Shut Them Off!

This Post can also be found at the First Few Moments website.  I will be doing some writing for Kyle David Bates and the rest of the FFM team, so those posts will be featured on both sites.

While I have always been aware that ambulance accidents were occurring, my involvement with First Few Moments over the last eight months have really brought the issue into the spotlight for me.  It often feels like I can’t go a day or two without seeing yet another article about an ambulance crash, and they seem to be occurring more and more frequently.

We’ve tackled this topic so many times on the show, and have come up with many different approaches to how reduce ambulance crashes.  We’ve talked about using simulators, the concept of sterile cockpits, increasing training time and frequency, and the effects of being overtired on drivers.  Above all of those though, there is one more topic I think we need to focus on more:

Shut them off!

I am of course, talking about our lights and sirens.  Why is there still such a desire to “run hot” to every call both to the scene and away from it?  How many actual complaints really warrant that lights and sirens response?  Priority Dispatch has done a good job of defining them, but in so many systems, we still insist on pushing the envelope and meeting what end up being unreasonable response times based on the staffing levels that most systems have.

And what about transporting to the hospital with lights and sirens active?  What’s the point of all of our training if we are just going to treat each and every patient with a “diesel bolus?”  Very few patient dispositions are time sensitive.  I’d even go as far to argue that the only patients out there who would require “hot” transports to the hospital are those requiring emergency surgery, whether that be due to trauma or otherwise, those having a cerebrovascular accident, and those having an ST elevation MI.  The only other one that I would put a “maybe” on would be the failed airway, but that would depend on the degree and severity of the failure.  They say that “time is myocardium” and “time is brain function” but I really feel that we lose sight on the fact that time is not motor function in a fracture, it is not index of suspicion when evaluating mechanism of injury, and it is not a safe mode of transport in most cases.

MedStar in Fort Worth, TX has the right idea.  They have started transporting active cardiac arrests that are not ROSC patients with no active lights or sirens.  Based on all of their numbers, they found that the difference in transport time was somewhere in the area of two minutes.  How did they make up those two minutes?  They stressed the importance of having everything ready to go in the back of the truck so that as soon as that truck was put in park at the hospital, they’d be ready to off load their patient.  The upside to this practice is a safer transport for the crew, and more effective CPR and patient care taking place in the back of the truck.

Nine times out of ten, EMS has the ability and the tools to bring peace to chaos, and “stop” the emergency that someone called 9-1-1 for, but I don’t think we do a good enough job of letting people know that we can do just that.  Back in my Volunteer days, I used to have a partner that would describe the arrival of the ambulance and paramedics as “bringing the Emergency Room to the patient’s bedside.”  I couldn’t agree more.  Even in this day and age, I don’t think that enough people understand that.  They still expect those EMTs to come running into the house, and that paramedic unit to come screeching to a halt outside their door.  What they don’t understand is that is not how we operate, and that is our fault.  We fail to help those that we serve understand what we really do, and what we are really capable of.

All a person has to do is Google “slow ambulance responses” or “the ambulance wasn’t quick enough” and they will be met with a myriad of news stories.  The public eats them up, and too many ambulance providers are threatened by them, and its putting many people in danger.  We need to stop letting the public and the media dictate how fast we get there, and how fast we transport to the hospital.  We need to stop shying away from bad publicity and negative news stories, and start being proactive and educating people as to what it really means when an ambulance is coming to help them.

We need to put the safety of our people and our patients first.  We need to make sure that our EMTs get to the scene safely, and our patients get to the hospital in one piece.  Right now, we are failing our colleagues and the public that we serve.