My List of the 16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic
7. Decreased Use of Lights and Sirens
Ambulances in this area drove faster twenty years ago than they do today. We had some wrecks. People were killed, other injured. It happened. The longer I worked, the more unnecessary it seemed. Drive half way across the city lights and sirens only to wait half the day in the triage line with the same patient. What was the point?
The worst drivers were young men in their early twenties, all full of testosterone and invincibility, wearing bullet proof vets, but not using seat belts, much less wearing crash helmets.
In time we got mandatory seat belts and were required to come to complete stops at all intersections when responding lights and sirens, and we had the black box technology to enforce it. You “fob” in to drive so the computer knows you are driving. If you don’t wear a seatbelt, drive too fast, take a corner too sharply, or stop too suddenly, you lose points and have to listen to the ambulance beep when it happens. I resisted the black boxes at first (not the seat belts, which I always wore), and in time, I came to think they were great. People definitely drive better now.
The role of lights and sirens is much less now. EMD, which I am not a big fan of, has at least, contributed to the downgrading of some responses.
We even have a statewide policy now to help limit the use of lights and sirens. The general rule of thumb now is only go lights and sirens to a hospital if the hospital can do something for the patient that you can’t in the amount of time you would save going lights and sirens over flow of traffic that will make a difference in the patient’s outcome.
I rarely even go lights and sirens to the hospital now. Despite this, I think lights and sirens are still overemphasized. Too many town and municipal contracts are based on on-time performance as well as outcomes. All these contracts measure is what time the ambulance arrives, not whether a medic is there or not or how good the care is. How about these for performance measures instead of response times? Percentage of patients 55 and over with hip fractures, who receive pain meds, % of STEMI patients who get ASA and have their 12-lead done and successfully interpreted or transmitted to the ED, CHF patient who receive CPAP and nitro?
When I started, the Golden Hour ruled, but it has been discredited over time. Quality Care and Safe Transportation are the new watchwords. I hope this trend continues.
Here’s a post I wrote about the debunking of the Golden Hour.
And here’s a post I wrote several years ago called My Death, which deals with my thoughts about overuse of lights and sirens.
Lights and Sirens Use Policy
STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
OFFICE OF EMERGENCY MEDICAL SERVICES
RESPONSE AND TRANSPORTATION GUIDELINES FOR AUTHORIZED EMERGENCY MEDICAL
VEHICLES (INCLUDING LIGHTS AND SIREN USE)
Due to the inherent risk of operating with lights and siren. Department of Public Health Authorized Emergency Medical Vehicles (AEMV),
(specifically ambulances and EMS non-transport vehicles) should use emergency lights and siren only when responding to calls involving or
transporting patients believed to need immediate life or limb threatening medical intervention. The mode of transport is a patient care medical
EMS personnel must use patient compartment vehicle occupant restraints whenever practical based upon patient critical needs. EMS personnel
must use occupant restraints when driving. Front seat and patient compartment passengers/patients must use occupant restraints. EMS employers
must ensure that EMS personnel who operate AEMVs are qualified and trained appropriately. Consideration should be given to the use of
electronic behavior modifying instant feedback systems as a skills improvement and coaching tool.
The Department of Public Health should strongly encourage and financially support;
1. Emergency Vehicle Operators Training for all EMS Providers and,
2. The use of vehicle monitoring systems that encourage coaching and provide operators with immediate driving
technique feedback and organizations with data for system improvement.
Connecticut Statute 14-283 must be adhered to.
Authorized Emergency Medical Vehicles should respond lights and siren only when directed by their dispatch center based on EMD criteria.
Should additional information be received from public safety personnel suggesting that a response no longer merits a lights and siren mode while
the AEMV is en route to the scene, the AEMV response should be downgraded to non-lights and siren mode. Similarly, should additional
information be received from public safety personnel suggesting that a non lights and siren response merits a lights and siren mode while the
AEMV is en route to the scene, the response should be upgraded to a lights and siren mode.
The highest level certified/licensed EMS provider responsible for the patient’s care will advise the driver of the appropriate mode of
transportation based upon the medical condition of the patient.
When transporting the patient utilizing lights and sirens, the need for immediate medical intervention should be beyond the capabilities of the
ambulance crew using available supplies and equipment and be documented on the patient care report.
The mode of transport for emergency interfacility transfers should be based upon the directions of the referring physician and on the condition of
the patient unless the patient’s condition has deteriorated en route.
Exceptions to these policies can be made under extraordinary circumstances.
16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic
8. Selective Spinal Immobilization Guidelines
9. Alternative Airways
10. Chemical Restraint
11. No More Lasix
13. Permissive Hypotension
14.Expanded Medication Routes, Less IV Emphasis
15. Narrower Use of Narcan
16. Increased Standing Orders