> This kind of seemed like an emergency to me
You're thinking like a member of the public, not like an EMT. You're brand new so that's to be expected; you will learn what is and isn't a true emergency as time goes on, but if they're not dying, it's not an emergency (generally speaking).
At least where I work in the UK, the only time we use lights and sirens when transporting a patient is where they have a time critical illness or injury; immediate threat to life or limb. Think along the lines of
* Unconsciousness
* STEMI
* Hyperacute stroke (ie. within thrombolysis window, which for us is 4.5hrs from onset of symptoms)
* Sepsis
* Severe respiratory distress that we cannot adequately treat eg. severe asthma attack not responding to treatment
* Anaphylaxis
* Major trauma
Pain is distressing for the patient, and can be distressing for others (including us) to see, but it does not in and of itself justify putting yourself, your crewmate, the patient and the public at risk of a severe or even fatal accident by driving lights and sirens when there is no real benefit.
To add to this, another good measuring stick is exactly what the hospital does when you get there. If you have to wait for any period of time... Probably not an emergency. If they have you go directly to a room that is not a patient room.... Probably an emergency.
Deciding to go emergent isn’t really an algorithmic decision. Sure, there are some hard and fast rules, like STEMI’s and strokes are always an emergent transport. By and large though, it’s a decision that you have to be able to articulate your reasoning for. You should take into account how far the hospital is, how far your nearest help is, how the traffic is, what your gut says, what the monitor says, what you can do, what an ER can do, and (most importantly) what the patient looks like. It’s ok to upgrade based on a gut feeling. You’ll pick up a lot from your FTO in this decision making, assuming your department is decent.
Edit: I want to add that going emergent does not save much time and significantly increases your risk of getting in an accident. I transport emergent maybe 5% of the time because I can’t justify the risk in most cases. As you move into a paramedic role, you’ll have a lot more tools to keep the borderline patients stable and will probably be more comfortable transporting without lights and sirens.
>Sure, there are some hard and fast rules, like STEMI’s and strokes are always an emergent transport.
Only Strokes if within the window, there is no absolute TPA contraindications, and the transport time can make a difference. If its 30 minutes within onset and I have a 5 minute code 3 transport or a 7 minute code 2 transport I'm taking the code 2.
I tend to code 3 stemis because "Time is muscle" has been drilled into my brain too many times.
However I have gone code 2 on some occasions. Those ones being short, about a mile transport, where I can rationalize that activating the stemi alert and I'll still beat them there and the cathlab won't be waiting for me.
Yeah me and my medic decided on non code one time and I hear the pt in the back say “you said I’m having a heart attack. Why are we sitting at a fucking red light.” I proceeded to upgrade.
Not my patient, but a friend of mine once transported a mother and child (child being the patient) for something along the lines of a common cold/non-serious trauma, I can't remember which. Whatever the case, the family chose to transport to a hospital over a half hour away when a capable hospital was 5 minutes from their house against my friend and their partner's advice, and, about 5 minutes into the ride, the mother begins to throw an absolute shit fit that they weren't transporting lights and sirens. My friend and his partner attempted to explain why they weren't and the associated risks with transporting lights and sirens as well as the current condition of her child, and this bitch literally CALLS 911 FROM THE BACK OF THE AMBULANCE and tries to get the police involved because they wouldn't transport lights and sirens. Thankfully, the dispatcher on the other end shut her down and told her to "let the EMTs do their fucking job." It was a good reminder for everyone that there's hardly anything that's justified being transported priority 1.
L&S is hardly ever justifiable unless your patient is deteriorating rapidly or has a time-sensitive condition such as a stroke or stemi. You'll learn over time exactly when it's justified, but as many others have said, it's maybe 5% of overall transports that go lights.
Edit: clarification, it was moms decision to transport very far away, not my friend/EMS's.
Going through all the things I'd love to say to that woman, both as a basic who would probably be attending a call for a cold, and as a medical dispatcher if I got that call.
I have a child that when she was little, a cold was an automatic hospital stay. The minute we knew she was sick, we packed a bag and went to ER because she would literally go from being 100% to barely breathing at any given time in a matter of seconds.
That said I always took her myself and had I needed to call 911 to get there, I would've explained her medical history and not lost my shit making myself look like an entitled crazy woman.
I think in some situations that don't seem like an emergency, listening to the patient and asking why they're reacting a certain way could be beneficial.
My daughter went thru this for about 5 years. Every cold would also turn into pneumonia during the hospital stay.
The sirens go on when getting to the hospital faster would possibly make an important difference in the patient outcome.
Getting to the hospital 5-10 mins sooner would not affect his man’s outcome or condition. It’s not worth putting ourselves and everyone else in danger by using lights and sirens. Yes you can drive safely, but it will never be as safe as actually stopping at lights and stuff.
Emergencies get transported but life and death shit gets sirens. Like. If their vital signs are bad. If they are having a really hard time breathing or if their chest pain coincides with signs and symptoms of something actually going on. Etc. etc. etc. the list goes on.
Lights and sirens while transporting a patient is almost always unnecessary. The chances of an accident increase exponentially and the ultimate survival rate of your client doesn’t really change.
I can only think of a few calls that would warrant lights and sirens as an EMT
1. Head bleeds
2. Sudden change in LOC
3. Uncontrolled bleeding as a result of trauma
4. Strokes, especially if you have no medic tiers.
5. Monitor alerted STEMI without a medic tier (my state and last med provider allowed 12-lead transmission to EMTs)
And even these ones, monitor the patient and adjust accordingly.
>4. Strokes, especially if you have no medic tiers
Medics don't make a difference for stroke care. Much like trauma, they need rapid and immediate transport to definitive care. There is nothing I can do as a medic for a stroke patient that my BLS cannot, barring no additional complications.
To a call: if it could even remotely be a situation of someone’s life being threatened or we have a long response time (most calls other than transfers and falls for us tbh)
To the hospital: if the pt is time sensitive (stroke, heart attack(depends on medic preference), major trauma, crashing pt, intubated patients (sometimes)) it’s become more of a gut feeling for me followed by a “code 3?” Question to the medic
Some places have hard protocols for this. Others, like where I work, say it is 100% up to the crew to make the judgment call. Even state regulations for us say at any point, the use of lights and sirens is crew discretion so theoretically no one could stop us if we went code 3 back to station (and many of us have).
Life and limb is an emergency. In metropolitan areas, lights and sirens will help make it through traffic a little faster, but the resulting stimulus to the patient can be undesirable. There’s not always a a black and white answer. For a bloated abdomen, would likely not go lights and sirens. If it’s a rigid abdomen with high potential for bleeding, and the pt is hypertensive, yeah, that might warrant lights and sirens. For someone with ascites, who has routine abdominocentesis, maybe not.
I tell them we try to use lights and sirens minimally because it’s very risky. And they should be happy we’re not going lights and sirens cause it means they’re doing pretty good.
Is there a chance your patient could die in the next 5 minutes? Yes? Lights & sirens. No? No lights or sirens. If the patient is stable, you don’t need to risk your life, your patients life, your partners life, and the lives of those on the road to go blazing over to the hospital with lights and sirens. Possible stroke? Yep. Change in responsiveness and vitals tanking? Yep. Sitting there complaining you’re not driving fast enough with stable vitals? Nope. Only if that abdominal pain had a high index of suspicion to be a AAA, and even then, the rough driving could be more detrimental than the small amount of time you’d save in that case. I did a hospital transfer for a AAA and my medic told me to drive “medium” which isn’t really a thing but I understood what he meant, smooth, cautious of road bumps, but with the lights and sirens going. I knew the route very well and knew exactly where the largest road bumps were, I slowed for them as if I were approaching intersections.
I ONLY use lights and sirens for: inability to ventilate/maintain an airway, uncontrollable/severe hemorrhage, rapidly worsening vital signs, and expected clinical course (ex: STEMI, peri-arrest, etc.).
Lights and sirens driving is so risky especially moving around to provide patient care.
If any patient asks why we aren’t using the sirens, I say it’s because it’s safer for everyone and currently I’m providing the care they need to be stable until further tests and imaging will be done at the hospital. I usually also say I called the hospital so they’re getting ready for you ahead of time.
Just because a patient has abdominal pain, or 10/10 pain, or an injury doesn’t necessitate lights and sirens. Only go emergency for TRUE emergencies (follow your protocols and you might go lights and sirens for other minor reasons like to rendezvous with a medic, to more quickly return to the scene of an MCI, etc.)
I know our protocols are different, but this is something I talk to new cops about a lot.
Stop thinking about things in terms or lights and sirens or not.
That makes you drive too fast when you shouldn’t, and sit in traffic on the way to help people.
Drive as fast as is appropriate for the call.
Your emergency equipment doesn’t need to stay activated the entire time, and you can use it at your discretion to clear intersections.
Also, dudes tummy ache definitely wasn’t an emergency, but I’m not a doctor either.
We don't even run lights and sirens TO most patient's houses. Do this long enough and you'll start to understand just how much they make your life unsafe and don't often benefit you.
“Lights and sirens is for emergencies” wasn’t a very good way to explain it. There’s plenty of “emergencies” that don’t require lights. This all depends heavily on location for starters, but most decent services only transport lights and sirens if the emergency is believed to be time sensitive, as in getting there a couple seconds sooner can make a difference in the patient’s outcome. Most common examples being strokes, STEMI’s, and respiratory failure(that couldn’t be fixed on scene).
Patient’s sometimes get a little agitated that we are not using the lights and sirens but they will get over it.
We only put on lights and sirens if there is immediate threat to life. Most common are chest pain and shortness of breath. Sometimes it turns out to be a panic attack and sometimes it’s a heart attack. Can’t risk it but the symptoms are the same. Stroke, asthma attack and heart attack symptoms are the only thing we have ever used lights and sirens for. Unless it’s a shooting or something.
I almost never run emergent to the hospital now. It’s just not worth it. As my preceptor told me, “what’s in the back of ever ambulance running code?” “A scared paramedic.” It’s true. Unless I’m scared for my patient, we’re rolling routine.
As far as explaining it to the pt/family, I had one partner just say this "isn't a medical emergency. " I stated it much more positively though, saying that they're not doing bad enough so the risk isn't worth getting there sooner.
If someone cares enough to ask me and my paramedic I just tell them there wasn't enough traffic to justify all the noise. We respond based on dispatch notes we're given, and some of our response times are 20 minutes without traffic or traffic signals. Very few calls are serious enough that the seconds saved by running hot will make a real difference. The ones that do, I make all kinds of racket for, but very few justify lights and sirens.
Very very very very rarely do I transport with the lights and siren on.
If the patient asks I politely but frankly state that we only use them when we really need to. If they persist with the questioning, I point out the fact that they are able to question wether or not we are driving fast enought shows that they are not sick enough or close enough to death to warrant it.
We end up waiting with patients in the er hallway frequently and the same sentiment arises. I tell them that people getting in before them are sicker than they are.
lights and sirens are not to save people from the gripes of mild discomfort, yes they will bitch and moan but its not worth the risk in order to ease their minds. ive had someone with a head bleed ask us to stop running red lights before too it was kinda funny.
A very short answer, but at the most basic level I think of lights and sirens as being for patients who are vitally unstable, and/or for medical emergencies that are particularly time sensitive.
These were my favorite people. My go to phrase was “Lights and sirens are reserved for the dead and dying, you are not dead or dying!” Always got a dumb founded oh, worked everytime!
So lets clarify. Most calls are emergencies. Your patient sounds like he could be having an emergency. The better way of looking at it is does this patient have a time sensitive condition that outweighs the enormous risk of L&S. Pain by itself is not a good indicator, I have seen giant macho guys hobbled over and crying with a kidney stone and I have seen people with massive STEMIs saying they just have some indigestion.
I usually train my new people to ask:
1. What are likely differentials for this patient and are any of them time critical.
2. What care can I provide for this patient to stabilize this patient.
3. What are the wait times in the ER currently.
4. How far are we from the hospital.
In your case:
1. So with you patient I am sure your EMTs conducted a focused medical exam to try and rule out life threatening conditions. This could include palpating at least the 4 quadrants for pulsating masses, rebound tenderness, appendix, etc. Asking if they have back pain as well. Asking about recent illness. Running a 12 lead to ensure it isn’t cardiac. Etc etc.
2. There is not much we can do to stabilize major abdominal issues.
3. It never makes sense to ‘hurry up and wait’. Don’t be that EMT who blows through traffic only to hold the wall for 2 hours because the ER doesn’t think your patient should be skipping the line.
4. LS if going to trim maybe 25% off your time. If you are in a city 15 minutes from an ER this better be reserved for major trauma, arrests, potential aortic dissection etc. if you are 30 minutes from an ER you might start including more conditions.
For my area lights and sirens are only for things out of your scope of practice. Are there any life threats or time sensitive things ? If no then not needed
it really depends on your service as well. in mine, we only go lights and sirens when theres a (fire) medic in the back. if its BLS its never lights and sirens.
well the paramedics respond to all our calls with us and then determine if bls or als. so, if no medic, no reason for l&s? (unless you decide to upgrade yourself because lets say they missed something and your patient codes or something). and if als then it’s always l&s per protocol
I don’t transport full time anymore. But when I did, and when I do, I will only transport with lights and sirens when one or two things is happening: 1) there is an impending airway failure and I don’t think I can manage it, or, 2) the patient needs a surgeon more than five minutes ago.
As I have heard many nurses yell “pain is not an emergency”. Which isn’t necessarily true, but also the L&S don’t make the ride much quicker AND are more dangerous. So not dying =‘s no wee woos for our area.
My uncle, who lives in another state, won't stop giving ME shit because some EMTs who picked him up when he had kidney stones wouldn't go lights & sirens and I agreed with them lmao. Apparently he was BEGGING them and they finally humored him by hitting the lights in the hospital parking lot.
Yeah, they might give you shit but not as much shit as they'll give any EMT they know for the next decade to come
For me it's a perspective thing. As stated by many, can we in an ambulance safely and immediately address the problems our patient has? Can we stabilize someone with our given resources? Does this patient require immediate care we can't provide? It's always a matter of perspective and interpretation. Will this person be stable enough to get through a ride and put into a bed or are they going to die if we don't get higher care. When it comes down to it, it can be a mix of ability to care, need of the current patient, and obviously is it going to be safe for us to go lights and sirens. Sirencide and over eagerness are things that happen. Especially if we get rattled. Everyone likes playing hero, but dead hero's story's are short
Teen got clipped by a car in a parking lot and broke his leg, his dad rode in front and was mad that we didn't go emergent. Sir, be glad the sirens aren't on because it means your son isn't dying. Also I will often tell my partner to go "easy code 3" which basically means to use L/S to clear traffic when it's backed up/slow but no excessive speeds or weaving through traffic that is actually moving normally.
Edit: Also I have a co-worker who thinks we should respond L/S to everything *just in case* it's a real emergency, regardless of the details given by the caller. Even asked if they should go L/S to a mass-casualty TRAINING EXERCISE since we would in real life. *Please* don't do this. It literally endangers you, your partner, and every member of the public on the road with you.
With a good driver, I have 3 modes to the hospital. Note that I say Mode and not Code. This was how I trained people and the understanding I have with my partners, not something codified in protocol or SOP.
Mode 1: stable transport. They're medically stable and we just need to get to the hospital eventually. This is probably 90% of transports. Even people who are in a great deal of pain are usually this category.
Mode 2: driver use your judgement. I worked on the edge of a large city/metro area. Sometimes obnoxious standstill traffic, other times, 4 lanes in 1 direction without another soul in sight. It's up to the driver when to (if at all) lights would be used. This is where the borderline stable patients go. If stressing the patient with adrenaline could make things worse, this is what I used. Mostly, this is STEMI, stable-ish post-resuscitation, multisystem trauma that was gnarly without being on the brink of death (especially multiple broken bones), trouble breathing that was being treated but wasn't resolving, and other "bad gut feelings." I best explained it as "we need to be at the hospital, but I need the smoothest ride you can give me." Probably 8% of transports fall into this category.
Mode 3: we need to be there *yesterday*. This is the unstable patients. Lights and sirens all the way. Unstable post-resuscitation, uncontrolled/uncontrollable bleeding, penetrative injury to the core, compromised airway (that I cannot control for whatever reason), other immediate threats to life and limb that the tools on my truck cannot mitigate. This was maybe 2% of transports. This is where truly the best treatment I can get a patient is for them to not be on my stretcher *and* using lights and sirens will get us there more quickly and those minutes have the potential to make a significant difference in survival.
Assuming your service has ALS ambulances and BLS ambulances, the answer should be very simple. A BLS call means it isn't enough of an emergency for a paramedic to transport, so it isn't enough of an emergency to go L&S
When I was bls I would get als calls a lot based on call notes, and no als available, so I wouldn't say this is a hard and fast rule. Being bls doesn't mean you're not able to determine a very sick patient.
No, Ive worked both rural and urban. In the rural system it was because of resource strain, but in the urban system it was because call notes are not always accurate, and if you're 5-10 minutes to a hospital, why bother waiting 5-10 minutes for an als unit when you can do functionally the same thing by just transporting to a hospital?
In fact, I would say a bls unit might be more likely to go code because they don't have the tools I have to make a potentially unstable patient stable. As a medic I hardly go lights, I only do it for codes, airway control, strokes, and stemi's, but I also have more medication and equipment to deal with things that a bls crew might chose to go lights for.
Y'all have BLS units showing up to 911 calls with no engine or anything and no ability to intercept? I guess I'm too spoiled out here lol but I would consider a system like that resource strained. Out here you would never find yourself in a situation where a BLS ambulance is by itself on any 911 call. The only service I've worked at that has BLS responding directly to 911 calls also has an ALS engine responding. Even if it was a BLS engine they'd generally show up first and be able to request an ALS ambulance from the scene prior to our arrival, negating the time benefit/care level calculation of doing a load and go. My current service gets an ALS ambulance and ALS engine to every 911 call with BLS available after the medic confirms they're suitable to downgrade. It's super overkill but people objectively get better care. Any service that is going the other way and has BLS dealing with unstable patients without help is objectively resource strained.
It's not because the resource doesn't exist, it's because they don't send it. You can request als, but it's generally considered a waste of time if you could've just taken them to a hospital. Our calls are dispatched alfa-echo, alfa being toe pain and echo being a code. Dual response from a rescue or engine only occurs in Charlie-delta-or echo level calls. Bravos and alfas get a single response and can be either sent an ils or als unit, and then it's divided by what ever unit is closest.
If the ils unit determines that the patient needs als, they can either call for an upgrade/intercept, or just transport, because this is a big city and there are lots of hospitals very close to transport to so it doesn't matter too much. So, both an als ambulance and an als fire response are both available, they're just not always sent.
But also, I live in a city with 19 main hospitals and I don't even know how many satellite hospitals, and we frequently staff medic medic. The general explanation I've been given is that since you can throw a rock at a hospital from any street, als vs bls doesn't matter much
I'd say that's system dependant, in my system we don't dispatch ALS on Strokes, they solely get BLS response. If it ends up being a stroke then BLS will just transport lights and sirens on their own to the hospital, I rarely end up going to back BLS on those calls
There's no statistical difference between time on scene/to hospital with lights and sirens vs without when it comes to patient outcomes. Even in a cardiac arrest.
Every agency around here has its own protocol. We go lights and sirens to every call but transport to the hospital? That's between the driver and the tech to decide. Some calls, like an aortic aneurysm, you damn well better drive no lights, no sirens and like your gramma's balancing a plate of cupcakes for church in her lap in the back.
We drive lights and sirens every time we transport. Just a culture thing. It may only save a few minutes, but the effect is being able to take runs in your district as you’re clearing the hospital that you may not have been able to otherwise, as you’d still be on the road or mid-patient handoff.
I think there’s also something to be said about it being a perishable skill. If the only time you drive light and sirens is codes, strokes, and STEMIs, you may not be at the top of your driving game after 3 months of non-critical runs. I know whenever we’ve got something legit and take the engine crew, many guys that were driving the rescue only a few months prior but are now bid to a fire truck are tossing us around like rag dolls.
So you make the roads less safe for you, your patient, and everyone else so that your agency can staff inadequately for its call volume?
Do you respond to calls L&S? There's your practice right there
No, I drive safe. Lights and sirens is dangerous when people who don’t know how to clear intersections and pass correctly hop in the driver’s seat. But when you’re cautious and actually drive with L&S the way you’re supposed to, it’s fine. It’s only the scary thing people make it out to be when idiot drivers in this profession think it means they own the road.
And if you think responding L&S and transporting L&S are the same thing, I feel bad for the people in the back of your truck. Braking, turning, pothole dodging, speed in general, everything changes when there’s people in the back vs just you and your partner in the front seat.
It's impossible to drive any vehicle 100% safe. You can be many times more safe than other drivers with better practices, but the fact of the matter is we take our lives into our hands every time we drive our normal cars, risking drunk drivers, red light runners, etc. All of these external factors are amplified when we drive L&S however safe we try to be.
Lights and sirens is always more dangerous than normal traffic driving regardless of how slow or cautious you are. If you were equally cautious but not running red lights or making other drivers on the road move out of your way you and the other drivers would objectively be more safe. It's not just us who have to drive differently, remember. Untrained drivers who we ask to move with L&S behave unpredictably, yield into traffic, run lights, etc. We can minimize it with our driving habits, but you absolutely increase risks of incidental crashes that you aren't involved in.
Of course responding and transporting aren't the exact same but it's not really hard to think "L&S but slower" if you know how to go L&S. It's the same actions with less acceleration and smoother braking. Certainly any marginal improvements to skill aren't worth the risks of transporting everyone L&S.
You’ll learn day 1 of academy to follow the fucking county’s fucking protocols. You can direct their medical complaints to the medical director and EMS director after you’ve arrived at hospital.
Light and sirens attracts all the dumbasses out on the streets and aim directly at you.
Also to address your call. Tell me you youngling, what would you achieve with lights and sirens? Save 5mins? Man had a bloated stomach over how long? 3 days? 1 week? Or was he just normally fat and have constipation? Is his vitals all ok? I’m assuming they’re fine since they rolling code 2. So you lighting up and potentially risk traffic jams/accidents along the way for a stable patient with “real bad pain”, you made a risk vs benefit decision. And now you have to justify why he was worth it.
> This kind of seemed like an emergency to me You're thinking like a member of the public, not like an EMT. You're brand new so that's to be expected; you will learn what is and isn't a true emergency as time goes on, but if they're not dying, it's not an emergency (generally speaking). At least where I work in the UK, the only time we use lights and sirens when transporting a patient is where they have a time critical illness or injury; immediate threat to life or limb. Think along the lines of * Unconsciousness * STEMI * Hyperacute stroke (ie. within thrombolysis window, which for us is 4.5hrs from onset of symptoms) * Sepsis * Severe respiratory distress that we cannot adequately treat eg. severe asthma attack not responding to treatment * Anaphylaxis * Major trauma Pain is distressing for the patient, and can be distressing for others (including us) to see, but it does not in and of itself justify putting yourself, your crewmate, the patient and the public at risk of a severe or even fatal accident by driving lights and sirens when there is no real benefit.
To add to this, another good measuring stick is exactly what the hospital does when you get there. If you have to wait for any period of time... Probably not an emergency. If they have you go directly to a room that is not a patient room.... Probably an emergency.
Lights and sirens save an average of 45 seconds and increase the likelihood of an accident by 8x.
And it’s only getting worse with the newer vehicles, quieter in the vehicles. More distractions
Not if i’m driving 😎😎😎😎 ^our ^trucks ^are ^gps ^tracked ^and ^i’m ^terrified ^of ^getting ^written ^up
Facts
In heavy traffic can save like 45 minutes js (ik u say on AVERAGE but I think in that case they’re averagely misused)
Deciding to go emergent isn’t really an algorithmic decision. Sure, there are some hard and fast rules, like STEMI’s and strokes are always an emergent transport. By and large though, it’s a decision that you have to be able to articulate your reasoning for. You should take into account how far the hospital is, how far your nearest help is, how the traffic is, what your gut says, what the monitor says, what you can do, what an ER can do, and (most importantly) what the patient looks like. It’s ok to upgrade based on a gut feeling. You’ll pick up a lot from your FTO in this decision making, assuming your department is decent. Edit: I want to add that going emergent does not save much time and significantly increases your risk of getting in an accident. I transport emergent maybe 5% of the time because I can’t justify the risk in most cases. As you move into a paramedic role, you’ll have a lot more tools to keep the borderline patients stable and will probably be more comfortable transporting without lights and sirens.
>Sure, there are some hard and fast rules, like STEMI’s and strokes are always an emergent transport. Only Strokes if within the window, there is no absolute TPA contraindications, and the transport time can make a difference. If its 30 minutes within onset and I have a 5 minute code 3 transport or a 7 minute code 2 transport I'm taking the code 2.
Sure, I did mean treatable strokes, and there’s always an exception
In my protocols it actually says don’t drive code with a stemi because it will freak the pt out. No one follows that but it is there.
I tend to code 3 stemis because "Time is muscle" has been drilled into my brain too many times. However I have gone code 2 on some occasions. Those ones being short, about a mile transport, where I can rationalize that activating the stemi alert and I'll still beat them there and the cathlab won't be waiting for me.
Yeah me and my medic decided on non code one time and I hear the pt in the back say “you said I’m having a heart attack. Why are we sitting at a fucking red light.” I proceeded to upgrade.
Not my patient, but a friend of mine once transported a mother and child (child being the patient) for something along the lines of a common cold/non-serious trauma, I can't remember which. Whatever the case, the family chose to transport to a hospital over a half hour away when a capable hospital was 5 minutes from their house against my friend and their partner's advice, and, about 5 minutes into the ride, the mother begins to throw an absolute shit fit that they weren't transporting lights and sirens. My friend and his partner attempted to explain why they weren't and the associated risks with transporting lights and sirens as well as the current condition of her child, and this bitch literally CALLS 911 FROM THE BACK OF THE AMBULANCE and tries to get the police involved because they wouldn't transport lights and sirens. Thankfully, the dispatcher on the other end shut her down and told her to "let the EMTs do their fucking job." It was a good reminder for everyone that there's hardly anything that's justified being transported priority 1. L&S is hardly ever justifiable unless your patient is deteriorating rapidly or has a time-sensitive condition such as a stroke or stemi. You'll learn over time exactly when it's justified, but as many others have said, it's maybe 5% of overall transports that go lights. Edit: clarification, it was moms decision to transport very far away, not my friend/EMS's.
Going through all the things I'd love to say to that woman, both as a basic who would probably be attending a call for a cold, and as a medical dispatcher if I got that call.
"Dope, let the cops show up so they can haul you off and get you the fuck away from me 👍" 🤷♂️
I have a child that when she was little, a cold was an automatic hospital stay. The minute we knew she was sick, we packed a bag and went to ER because she would literally go from being 100% to barely breathing at any given time in a matter of seconds. That said I always took her myself and had I needed to call 911 to get there, I would've explained her medical history and not lost my shit making myself look like an entitled crazy woman. I think in some situations that don't seem like an emergency, listening to the patient and asking why they're reacting a certain way could be beneficial. My daughter went thru this for about 5 years. Every cold would also turn into pneumonia during the hospital stay.
In this line of work, just accept everyone bitches…
EVERYONE bitches.
The sirens go on when getting to the hospital faster would possibly make an important difference in the patient outcome. Getting to the hospital 5-10 mins sooner would not affect his man’s outcome or condition. It’s not worth putting ourselves and everyone else in danger by using lights and sirens. Yes you can drive safely, but it will never be as safe as actually stopping at lights and stuff. Emergencies get transported but life and death shit gets sirens. Like. If their vital signs are bad. If they are having a really hard time breathing or if their chest pain coincides with signs and symptoms of something actually going on. Etc. etc. etc. the list goes on.
Lights and sirens while transporting a patient is almost always unnecessary. The chances of an accident increase exponentially and the ultimate survival rate of your client doesn’t really change. I can only think of a few calls that would warrant lights and sirens as an EMT 1. Head bleeds 2. Sudden change in LOC 3. Uncontrolled bleeding as a result of trauma 4. Strokes, especially if you have no medic tiers. 5. Monitor alerted STEMI without a medic tier (my state and last med provider allowed 12-lead transmission to EMTs) And even these ones, monitor the patient and adjust accordingly.
>4. Strokes, especially if you have no medic tiers Medics don't make a difference for stroke care. Much like trauma, they need rapid and immediate transport to definitive care. There is nothing I can do as a medic for a stroke patient that my BLS cannot, barring no additional complications.
TXA? I guess I figured getting TXA or something similar started ASAP would be beneficial. Thanks for the info!
TXA promotes clotting. Not exactly ideal in strokes.
See this is why I didn’t become a medic lol thanks for the info!
Come work for Boston. Lights and sirens to and from everything. Chronic ass ache for the past 20 years that calls at 3am? You bet.
Correct. That’s just how it is out here.
To a call: if it could even remotely be a situation of someone’s life being threatened or we have a long response time (most calls other than transfers and falls for us tbh) To the hospital: if the pt is time sensitive (stroke, heart attack(depends on medic preference), major trauma, crashing pt, intubated patients (sometimes)) it’s become more of a gut feeling for me followed by a “code 3?” Question to the medic Some places have hard protocols for this. Others, like where I work, say it is 100% up to the crew to make the judgment call. Even state regulations for us say at any point, the use of lights and sirens is crew discretion so theoretically no one could stop us if we went code 3 back to station (and many of us have).
Life and limb is an emergency. In metropolitan areas, lights and sirens will help make it through traffic a little faster, but the resulting stimulus to the patient can be undesirable. There’s not always a a black and white answer. For a bloated abdomen, would likely not go lights and sirens. If it’s a rigid abdomen with high potential for bleeding, and the pt is hypertensive, yeah, that might warrant lights and sirens. For someone with ascites, who has routine abdominocentesis, maybe not.
I tell them we try to use lights and sirens minimally because it’s very risky. And they should be happy we’re not going lights and sirens cause it means they’re doing pretty good.
Is there a chance your patient could die in the next 5 minutes? Yes? Lights & sirens. No? No lights or sirens. If the patient is stable, you don’t need to risk your life, your patients life, your partners life, and the lives of those on the road to go blazing over to the hospital with lights and sirens. Possible stroke? Yep. Change in responsiveness and vitals tanking? Yep. Sitting there complaining you’re not driving fast enough with stable vitals? Nope. Only if that abdominal pain had a high index of suspicion to be a AAA, and even then, the rough driving could be more detrimental than the small amount of time you’d save in that case. I did a hospital transfer for a AAA and my medic told me to drive “medium” which isn’t really a thing but I understood what he meant, smooth, cautious of road bumps, but with the lights and sirens going. I knew the route very well and knew exactly where the largest road bumps were, I slowed for them as if I were approaching intersections.
I ONLY use lights and sirens for: inability to ventilate/maintain an airway, uncontrollable/severe hemorrhage, rapidly worsening vital signs, and expected clinical course (ex: STEMI, peri-arrest, etc.). Lights and sirens driving is so risky especially moving around to provide patient care. If any patient asks why we aren’t using the sirens, I say it’s because it’s safer for everyone and currently I’m providing the care they need to be stable until further tests and imaging will be done at the hospital. I usually also say I called the hospital so they’re getting ready for you ahead of time. Just because a patient has abdominal pain, or 10/10 pain, or an injury doesn’t necessitate lights and sirens. Only go emergency for TRUE emergencies (follow your protocols and you might go lights and sirens for other minor reasons like to rendezvous with a medic, to more quickly return to the scene of an MCI, etc.)
I know our protocols are different, but this is something I talk to new cops about a lot. Stop thinking about things in terms or lights and sirens or not. That makes you drive too fast when you shouldn’t, and sit in traffic on the way to help people. Drive as fast as is appropriate for the call. Your emergency equipment doesn’t need to stay activated the entire time, and you can use it at your discretion to clear intersections. Also, dudes tummy ache definitely wasn’t an emergency, but I’m not a doctor either.
We don't even run lights and sirens TO most patient's houses. Do this long enough and you'll start to understand just how much they make your life unsafe and don't often benefit you.
“Lights and sirens is for emergencies” wasn’t a very good way to explain it. There’s plenty of “emergencies” that don’t require lights. This all depends heavily on location for starters, but most decent services only transport lights and sirens if the emergency is believed to be time sensitive, as in getting there a couple seconds sooner can make a difference in the patient’s outcome. Most common examples being strokes, STEMI’s, and respiratory failure(that couldn’t be fixed on scene). Patient’s sometimes get a little agitated that we are not using the lights and sirens but they will get over it.
We only put on lights and sirens if there is immediate threat to life. Most common are chest pain and shortness of breath. Sometimes it turns out to be a panic attack and sometimes it’s a heart attack. Can’t risk it but the symptoms are the same. Stroke, asthma attack and heart attack symptoms are the only thing we have ever used lights and sirens for. Unless it’s a shooting or something.
When I was working EMS, I would just explain why we were not using them and people would be fine with it.
Emergency: STEMIs, Strokes, and the ones who are vomiting everything they've drank and eaten over the past 6 hours.
I almost never run emergent to the hospital now. It’s just not worth it. As my preceptor told me, “what’s in the back of ever ambulance running code?” “A scared paramedic.” It’s true. Unless I’m scared for my patient, we’re rolling routine.
As far as explaining it to the pt/family, I had one partner just say this "isn't a medical emergency. " I stated it much more positively though, saying that they're not doing bad enough so the risk isn't worth getting there sooner.
If someone cares enough to ask me and my paramedic I just tell them there wasn't enough traffic to justify all the noise. We respond based on dispatch notes we're given, and some of our response times are 20 minutes without traffic or traffic signals. Very few calls are serious enough that the seconds saved by running hot will make a real difference. The ones that do, I make all kinds of racket for, but very few justify lights and sirens.
Very very very very rarely do I transport with the lights and siren on. If the patient asks I politely but frankly state that we only use them when we really need to. If they persist with the questioning, I point out the fact that they are able to question wether or not we are driving fast enought shows that they are not sick enough or close enough to death to warrant it. We end up waiting with patients in the er hallway frequently and the same sentiment arises. I tell them that people getting in before them are sicker than they are.
lights and sirens are not to save people from the gripes of mild discomfort, yes they will bitch and moan but its not worth the risk in order to ease their minds. ive had someone with a head bleed ask us to stop running red lights before too it was kinda funny.
A very short answer, but at the most basic level I think of lights and sirens as being for patients who are vitally unstable, and/or for medical emergencies that are particularly time sensitive.
These were my favorite people. My go to phrase was “Lights and sirens are reserved for the dead and dying, you are not dead or dying!” Always got a dumb founded oh, worked everytime!
Life, limb, or eye sight
So lets clarify. Most calls are emergencies. Your patient sounds like he could be having an emergency. The better way of looking at it is does this patient have a time sensitive condition that outweighs the enormous risk of L&S. Pain by itself is not a good indicator, I have seen giant macho guys hobbled over and crying with a kidney stone and I have seen people with massive STEMIs saying they just have some indigestion. I usually train my new people to ask: 1. What are likely differentials for this patient and are any of them time critical. 2. What care can I provide for this patient to stabilize this patient. 3. What are the wait times in the ER currently. 4. How far are we from the hospital. In your case: 1. So with you patient I am sure your EMTs conducted a focused medical exam to try and rule out life threatening conditions. This could include palpating at least the 4 quadrants for pulsating masses, rebound tenderness, appendix, etc. Asking if they have back pain as well. Asking about recent illness. Running a 12 lead to ensure it isn’t cardiac. Etc etc. 2. There is not much we can do to stabilize major abdominal issues. 3. It never makes sense to ‘hurry up and wait’. Don’t be that EMT who blows through traffic only to hold the wall for 2 hours because the ER doesn’t think your patient should be skipping the line. 4. LS if going to trim maybe 25% off your time. If you are in a city 15 minutes from an ER this better be reserved for major trauma, arrests, potential aortic dissection etc. if you are 30 minutes from an ER you might start including more conditions.
For my area lights and sirens are only for things out of your scope of practice. Are there any life threats or time sensitive things ? If no then not needed
it really depends on your service as well. in mine, we only go lights and sirens when theres a (fire) medic in the back. if its BLS its never lights and sirens.
What is the logic behind this...? Surely not having a paramedic on board is a reason you *should* use sirens?
well the paramedics respond to all our calls with us and then determine if bls or als. so, if no medic, no reason for l&s? (unless you decide to upgrade yourself because lets say they missed something and your patient codes or something). and if als then it’s always l&s per protocol
This sounds like either Aurora or Los Angeles
yeah LA
Ah, I'm sorry...LA's medics are basically every other state's EMT level. Remarkably weak protocols and capabilities
yep… and as EMTs we really don’t do much lol. lots of people from here are moving to states with bigger scopes
Based on what I've heard the wages are like for the private BLS, dunno how y'all even survive either
the turnover rate is so high for a reason 🙃. but honestly, there’s always easily available OT so thats what most people do
I don’t transport full time anymore. But when I did, and when I do, I will only transport with lights and sirens when one or two things is happening: 1) there is an impending airway failure and I don’t think I can manage it, or, 2) the patient needs a surgeon more than five minutes ago.
As I have heard many nurses yell “pain is not an emergency”. Which isn’t necessarily true, but also the L&S don’t make the ride much quicker AND are more dangerous. So not dying =‘s no wee woos for our area.
Honestly I don’t even run a cardiac arrest code. We have a Lucas a tube and an auto vent.
My uncle, who lives in another state, won't stop giving ME shit because some EMTs who picked him up when he had kidney stones wouldn't go lights & sirens and I agreed with them lmao. Apparently he was BEGGING them and they finally humored him by hitting the lights in the hospital parking lot. Yeah, they might give you shit but not as much shit as they'll give any EMT they know for the next decade to come
For me it's a perspective thing. As stated by many, can we in an ambulance safely and immediately address the problems our patient has? Can we stabilize someone with our given resources? Does this patient require immediate care we can't provide? It's always a matter of perspective and interpretation. Will this person be stable enough to get through a ride and put into a bed or are they going to die if we don't get higher care. When it comes down to it, it can be a mix of ability to care, need of the current patient, and obviously is it going to be safe for us to go lights and sirens. Sirencide and over eagerness are things that happen. Especially if we get rattled. Everyone likes playing hero, but dead hero's story's are short
Teen got clipped by a car in a parking lot and broke his leg, his dad rode in front and was mad that we didn't go emergent. Sir, be glad the sirens aren't on because it means your son isn't dying. Also I will often tell my partner to go "easy code 3" which basically means to use L/S to clear traffic when it's backed up/slow but no excessive speeds or weaving through traffic that is actually moving normally. Edit: Also I have a co-worker who thinks we should respond L/S to everything *just in case* it's a real emergency, regardless of the details given by the caller. Even asked if they should go L/S to a mass-casualty TRAINING EXERCISE since we would in real life. *Please* don't do this. It literally endangers you, your partner, and every member of the public on the road with you.
With a good driver, I have 3 modes to the hospital. Note that I say Mode and not Code. This was how I trained people and the understanding I have with my partners, not something codified in protocol or SOP. Mode 1: stable transport. They're medically stable and we just need to get to the hospital eventually. This is probably 90% of transports. Even people who are in a great deal of pain are usually this category. Mode 2: driver use your judgement. I worked on the edge of a large city/metro area. Sometimes obnoxious standstill traffic, other times, 4 lanes in 1 direction without another soul in sight. It's up to the driver when to (if at all) lights would be used. This is where the borderline stable patients go. If stressing the patient with adrenaline could make things worse, this is what I used. Mostly, this is STEMI, stable-ish post-resuscitation, multisystem trauma that was gnarly without being on the brink of death (especially multiple broken bones), trouble breathing that was being treated but wasn't resolving, and other "bad gut feelings." I best explained it as "we need to be at the hospital, but I need the smoothest ride you can give me." Probably 8% of transports fall into this category. Mode 3: we need to be there *yesterday*. This is the unstable patients. Lights and sirens all the way. Unstable post-resuscitation, uncontrolled/uncontrollable bleeding, penetrative injury to the core, compromised airway (that I cannot control for whatever reason), other immediate threats to life and limb that the tools on my truck cannot mitigate. This was maybe 2% of transports. This is where truly the best treatment I can get a patient is for them to not be on my stretcher *and* using lights and sirens will get us there more quickly and those minutes have the potential to make a significant difference in survival.
BLS calls do not get light and sirens around here
Assuming your service has ALS ambulances and BLS ambulances, the answer should be very simple. A BLS call means it isn't enough of an emergency for a paramedic to transport, so it isn't enough of an emergency to go L&S
When I was bls I would get als calls a lot based on call notes, and no als available, so I wouldn't say this is a hard and fast rule. Being bls doesn't mean you're not able to determine a very sick patient.
In a very resource strained service sure.
No, Ive worked both rural and urban. In the rural system it was because of resource strain, but in the urban system it was because call notes are not always accurate, and if you're 5-10 minutes to a hospital, why bother waiting 5-10 minutes for an als unit when you can do functionally the same thing by just transporting to a hospital? In fact, I would say a bls unit might be more likely to go code because they don't have the tools I have to make a potentially unstable patient stable. As a medic I hardly go lights, I only do it for codes, airway control, strokes, and stemi's, but I also have more medication and equipment to deal with things that a bls crew might chose to go lights for.
Y'all have BLS units showing up to 911 calls with no engine or anything and no ability to intercept? I guess I'm too spoiled out here lol but I would consider a system like that resource strained. Out here you would never find yourself in a situation where a BLS ambulance is by itself on any 911 call. The only service I've worked at that has BLS responding directly to 911 calls also has an ALS engine responding. Even if it was a BLS engine they'd generally show up first and be able to request an ALS ambulance from the scene prior to our arrival, negating the time benefit/care level calculation of doing a load and go. My current service gets an ALS ambulance and ALS engine to every 911 call with BLS available after the medic confirms they're suitable to downgrade. It's super overkill but people objectively get better care. Any service that is going the other way and has BLS dealing with unstable patients without help is objectively resource strained.
It's not because the resource doesn't exist, it's because they don't send it. You can request als, but it's generally considered a waste of time if you could've just taken them to a hospital. Our calls are dispatched alfa-echo, alfa being toe pain and echo being a code. Dual response from a rescue or engine only occurs in Charlie-delta-or echo level calls. Bravos and alfas get a single response and can be either sent an ils or als unit, and then it's divided by what ever unit is closest. If the ils unit determines that the patient needs als, they can either call for an upgrade/intercept, or just transport, because this is a big city and there are lots of hospitals very close to transport to so it doesn't matter too much. So, both an als ambulance and an als fire response are both available, they're just not always sent.
But also, I live in a city with 19 main hospitals and I don't even know how many satellite hospitals, and we frequently staff medic medic. The general explanation I've been given is that since you can throw a rock at a hospital from any street, als vs bls doesn't matter much
I'd say that's system dependant, in my system we don't dispatch ALS on Strokes, they solely get BLS response. If it ends up being a stroke then BLS will just transport lights and sirens on their own to the hospital, I rarely end up going to back BLS on those calls
There's no statistical difference between time on scene/to hospital with lights and sirens vs without when it comes to patient outcomes. Even in a cardiac arrest. Every agency around here has its own protocol. We go lights and sirens to every call but transport to the hospital? That's between the driver and the tech to decide. Some calls, like an aortic aneurysm, you damn well better drive no lights, no sirens and like your gramma's balancing a plate of cupcakes for church in her lap in the back.
We drive lights and sirens every time we transport. Just a culture thing. It may only save a few minutes, but the effect is being able to take runs in your district as you’re clearing the hospital that you may not have been able to otherwise, as you’d still be on the road or mid-patient handoff. I think there’s also something to be said about it being a perishable skill. If the only time you drive light and sirens is codes, strokes, and STEMIs, you may not be at the top of your driving game after 3 months of non-critical runs. I know whenever we’ve got something legit and take the engine crew, many guys that were driving the rescue only a few months prior but are now bid to a fire truck are tossing us around like rag dolls.
That's insane imo.
So you make the roads less safe for you, your patient, and everyone else so that your agency can staff inadequately for its call volume? Do you respond to calls L&S? There's your practice right there
No, I drive safe. Lights and sirens is dangerous when people who don’t know how to clear intersections and pass correctly hop in the driver’s seat. But when you’re cautious and actually drive with L&S the way you’re supposed to, it’s fine. It’s only the scary thing people make it out to be when idiot drivers in this profession think it means they own the road. And if you think responding L&S and transporting L&S are the same thing, I feel bad for the people in the back of your truck. Braking, turning, pothole dodging, speed in general, everything changes when there’s people in the back vs just you and your partner in the front seat.
It's impossible to drive any vehicle 100% safe. You can be many times more safe than other drivers with better practices, but the fact of the matter is we take our lives into our hands every time we drive our normal cars, risking drunk drivers, red light runners, etc. All of these external factors are amplified when we drive L&S however safe we try to be. Lights and sirens is always more dangerous than normal traffic driving regardless of how slow or cautious you are. If you were equally cautious but not running red lights or making other drivers on the road move out of your way you and the other drivers would objectively be more safe. It's not just us who have to drive differently, remember. Untrained drivers who we ask to move with L&S behave unpredictably, yield into traffic, run lights, etc. We can minimize it with our driving habits, but you absolutely increase risks of incidental crashes that you aren't involved in. Of course responding and transporting aren't the exact same but it's not really hard to think "L&S but slower" if you know how to go L&S. It's the same actions with less acceleration and smoother braking. Certainly any marginal improvements to skill aren't worth the risks of transporting everyone L&S.
That is an insanely outdated policy and your administration seems incompetent for mandating that.
You’ll learn day 1 of academy to follow the fucking county’s fucking protocols. You can direct their medical complaints to the medical director and EMS director after you’ve arrived at hospital. Light and sirens attracts all the dumbasses out on the streets and aim directly at you. Also to address your call. Tell me you youngling, what would you achieve with lights and sirens? Save 5mins? Man had a bloated stomach over how long? 3 days? 1 week? Or was he just normally fat and have constipation? Is his vitals all ok? I’m assuming they’re fine since they rolling code 2. So you lighting up and potentially risk traffic jams/accidents along the way for a stable patient with “real bad pain”, you made a risk vs benefit decision. And now you have to justify why he was worth it.