though, dispatch and the governing body are using the emergent response to cover their asses. In a time of litigation, if that drunk at the bus stop who’s called 7 times in the last week is truly having a medical emergency, you better believe he just reconnected with his long lost lawyer family member. The whole dispatch system needs to be re-evaluated.

  71. From my experience, emergent driving very rarely helps. I work in a rural area and the nearest cath lab is a 30 minute drive. The nearest level 2 trauma center is 1.5 hours away and same for a children’s hospital or a decent neuro hospital. We just fly what we can if it’s bad. I like to consider risk versus reward.

  72. Our policy specifies emergent to ALS calls unless weather prohibits, BLS/ILS it’s crew discretion. I’d say we drive non emergent more often than not to those unless call notes sound serious. Even then though we can people who drive dangerously and won’t take coaching.

  73. I think that you definitely have a very good point but I've also been the BLS truck that showed up to a service call and it turned out to be a full blown code. It's times like that where I'm glad we still went emergent. But with that being said I also agree that a lot of drivers in EMS are very reckless. I think the best solution would be to get strict about driving protocols. We all took EVOC and so we should all act like we've been trained to drive emergent instead of blowing through intersections and forcing other drivers to risk their own safety.

  74. I 100% agree with this, but with a caveat. Code 3 driving is easily the most dangerous thing we do in this profession, but if we are going to make the code 3 or code 2 response distinction before we arrive we need to ensure our 911 call-takers (who often are our dispatchers, but not always) are trained to ask the right questions to determine what level of response is warranted. PSAP is already standard in some places but it would need to be implemented on a much larger scale, especially in rural areas where going flow of traffic can easily tack on several minutes to response times. If a 911 call-taker/dispatcher can’t get information out of the caller, default to code 3 response.

  75. Definitely a time and a place. But, alternatively, there are professional EMS drivers that don't take it seriously enough and will go on a Sunday drive to a 3 month old choking on her own blood (true story).

  76. I second this, and would like to up the ante by saying (seriously) why put people at risk going to pick up the same person seven times, or anyone, for bullshit, regardless of response speed.

  77. The chronic back pain !!! Or granny’s tummy had been upset for 2 weeks. These are the calls that make us a hero!!!!

  78. We implemented a policy that all lights and sirens use needs to have paperwork completed with justification & the run be reviewed by a committee to determine if it was necessary. In a year we decreased usage by 90 percent.

  79. No even if you drive safe driving hot is way more dangerous that cold. There is endless studies that driving hot is literally the most dangerous thing we do on a daily basis. They teach you that in EMT and paramedic school, as well as there is plenty of online research to prove it.

  80. I rarely go L/S anymore. I work in a rural area and the time saved is really not much unless we're in town, and even then it's debatable. I almost never transport code 3. The 1-2 minutes it saves is not going to make any measurable difference except in cardiac arrest, major trauma, and maybe stroke, and puts you and everyone else on the road in considerable danger because people already cant drive normally in best conditions. I mostly only go L/S to CPR in progress/unresponsive/traffic collisions/possible stroke anymore. The argument of "but it could be the one time!" Is not a good argument because Any dispatch could end up being anything. IMO L/S is used many times because people like to feel cool, do things other people can't, it's a sacred cow, and we vastly overestimate the amount of difference saving 90-120 seconds is going to make.

  81. also, as someone who understands that it’s fun to drive fast, if we get dispatched non-emergent to something, let’s not insist on still going way over the speed limit and disobeying traffic laws just because we can. if it needs to be upgraded, dispatch will upgrade it. i’ve seen EMTs, Paramedics, and firefighters do it and it’s equally unsafe for all of us. if you are dispatched routine to a call, why the hell are you going way over the speed limit (i’m not talking a few mph over on the highway, i’m talking about people that i’ve seen going 20 mph over in residential areas and on busy ass streets), blowing through signs and lights, disrespecting school zones, and just generally driving emergent without lights or sirens? even if it’s late at night and you don’t see anyone around, what if someone else decides to also speed and run a stop sign, you don’t see them, they don’t see you due to the lack of lights and sirens, and you end up in a crash? i promise that’s not going to help anyone. i swear, some people seem to think that just because they’re in an emergency vehicle, they can do whatever they want at all times. STOP GOING WAY OVER THE SPEED LIMIT AND DRIVING UNSAFELY ON NON EMERGENT CALLS .

  82. Driving lights and sirens needs to be approached as a medical decision. Allowing a limitedly trained EMD to make that decision over a paramedic is just stupid.

  83. Well I mean the reality is that EMS has come a long way, we do more home health calls, community service than we used to, a lot of calls we go to are not significant, and are more of a community service type call, bringing the homeless to home less shelters,having the ability to do tele health consults on scene to get med refills or things like COVID figured out.

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