Use of Emergency Response equiptment en route to the hospital [Archive]

BLSboy

03-21-2007, 06:17 PM

OK, something thats has been bugging me....how many ambulance providers run "Code 3" en route to the hospital, NO MATTER what the pts. condition is?
From a cardiac arrest to a papercut, some squads go hauling *** to get that pt in triage!
This is something that NEEDS to be addressed!!!

(this is borrowed from Brevard County Fire Rescue)

CLASS 1 - Patient with serious / critical trauma or medical condition requiring advanced life support.
CLASS 2 - Patient with obvious trauma or medical condition, but not of a serious nature.
CLASS 3 - Patient with minimal or no apparent trauma or medical condition; in for check-up.

Only Class 1, sometimes Class 2 pts get a "priority" response to hospital!

Folks, its inheranty dangerous to use L&S, so lets save them for those who NEED it!!:cool:

FiremedicSpud

03-21-2007, 07:57 PM

I couldn't agree more. However, I have heard of some systems where the physician adviser REQUIRES it, simply because he or she doesn't trust the service to properly care for the patient.

Sad.

BLSboy

03-21-2007, 08:16 PM

Scotttt

03-22-2007, 01:00 AM

I'm always amused when working in NJ when I see BLS squads running hot without ALS. If the call is BLS, then WHY are L/S being used? Hell, more than half of the calls that ALS treat do no need L/S. I've personally told BLS to not go L/S and they have rebuffed my request multiple times, and have done so even when I tell them bluntly that if they crash I will have no problem testifying that I told them not to drive L/S.

This is one thing I would love to see OEMS crack down on.

DrParasite

03-22-2007, 01:15 AM

Cant properly care for a splinter, or a direct admit (no joke, didnt feel like paying for a cab, so called us)
the wackersquads, I mean Volunteer Ambulance Corps(e) run Code 3 all he time, as well as the career, we see one call a day, and we run L&S dammit cause we can, do as well. While the busy squads seem to use them only
A. When ALS is aboard
B. When the pt needs transport, and needs it YESTERDAY
or
C. When there are calls "stacked"

It really is going to take someone getting killed before these issues are changed....*sigh*First of all, you are no more trained than those who are on the wackersquads. they are your equals, and with the experience and years they have put in, might even be better EMTs than you.

Don't think that just because you receive a paycheck makes you any better than a volunteer EMT, because there are volunteers who can run circles around you.

I know busy paid agencies that transport with L&S for ALL calls. I know busy suburban volunteer agencies that do the same. and agencies in New York that will transport a chest pains call with 2 medics without using L&S.

I also know that most agencies leave it up to the crew chief's (or whatever you call the leader of the crew) discretion as to if lights and sirens are needed.

many ambulances transport using L&S when in reality they probably don't need them. In the grand scheme of things, those few minutes aren't going to drastically affect the outcomes of the patients. Exceptions to this include confirmed MIs, CVAs, and major traumas.

neck and back pains from an MVC don't need L&S. in reality, does your asthma attack that is being treated by ALS need to be transported with L&S? or injuries from a fall? or ETOH?

Since you mentioned it, if you have jobs pending, why run lights and sirens? if you are transporting a stubbed toe with L&S, and you crash into a bus load of nuns killing them, what are you going to tell the cops/judge/jury? you can only deal with the current call. and according to NJ law, you can only use L&S in an emergency. I don't believe you can call a stubbed toe an emergency.

I happen to agree that lights and sirens are over used, especially when transporting patients. however, it's not an issue specific to volunteers or career staff and it's both insulting and unprofessional to accuse one group more than others. It's a mentality overall that needs to change.

btw, I work full time as an EMT in a system that does EMS in both an urban and suburban environment, as well as volunteer on the side. and yes, I have seen it happen in both places.

BLSboy

03-22-2007, 03:44 AM

First of all, you are no more trained than those who are on the wackersquads. they are your equals, and with the experience and years they have put in, might even be better EMTs than you.

Don't think that just because you receive a paycheck makes you any better than a volunteer EMT, because there are volunteers who can run circles around you.

I know busy paid agencies that transport with L&S for ALL calls. I know busy suburban volunteer agencies that do the same. and agencies in New York that will transport a chest pains call with 2 medics without using L&S.

I also know that most agencies leave it up to the crew chief's (or whatever you call the leader of the crew) discretion as to if lights and sirens are needed.

many ambulances transport using L&S when in reality they probably don't need them. In the grand scheme of things, those few minutes aren't going to drastically affect the outcomes of the patients. Exceptions to this include confirmed MIs, CVAs, and major traumas.

neck and back pains from an MVC don't need L&S. in reality, does your asthma attack that is being treated by ALS need to be transported with L&S? or injuries from a fall? or ETOH?

Since you mentioned it, if you have jobs pending, why run lights and sirens? if you are transporting a stubbed toe with L&S, and you crash into a bus load of nuns killing them, what are you going to tell the cops/judge/jury? you can only deal with the current call. and according to NJ law, you can only use L&S in an emergency. I don't believe you can call a stubbed toe an emergency.

I happen to agree that lights and sirens are over used, especially when transporting patients. however, it's not an issue specific to volunteers or career staff and it's both insulting and unprofessional to accuse one group more than others. It's a mentality overall that needs to change.

btw, I work full time as an EMT in a system that does EMS in both an urban and suburban environment, as well as volunteer on the side. and yes, I have seen it happen in both places.

DrP; If you read ALL of my post, you would have seen I went after BOTH groups, paid and volly.
This is not a paid vs volly debate, this is a safety issue. Running L&S increases danger to all on the road.

However, I will not make it a secret of my dislike of Volunteer EMS. If you can prove to me that an All-Call, a second All-Call 2 min later, then finally going Mutual Aid is better then having a crew respond, from the district, within 2 minutes, then you can change my mind. I dont care what the call is, confirmed Code, to a skinned knee, the citizens deserve an ambulance with a MINIMUM of 2 EMT-Bs on scene within 5 minutes of dispatch. Not a bus out the door in 5 min.

And I do find it rather intresting, that in other states, EMTs typically make somewhere in the 12-13 an hr starting pay rate, and up here, it is typically 10-11. I even posed that question to a admin level person, and the response was
well, there are people who do it for free, what are you b*tiching about?

hmmmmmm:eek:

the1141man

03-22-2007, 07:41 AM

And I do find it rather intresting, that in other states, EMTs typically make somewhere in the 12-13 an hr starting pay rate, and up here, it is typically 10-11. I even posed that question to a admin level person, and the response was
well, there are people who do it for free, what are you b*tiching about?

hmmmmmm:eek:

Not this state...plenty of private ambulance EMT-Bs around here making min wage (just bumped to $7.25/hr, goin to $8/hr in Jan 2008)--$12-13 is more likely starting rate for private ambo Paramedics.

mitllesmertz1

03-22-2007, 03:42 PM

8 shifts per month, give or take.
average 15-20 calls per shift.
We run L&S to the ED maybe 6-8 times per month.

Firescueguy

03-22-2007, 05:22 PM

My squad (vollie, running about 2,500+ calls yearly) has had a long standing policy that we only run lights & sirens to the hospital if the pt. is critical (cardiac arrest, unmanageable airway, significant trauma, etc.). Other than that, we travel with the flow of traffic obeying all traffic control devices with just our headlights on and the rear amber strobes activated (simply an auxiliary warning light). Our thought process instilled by our chiefs has always been 1) the emergency is over when we get there, 2) we are not getting killed for a cab ride (which is probably 90% of our calls) and 3) it's just not worth the liability involved to drive at break neck speed when our level 2 area trauma center is 8-10 minutes away (and that's driving with the flow of traffic as described above).

I don't agree that having ALS on board dictates the need for a lights & siren response to the hospital...while there are certainly times where rapid transport are in order (even with ALS on board), there is no sense in flipping an ambulance over traveling at Mach 2 while administering a breathing treatment. Even on a cardiac arrest, if you have ALS being administered, there's no need to drive at break neck speed...the pt. needs electroshock therapy, advanced airway management & medications...all the things we as ALS providers offer. Now if you've got a significant trauma that needs a surgeon's skilled hands, then a rapid yet safe lights & siren response is indictated.

From my experience having worked both paid & vollie in several different areas, it depends on the agency as to how the whole lights & sirens issue is addressed. Many VFD's will often have a guy that they would NEVER in a million years let drive a fire apparatus but he keeps bugging the SH&* outta his officer so they finally say "ENOUGH!!...we'll let you drive the ambulance, ok?"...BIG mistake...even bigger when the dept. requires no formal driver training other than driving around the corner a few times to get cleared. The problem is compounded when this guy drives a Yugo as his POV and now he gets behind the wheel of an ambulance with the ability to go WOO WOO (yes, I speak from experience on this one...only the guy drove a Hyundai).

You need to have a very clearly defined policy regarding emergency response which needs to be explained to all your drivers, adhered to accordingly and enforced by the officers...if they don't buy into it, the membership will not either. The policy needs to clearly state when & why lights & sirens should be used and who has the ultimate say in determining so (your local EMS prototcols and state traffic laws should be used to address this as well)...in my agency, the technician in charge (ALS or BLS) says what mode we respond in (again, normal flow of traffic probably 99% of the time)...they will be the one who will hang when the driver says "hey, HE told me to go lights & sirens"...the tech knows the pt's condition and should determine the response level accordingly. Conversely, I've worked for a VFD as an ALS provider where I told the driver (a FF with NO EMS training at all) to take it easy & they drove at break neck speed sounding the phaser the whole way while there was NO traffic in front of them (I mean NO traffic). Unfortunately, non-EMT trained FF's who act as drivers often think that speed = care.

Just my 2 cents...Stay Safe...remember, there's no glory in getting killed in an ambulance crash while transporting a geriatric patient with a urinary catheter blockage...:rolleyes:

Bones42

03-22-2007, 06:40 PM

I'm always amused when working in NJ when I see BLS squads running hot without ALS. In our case, it would probably be because the paid ALS is not available as there are too few for the number of runs they are dispatched to. We don't sit on scene waiting 20 minutes for the next ALS unit to arrive, we figure it's better to get the person to the hospital. ;)

And I agree with the others, the L&S are probably overused a lot. I can't explain why.

BLSBoy, I'll agree, a crew of 2 EMT-Bs responding is much better than a delay while there is request after request after request. But then again, I'm used to my agency responding with 3 EMT-B's and being on scene within 4 minutes. And yes, we are volunteers that you don't like. (And we don't really care if you like us or not.) :cool:

Brian1023

03-22-2007, 08:09 PM

I think it's safe to say that this is another argument that can be throwin into the "I guess it depends on where you work" file.

Also, it's not the lights and sirens that make your ambulance dangerous. It's whoever is behind the wheel.

TurkII

03-23-2007, 12:07 AM

Back when I was precepting as a new medic I remember hearing from an older medic that he almost NEVER runs L&S to the ED. His motto was, "Once I'm here with the patient, the emergency is over."

I used to think he was just ****y but if you think about it he makes a lot of sense. The majority of life saving medications, interventions, and skills that are administered by a doctor in an ED can be administered by a medic.

Obviously there's no cath lab or trauma OR in the back of an ambulance so there are always times when L&S to an ED is necessary... but for the most part, unstable patients can often be managed and stabilized on scene. Once they're stable, no need for L&S.

Janmedic

03-23-2007, 12:09 AM

in my mind any call that where the message is unclear but have a-b-c problems and sudden disability problem is a code red in norway. And if where the dirver i would have ued lights an sound on the way out to the scene. qick help is dobbel help.

TurkII

03-23-2007, 12:10 AM

If you can prove to me that an All-Call, a second All-Call 2 min later, then finally going Mutual Aid is better then having a crew respond, from the district, within 2 minutes, then you can change my mind. I dont care what the call is, confirmed Code, to a skinned knee, the citizens deserve an ambulance with a MINIMUM of 2 EMT-Bs on scene within 5 minutes of dispatch. Not a bus out the door in 5 min.

Well said.

emt161

03-23-2007, 07:34 AM

I don't have a problem with BLS running hot to the ED, as long as they're doing it because they have a truly critical patient and transporting will take less time than an ALS intercept.

If they're running hot with a BLS patient, feel free to b!tchslap em.

armymedic571

03-23-2007, 12:49 PM

doughesson

03-23-2007, 04:00 PM

There are a couple departments,I think one of the Chief's name rhymes with Brunacinni,that when they come on an "Expensive Medical Taxi"run will offer a voucher for a real cab to transport the patient non emergency.
I spent 3 years working for a cab company in Kentucky that covered a lot of non emergency medical trips.Basically,we were just like any other cab,only we had wheelchair lifts in vans and minibuses(A Ford E-350 is mini?)and took either Medicaid or private pay runs to doctor's offices from residences,nursing homes and managed homes.
While the cabbies still had their paying runs and lease payments to cover,those of us in the wheelchair department got weekly pay and scheduled routes taking mentally handicapped pax to area workshops.
The highest level of medical care we were taught was first aid and CPR,which most drivers forgot and simply screamed their location and that their passenger was having a heart attack in the back seat.
You'd think that more cab companies would think about doing this,even if the costs of added insurance would affect the bottom line.If they do it right,they get an added boost in the public's eye,and the FD or private services doesn't have to run a fully qualified crew of EMTs to drive someone to a doctor's appointment to get their cholesterol level checked.

BLSboy

03-23-2007, 04:38 PM

************************************************** ******

Two Things,

1. Why would you ever run Code three with ALS, unless specifically told to do so by that provider.

2. Since when is having calls stacked a reason to run code three back to the hospital. That is poor form and STUPID!!! That is why the EMS gods invented things like mutual aid and such. If your system is that busy, you should consider going paid....

ARMYMEDIC...did you take the time to LOOK at my profile and SEE who I work for??
The City of Atlantic City!
At a minimum, we have 3 buses going, 4 is not uncommon, and out closest mutual aid during 0600-1800 is 5-6 min away, a paid duty crew...that is, is they arent running their OWN calls....and between 1800 and 0600, they are volunteer, so then they have to respond to building, open it up, and go!
And I dont know what kind of EMS system you have, but there are 4 medic trucks covering out entire county, including Atlantic City, so they are always busy, hence the stacked calls thing. Do I like it? NO!
But, am I going to endanger the Cardiac emergency that they have pending to sit and wait in traffic? NO. I drive maby 35-40 in a 30 mph zone, full stop at red lights, etc.

Bones42

03-23-2007, 06:09 PM

BLSboy, is Atlantic County still covered by MONOC? or did someone else get in there?

BLSboy

03-23-2007, 06:28 PM

AtlanitCare Regional Medical Center Provides it now for Cape May, and Atlantic Counties. SCTU/Medic 1 and Medic 6 in AC, Medic 5 in Wildwood (Cape May), Medic 7 in Galloway, Medic 8 in Somers Point, Medic 9 in Cape May Courthouse (Cape May), and Medic 10 in Western Atlantic County. On occasion, they will put power Medic trucks up, in addition to Medic 200, the Medic Supervisor.

MONOC left, from my understanding, 4 years or so ago, coinciding with their loss of the AC EMS contract to Exceptional Medical Transportation, who I now work for, in AC.

TurkII

03-24-2007, 05:30 PM

and between 1800 and 0600, they are volunteer, so then they have to respond to building, open it up, and go!
And I dont know what kind of EMS system you have, but there are 4 medic trucks covering out entire county, including Atlantic City, so they are always busy, hence the stacked calls thing. Do I like it? NO!
But, am I going to endanger the Cardiac emergency that they have pending to sit and wait in traffic? NO. I drive maby 35-40 in a 30 mph zone, full stop at red lights, etc.

Very similar to one service I work for. 2-3 ALS units covering a city of about 80,000 people. Surrounded on three sides by volunteer companies that at at minimum are 12-15 minutes away from any scene in my city. I can almost always safely turn around from a BS call to take another call in the stack faster than a mutual aid unit can come into my city.

Of course the simple answer is to just put another truck on in my city. Good luck with that one.

BLSboy

03-24-2007, 05:40 PM

Very similar to one service I work for. 2-3 ALS units covering a city of about 80,000 people. Surrounded on three sides by volunteer companies that at at minimum are 12-15 minutes away from any scene in my city. I can almost always safely turn around from a BS call to take another call in the stack faster than a mutual aid unit can come into my city.

Of course the simple answer is to just put another truck on in my city. Good luck with that one.

Minimum of 3 staffed BLS Trucks, a 4th put up for holidays, and summertime, with a 5th every time its REALLY hopping.
Our South is the Atlantic Ocean, so unless the USCG wants to come in that way, scratch that idea....
North Depts all MINIMUM of 8 minute response with no traffic and stars aligning , etc, etc.

East has to go over the river and through the woods (well no river, but the Bay, and the ghetto), so they are 8 or so away.
And the West is a Career Dept that has one bus, that they may or may not even be able to spare, with about a 6min eta to our Western Border.
So, which Mutual Aid place are YOU going to pick, oh high armchair Commander?

lol

Catch22

03-24-2007, 06:26 PM

DrP; If you read ALL of my post, you would have seen I went after BOTH groups, paid and volly.
This is not a paid vs volly debate, this is a safety issue. Running L&S increases danger to all on the road.

However, I will not make it a secret of my dislike of Volunteer EMS. If you can prove to me that an All-Call, a second All-Call 2 min later, then finally going Mutual Aid is better then having a crew respond, from the district, within 2 minutes, then you can change my mind. I dont care what the call is, confirmed Code, to a skinned knee, the citizens deserve an ambulance with a MINIMUM of 2 EMT-Bs on scene within 5 minutes of dispatch. Not a bus out the door in 5 min.
Explain to me something, if you went after both groups, why did you not have a slang term for the paid EMS guys? "Wackersquads?" You went after the vollie EMS squads, buck up and admit it. While there is nothing better than an agency that can respond out the gate instead of waiting on vollunteers to come in to the station, there are those areas outside of the Atlantic City region who can't afford career EMS crews and do what they can.

Most vollie EMS squads I know of, the vollies stay at the station for a shift and get paid for the calls they run. So, they are just as well staffed as any career agency, they just don't get an hourly rate.

Also, the "minimum" care in my mind is ALS (which is what most "wackersquads" I know run).

And I do find it rather intresting, that in other states, EMTs typically make somewhere in the 12-13 an hr starting pay rate, and up here, it is typically 10-11. I even posed that question to a admin level person, and the response was
well, there are people who do it for free, what are you b*tiching about?

hmmmmmm:eek:

As someone else said, many states have EMTs making minimum wage, mine included. The highest EMT starting wage I know of in my area is $7.25/hr. The biggest reason is that EMTs are a dime-a-dozen and you can replace one in about 3-4 months when the next class graduates.

Catch22

03-24-2007, 06:39 PM

BLSboy

03-24-2007, 06:41 PM

Catch...I DID admit to disliking Volunteer EMS, and admitted so here....

DrP; If you read ALL of my post, you would have seen I went after BOTH groups, paid and volly.
This is not a paid vs volly debate, this is a safety issue. Running L&S increases danger to all on the road.

However, I will not make it a secret of my dislike of Volunteer EMS. If you can prove to me that an All-Call, a second All-Call 2 min later, then finally going Mutual Aid is better then having a crew respond, from the district, within 2 minutes, then you can change my mind. I dont care what the call is, confirmed Code, to a skinned knee, the citizens deserve an ambulance with a MINIMUM of 2 EMT-Bs on scene within 5 minutes of dispatch. Not a bus out the door in 5 min.

And I do find it rather intresting, that in other states, EMTs typically make somewhere in the 12-13 an hr starting pay rate, and up here, it is typically 10-11. I even posed that question to a admin level person, and the response was
well, there are people who do it for free, what are you b*tiching about?

hmmmmmm:eek:

And later on, I stated....

If you can prove to me that an All-Call, a second All-Call 2 min later, then finally going Mutual Aid is better then having a crew respond, from the district, within 2 minutes, then you can change my mind. I dont care what the call is, confirmed Code, to a skinned knee, the citizens deserve an ambulance with a MINIMUM of 2 EMT-Bs on scene within 5 minutes of dispatch. Not a bus out the door in 5 min.

Sure, you can have a Volunteer Duty Crew in quarters, at all times, and they are compensated for their services. And I applaud your service for being progressive and compensating your members services with money, which, sadly, is what drives the world.
The "minimum standard of care" in my mind, is Paramedic-EMT combo, which is what was run down where I was from.

I still stand by my dislike of Volunteer EMS, however, and like I said, prove to me why not.
A Career private agency can come in most cases and do the same service at the same, or less cost to the city/township/etc. Do I like working for a private EMS company? HELL NO! Is it better then volunteers?
HELL YES!

Think I am wrong?
PROVE IT

And if you can afford a Career Police Dept, you can damn sure afford a Career EMS Staff

BLSboy

03-24-2007, 06:43 PM

Well, to actually be back on topic, I didn't realize there was anywhere in this country that transported patients L&S on all calls. I can't imagine anyone wanting the liability! I don't go as extreme as the vet that considers the emergency over once he arrives, but I'm very conservative on when I run hot to a hospital.

Running hot responding to all calls, I could almost see. I think that's even a bit overboard, though.

This is where we DO agree:D
Welcome to New Jersey, home of the Wackers!!

(And they can be paid, on call, paid on call, volunteer, whatever, most of them are entranced by lights and sirens)

We go hot to all calls, nosebleed, help me, ive fallen and cant get up, put me back in my chair, and Cardiac Arrests.....:o

Catch22

03-24-2007, 07:12 PM

OK, let me clarify, my particular issue is your term "wackersquads." I don't work vollie EMS, never have. I have several friends and colleagues that do. To insinuate anyone who is a vollie EMT is a "wacker" is idiotic to say the least, that is exactly what that statement did.

I won't argue with your view of vollunteer EMS in your area. Just keep in mind that what works in Atlantic City and the surrounding area does not work in other areas, particularly the rural world. For example, my hometown is covered by a career EMS agency. Problem is, they are 8+ minutes away. Would we benefit from a vollie ambulance? Yeah. I can count on one hand the number of EMS calls per year where less than two guys respond. On the contrary, the ambulance district turns the same number per month over to mutual aid. We rarely have the ambulance beat us to scene.

And yes, we have a "career" police force. It's the chief, one officer, and two part-time officers. Hardly enough money goes into the PD to fund an EMS agency, even if we could bypass the district.

BLSboy

03-24-2007, 07:37 PM

See, our problem is the wackersquads. They talk a big big game, and when the tones drop, nobody shows up. There is one squad that is pretty good about turnouts, and getting there on time, but when there is a code in your town, PD is screaming for a Bus, and nobody shows up, and the members talk a big game, then I got issues!
I am not knocking the people, Im knocking the system.
In other words, im hatin tha game, not tha playa

:cool:

Edited to say, the same squad that I have the issues with also likes to tone test in the middle of Major Incidents, eg multi car MVC, and Command cant get through to Medcom, and tone test the FD during a multi alarm response.

DrParasite

03-24-2007, 08:44 PM

Explain to me something, if you went after both groups, why did you not have a slang term for the paid EMS guys? "Wackersquads?" You went after the vollie EMS squads, buck up and admit it. While there is nothing better than an agency that can respond out the gate instead of waiting on vollunteers to come in to the station, there are those areas outside of the Atlantic City region who can't afford career EMS crews and do what they can...OK, let me clarify, my particular issue is your term "wackersquads." I don't work vollie EMS, never have. I have several friends and colleagues that do. To insinuate anyone who is a vollie EMT is a "wacker" is idiotic to say the least, that is exactly what that statement did.thank you, someone else who picked up on it too. Sorry BLSboy, but said it, and while you might have intended to paint both paid and volunteer with the same brush, it definitely was directed at your non-paid equals.

See, our problem is the wackersquads. They talk a big big game, and when the tones drop, nobody shows up. There is one squad that is pretty good about turnouts, and getting there on time, but when there is a code in your town, PD is screaming for a Bus, and nobody shows up, and the members talk a big game, then I got issues!
I am not knocking the people, Im knocking the system.
In other words, im hatin tha game, not tha playaI'll let you in on a dirty little secret with paid squads/agencies/etc. they get overwhelmed just as often as volunteer squads. how do they handle it? stacking jobs, letting ALS transport, doing quick turnarounds from the hospital, getting a second call while transporting to a 10 minutes away hospital and doing a quick turnaround for a call in their primary, shorter transports to hospitals in town, even pulling non-agency rigs who are at hospitals for 911 jobs in their primary.

Now, if a volunteer agency did that, people would be screaming that the volunteer system is failing, and a paid system should replace it. now, if your city gets 6 EMS calls at once, what do you do? and if the first 5 are stubbed tows with your crews all treating and transporting and a cardiac arrest is holding, does that mean your system is failing? I mean, FD/PD is screaming for a bus, and you guys don't have a rig to send them. But you guys still talk big because you are "Atlantic City EMS" we do it in the big city.

But of course, it's all about the volunteers not getting out and wacker squads running hot to the hospitals

Catch22

03-24-2007, 10:19 PM

I'll let you in on a dirty little secret with paid squads/agencies/etc. they get overwhelmed just as often as volunteer squads. how do they handle it? stacking jobs, letting ALS transport, doing quick turnarounds from the hospital, getting a second call while transporting to a 10 minutes away hospital and doing a quick turnaround for a call in their primary, shorter transports to hospitals in town, even pulling non-agency rigs who are at hospitals for 911 jobs in their primary.

Now, if a volunteer agency did that, people would be screaming that the volunteer system is failing, and a paid system should replace it. now, if your city gets 6 EMS calls at once, what do you do? and if the first 5 are stubbed tows with your crews all treating and transporting and a cardiac arrest is holding, does that mean your system is failing? I mean, FD/PD is screaming for a bus, and you guys don't have a rig to send them. But you guys still talk big because you are "Atlantic City EMS" we do it in the big city.

But of course, it's all about the volunteers not getting out and wacker squads running hot to the hospitals

Or they could do like one agency I know of. They got slammed, were having stacked calls on rigs and decided they weren't going to run on alpha calls (mutual aid was slammed as well, closest unit was 30 mins. away). They had one that the FD found to be more serious than an alpha, the EMD just didn't have the right answers to make it a charlie. Bit the career EMS agency square in the tail.

I also still see BLSBoy hasn't figure it out. Drop the "wackersquads" thing. Some day, you're agency is likely to be slammed or have an MCI where you're going to need these guys. It happens all the time all over this country. For example, the FD I work for had never had to call in a vollie FD for mutual aid...until about 3 years ago. The big time career guys who liked to mouth about the vollies had to eat some crow in a big way. It's happened several times since and the new admin has realized that they are a valuable resource that we use much more frequently.

At the same time, wouldn't it be fair to call his agency a "wackersquad" seeing as they run emergency to all calls? I mean, it's got to be because they like the lights and sirens going. :rolleyes:

BLSboy

03-25-2007, 12:49 AM

thank you, someone else who picked up on it too. Sorry BLSboy, but said it, and while you might have intended to paint both paid and volunteer with the same brush, it definitely was directed at your non-paid equals.
I'll let you in on a dirty little secret with paid squads/agencies/etc. they get overwhelmed just as often as volunteer squads. how do they handle it? stacking jobs, letting ALS transport, doing quick turnarounds from the hospital, getting a second call while transporting to a 10 minutes away hospital and doing a quick turnaround for a call in their primary, shorter transports to hospitals in town, even pulling non-agency rigs who are at hospitals for 911 jobs in their primary.

Now, if a volunteer agency did that, people would be screaming that the volunteer system is failing, and a paid system should replace it. now, if your city gets 6 EMS calls at once, what do you do? and if the first 5 are stubbed tows with your crews all treating and transporting and a cardiac arrest is holding, does that mean your system is failing? I mean, FD/PD is screaming for a bus, and you guys don't have a rig to send them. But you guys still talk big because you are "Atlantic City EMS" we do it in the big city.

But of course, it's all about the volunteers not getting out and wacker squads running hot to the hospitals

This isn't about getting overwhelmed. This is about borderline negligance! The squad I am referring to wasn't slammed, they weren't even on a call. I am NOT going to publicly humiliate this squad, I DO have some respect for the good people on it, contrary to popular belife.
At my part time job, unless we are AT the hospital (which is in out town), and dispatch asks us our turnaround time, bam, automatic mutual aid, which is usually our own company, they have a 911, and 2 SCTU rigs in town, unless they are on a call, then it goes to the next town over, who has 1 911, and 2 BLS Transport rigs.
ALS Doing transport? Not unless they want to sit in the backseat of an Expedation or Explorer, they arent going to be doing that. :cool:

Even at my FT gig at AC, if all are txing BS calls, and a code comes in with the FD screaming for a bus,
1, they are BLS, they are going to start treatment.
2 ALS will be there before us to do their thing
3 There isnt a place in the city, even driving conservatly that cant be reached within 5 min from the hospital, and vice versa. So, it comes down to the Crew Chiefs decision to go for Mutual Aid, not mine.

Anywhere you go, however, if calls > resources, people will wait

If calls are not answered due to lack of intrest, thats a completly different thing then not enough resources

Bones42

03-26-2007, 01:33 PM

BLSboy, I'd recommend buying a compass and a map. East of you is the Ocean, not South. :p

Anywhere you go, however, if calls > resources, people will wait
That's about the most correct statement in many of these posts.

FYI, in parts of NJ, ALS does transport if they are first on scene and have the patient ready before an overworked BLS unit can arrive.

A town near me went from 4 active volunteer EMS agencies to 4 not as active volunteer EMS agencies. They then started up 1 paid BLS rig to cover the area with volunteers to back them up. Response times have increased. Why, because some genius that set the plan up decided that the vol agencies would not be dispatched until the paid rig requested them to be. Paid guys don't want vols taking their calls so they don't request them. Yup, a pretty crappy setup. Left a fairly crappy feeling towards paid EMS...and a partially unfair feeling.

and while I don't see them on every call....I have never seen them without their lights and sirens on. So I guess there are paid "whackersquads" as well.

And if you can afford a Career Police Dept, you can damn sure afford a Career EMS Staff :rolleyes:

wag11c

03-26-2007, 02:26 PM

Wackers have EMS patches that say stuff like "defibrillation" and other hi-tech sayings. Sound familiar BLSBOY? Leave the vollies outta your discussion.

lexfd5

03-26-2007, 03:48 PM

We run L&S on every response. In addition every transport to the hospital is L&S, ALS, BLS or BS. Do I agree with this policy, no. I have worked volunteer BLS services that would transport BLS and ALS over 30 minutes from the hospital non-L&S.

IMHO, unless there is something critically wrong with A, B, or C then non-L&S should be the way to go.

BLSboy

03-27-2007, 12:25 AM

Bones;
I dont know how to implant a picture, so this will have to do.....
http://www.google.com/maps?q=Atlantic+City,+NJ,+USA&sa=X&oi=map&ct=title
Up is due North, Down due South, etc, etc

the Atlantic Ocean really IS to our south!:eek:
lol
after I was told that, my world crashed down for the rest of the week

The career EMS place I was with is a paid wackersquad as well, thats why I left.
When call volume, experience, and responsible supervision lack, it seems, that the wackers will prevail, at least at the one place I worked....:(

Wackers have EMS patches that say stuff like "defibrillation" and other hi-tech sayings. Sound familiar BLSBOY? Leave the vollies outta your discussion.

All those NJ EMTs that are issued EMT-D patches, please stand up, we have a kool aid drinker that needs to be put in his place

Are "Intermediate", and "Paramedic" too big of words for you too?
In fact, your patch must just say First Responder, since Emergency and Technician are big words too

flyinggecko46

03-27-2007, 12:56 AM

It's in our org's SOPs to respond 2-7 (L&S) to all calls, which I think is a bit much, but it's up to the highest medical authority of the crew to determine use of L&S en route to the hospital. Personally, I use them sparingly, as transport time isn't markedly different for the area I'm in (rural area with a small "city" mostly back roads and uncongested streets). I feel psychological first aid and communication are just as if not more important as other treatments. Essentially, if you're going to make the patient freak out because "OMG, they turned the lights and siren on, I must be dying," you're not providing the best care you can. So if it is necessary to transport 2-7, I explain to the patient why, and try to reassure them. So essentially I consider what's best for the patient in my decision to transport with lights and siren.

TurkII

03-27-2007, 01:04 AM

Not really sure how you can classify someone as a wacker based on a state patch that their employer probably makes them wear as part of a uniform. If the state patch was pink with purple letters that said, "I like ambulances" then I'm sure that's what we would wear.

Anytime I have a question about what a slang term means I go directly to the "bible." So here's the official slang definition of "wacker" from urbandictionary.com :

"A person, who is in the Fire, EMS, or Police service, or one who badly wants to be apart of such service. A wacker always has the latest gear, the "coolest" shirts and plenty of stickers on his car. Wackers often overdoo everything, such as lights, sirens, or expensive equipement. These items are almost always paid out-of-pocket, as no organization can justify that much wasted spending. Wackers are most commonly between the agest of 14 and 30, and are usually trying to show off to others, how "cool" they are for being a Firefighter, EMT, Police officer, or for wanting to be one of the above. A Wacker can often be found with their radio turned way up, so that everyone can hear it from a mile radius, or sitting around their local headquarters trying to catch any scrap of action going on in any of the surrouding districts."

Doesn't say anything about wearing state patches.

BLSboy

03-27-2007, 01:50 AM

armymedic571

03-27-2007, 07:49 AM

wah, wah, wah

BLSboy

03-27-2007, 09:50 AM

How insightful

Bones42

03-27-2007, 12:44 PM

All those NJ EMTs that are issued EMT-D patches, please stand up, we have a kool aid drinker that needs to be put in his place
I'm guessing you have not been an EMT in NJ for too long. ;) When NJ first started certifying EMT's in AED's, you did receive a patch. When it became part of the state EMT curriculum, you did get a EMT-D patch. In the last few years, when it became "standard", the -D was removed and NJ has gone back to EMT-B patches. For a few years, there were EMT-B and EMT-D patches in the state, so in essence...the patches that wag11c mentions, did (and do) exist.

cmccaigmd

03-27-2007, 03:08 PM

I couldn't agree more. However, I have heard of some systems where the physician adviser REQUIRES it, simply because he or she doesn't trust the service to properly care for the patient.

Sad.
Then those docs need their eyes opened! http://www.objectivesafety.net/index.html

BLSboy

03-27-2007, 11:35 PM

I am issued the EMT-D patch at my P/T job, and EMT-B at F/T. I started my P/T job first, so thats what patch I put up......

wag11c

03-29-2007, 05:14 PM

Whackers love to post lots of initials and job descriptions after there threads. When you grow up BLSBOY perhaps you'll understand. Now be a nice boy and go to your room, you are grounded for a week.

BLSboy

03-29-2007, 07:41 PM

Whackers love to post lots of initials and job descriptions after there threads. When you grow up BLSBOY perhaps you'll understand. Now be a nice boy and go to your room, you are grounded for a week.

Before you get all huffy puffy, spell check:cool:

TurkII

03-31-2007, 12:38 AM

So yet another forum that starts as a legitimate discussion full of thought and good ideas turns into a ****ing match between a few people.

We all come from different professional backgrounds and have different opinions based on what works and what doesn't work in our own services. BLSboy's initial question and post brought up a great topic having to do with our own SAFETY. Somewhere about half way down Page 2 this turned into yet another rediculous paid/volly conversation.

Let's start again. My thoughts = no L&S back to the hospital 90% of the time.

- Turk II
- EMT-P, EMS-I
- Do I have too many letters??? Am I a wacker?? Who cares.

BLSboy

03-31-2007, 12:48 AM

OK, lets start over again. Im a paid guy, trying to save ALL EMS personnel injuries or death. IDK if you are paid, free, volunteer, white, black, purple, whatever. If your pt isn't circling the drain, why go code to the facility? Yea you may think it's "cool" to go hot to the call, but, if you think its "cool" then you need to be treating or in the passenger seat. L&S are no different then a monitor, or an IV, or drugs..your not going to use them on a stable pt that doesn't need it.

the1141man

03-31-2007, 06:40 PM

- Turk II
- EMT-P, EMS-I
- Do I have too many letters??? Am I a wacker?? Who cares.

I don't necessarily care, but I'm a bit confused--I've seen it spelled "whacker" and "wacker". Is that a regional thing or what? Or does "whacker" denote someone who literally hits people, as in "whack upside the head", whereas "wacker" indicates the figurative tense, e.g. "wacking to the sound of the siren"??
This is something we should discuss at length, since it could cause some serious confusion and problems if the two terms are mixed haphazardly. :D

DobermanXXL

03-31-2007, 06:49 PM

Its up to the medic

we go code 3 to every call, we must because it's part of the county contract. ALS fire must be on scene within 5 minutes, and ALS ambulance must be on scene with in 11 min and 45 sec or we get fined

When we get there, and assess pt we decide to come back priority 1 2 or 3

p1 - code 3 with medic

p2 - code 2 with medic

p3 - code 2 with emt in back

all ambulances here are 1 and 1 emt/medic

Bushwhacker

04-02-2007, 05:49 AM

Call me out of the loop but how in the **** did we go from getting our ***'s chewed for "Not using all avaliable warning devices to, don't turn on the siren it too big of a liability!" I do not get it, but there are a lot of things I mis-fire on also.

And is it really the strobe lights and the sirens that are causing the wrecks or is it the jackass behide the wheel that belives he is god, or its "just another normal run". I can not understand the reasoning behide this, I am sure there are facts to back it up but what in the hell? Sounds to me like some one is trying to pass the blame off for there actions on something else.

Disclamier: I am a Rural EMT/FF and very often get annoyed over stupid **** like this.

yowzer

04-02-2007, 05:55 AM

Let's start again. My thoughts = no L&S back to the hospital 90% of the time.

For BLS, about the only thing we might normally encounter that warrants a priority transport is recent onset of stroke symptoms. Then there's the rarer cases such as where there aren't any medics closer to you than you are to a hospital for someone who needs ALS... 10% seems like a high percentage.

In critical care interfacility transport, it happens more often but even then the vast majority of transports are routine. The guy with resolved chest pain going to a hospital with a free cardiac observation bed so his enzymes can be checked a few more times to rule out a MI? No rush. The post-arrest guy on a ventilator and balloon pump going from a cath lab to an available OR or ICU? The lights are going on.

BLSboy

04-02-2007, 03:04 PM

For BLS, about the only thing we might normally encounter that warrants a priority transport is recent onset of stroke symptoms. Then there's the rarer cases such as where there aren't any medics closer to you than you are to a hospital for someone who needs ALS... 10% seems like a high percentage.

In critical care interfacility transport, it happens more often but even then the vast majority of transports are routine. The guy with resolved chest pain going to a hospital with a free cardiac observation bed so his enzymes can be checked a few more times to rule out a MI? No rush. The post-arrest guy on a ventilator and balloon pump going from a cath lab to an available OR or ICU? The lights are going on.

Exactly!
When you do SCT/CCT, the chances of picking up a seriously ill or injured person is almost 100%, and thats when you want to have a kickass driver who can navigate with L&S safely, know his way around, and NOT throw around the Nurse and EMT in the back.
SCT/CCT work is pretty cool, and you learn alot from it

wag11c

04-02-2007, 03:26 PM

Or, you can always use your "defibrillation" patch to help save their lives. If that doesn't work, a "kick *** driver" surely will make the difference.

BLSboy

04-02-2007, 04:23 PM

Or, you can always use your "defibrillation" patch to help save their lives. If that doesn't work, a "kick *** driver" surely will make the difference.

Who put a quarter in this guy?:confused:
:cool:

DrParasite

04-02-2007, 08:29 PM

Exactly!
When you do SCT/CCT, the chances of picking up a seriously ill or injured person is almost 100%, and thats when you want to have a kickass driver who can navigate with L&S safely, know his way around, and NOT throw around the Nurse and EMT in the back.
SCT/CCT work is pretty cool, and you learn alot from it
how many SCT trips have you done? I only ask because I have done a few (like, maybe 4), as well as a ton of PICU CCT runs, and most of them are just glorified non-emergency transports. in most cases, the patient is "relatively" stable, and could go by BLS ambulance except the doctor wants a heart monitor, so you need to tack on an RN to monitor it. I even had a medic once tell me he had no idea why he was on the transport (our CCT units are staffed with one MICN, one EMT-P and one EMT).

yes, there are those truly life threatening SCT runs, but most of the time the patient has been stabilized at the sending facility, and is being transported by SCT just as a "well, just in case" situation.

BLSboy

04-02-2007, 08:37 PM

how many SCT trips have you done? I only ask because I have done a few (like, maybe 4), as well as a ton of PICU CCT runs, and most of them are just glorified non-emergency transports. in most cases, the patient is "relatively" stable, and could go by BLS ambulance except the doctor wants a heart monitor, so you need to tack on an RN to monitor it. I even had a medic once tell me he had no idea why he was on the transport (our CCT units are staffed with one MICN, one EMT-P and one EMT).

yes, there are those truly life threatening SCT runs, but most of the time the patient has been stabilized at the sending facility, and is being transported by SCT just as a "well, just in case" situation.

I dont honestly know, is alot an acceptable answer?:D
The one Company I work for staffs the SCTU with 1 RN, and a minimum of 2 EMTs, but they can do it one 1 RN/EMT (P) and an EMT. its about 50-50 the amount of BS SCT and real, life threatening runs. The hospital we have the contract for is not a trauma center, or heart center, nor does it have a good pedes floor, so all those must go to the respective facilities. Since most of the night shifts I pick up are SCT, most of the "bad" trips also come at night, I have seen a fair share of MIs, Trauma Transfers, real sick kids, etc.

DrParasite

04-02-2007, 08:52 PM

sorry dude, but your credibility with me just went down a notch. here is why:
Exactly!
When you do SCT/CCT, the chances of picking up a seriously ill or injured person is almost 100%followed by

its about 50-50 the amount of BS SCT and real, life threatening runs.yeah, I really think you are a seasoned vet when it comes to EMS:rolleyes:

As to yowzer's comments, I think they are over used. L&S dramatically increase your chances of getting into an MVC. whether you have an A-hole driver or the best, you can't control what the other idiots on the road are doing. They save maybe 30 seconds (usually traffic lights) and when you consider the danger they put both you and the rest of the public in (remember, the other idiot drivers have to adjust their normal driving habits to accommodate the emergency vehicle) they might not be worthwhile when you consider if that 30 seconds is really going to make a difference.

and in 95% of the calls, it doesn't.

BLSboy

04-02-2007, 09:10 PM

sorry dude, but your credibility with me just went down a notch. here is why:
followed by
yeah, I really think you are a seasoned vet when it comes to EMS:rolleyes:

As to yowzer's comments, I think they are over used. L&S dramatically increase your chances of getting into an MVC. whether you have an A-hole driver or the best, you can't control what the other idiots on the road are doing. They save maybe 30 seconds (usually traffic lights) and when you consider the danger they put both you and the rest of the public in (remember, the other idiot drivers have to adjust their normal driving habits to accommodate the emergency vehicle) they might not be worthwhile when you consider if that 30 seconds is really going to make a difference.

and in 95% of the calls, it doesn't.

Just because someone is seriously ill does not mean that is requires an emergency run. ALOT of the daytime SCT we do are from the hospital to the Cancer Center.......which is right across the street.
These people are seriously ill if they go by SCT across the street, but we dont use lights and sirens. The cardiac cath runs, when NOT STAT, are routine, pick em up, and take em to get their cath done, they are sick, and I sure as hell wouldn't feel comfortable taking them BLS.
But those are all daytime runs, at least where I work.

My 100 % comment was for the night owls who do SCT (like me) that see the Active MIs, the Trauma Transfer, or the unstable pt in multi-system organ failure, with a BP that is about room temp, that needs to go to a facility in Camden at 11 at night. These are the runs I like, and I get to put my skills to use, and learn a thing or two. But even on the stable trips, if you have a good RN, you can pick his or her brain to learn what meds are used, when, etc.

BLSboy

04-02-2007, 09:12 PM

Where you work, who makes the determination to go hot to the hospital, standing orders, the Medics, the person treating, the driver?

DrParasite

04-02-2007, 09:34 PM

the hospital I work for is a Level I trauma center, Cardiac center, and even a stroke center (probably classified other things too). We have a PICU and a NICU, as well as a SCN. and most of the time when someone is transferred here, it's our CCT unit that goes to get them.

where I work, the decision to go lights and sirens is usually made by the treating RN/MICN on CCT units. for PICU CCT runs, the decision is left up to the transport MD. for BLS calls, typically the treating EMT makes the call to use lights and sirens or not.

BLSboy

04-03-2007, 12:01 AM

What happens if the driving EMT thinks that the call doesnt need L&S?
What do you do?

DrParasite

04-03-2007, 04:58 PM

it's his call. The treating EMT (ie, the one who is assessing and treating the patient) makes the decision as to whether to use lights and sirens.

if he says you don't go lights and sirens, you don't go lights and sirens

CenTexMedic

04-05-2007, 12:26 AM

I RARELY ever run emergency traffic TO the hospital. If one of our crews are running L/S somebodys sick. On the other hand we ALMOST always run code TO a scene due to lack of information provided by callers. ie. 82 year old female that calls for 'feeling queazy'. Is it an MI or the flu? exceptions are to suicide attempts where PD isnt on scene yet, overdoses, psych PT's, fire is on scene first and advises us to reduce code to a wreck, etc.

devilbutt

04-05-2007, 12:56 AM

New to this site. Been checking it out for the past couple of weeks. Lots of good talk, advice, and information. Been an EMT for over ten years, the past 4 as a Specialist/Intermediate. Currently taking a teleconferece class for Paramedic. Very rural here. Only "Wilderness" designated hospital in the state, I believe. Anyways.........here is an article that may be of interest. Hopefully the address is correct and works. This involved a student from one of the other "off" sites. PLEASE read it. As I said, hopefully the address is correct.

http://www.dailypress.net/stories/articles.asp?articleID=8642

devilbutt

04-05-2007, 01:57 AM

New to the site. Been checking it out for the past couple of weeks. Lots of good talk, advice, and ideas. Been an EMT for over 10 years, the last 4 as a Specialist/Intermediate. Currently taking teleconference class for Paramedic. Very rural here. Only "Wilderness" designated hospital in the state, I believe. Anyways.........thought this article may be of interest. Actually one of the students from a different "off" site was the driver. Needless to say, her career is over even before it started. Probably the least of her concerns right now. Anyways, PLEASE read the article. Hopefully the address is correct. Be careful out there!

http://www.dailypress.net/stories/articles.asp?articleID=8642