Safety Sunday, Volume 1. Issue 1 (3/10/13)
When Silence is Golden:
The Misuse of Lights & Sirens
in EMS
For my first installment I am looking at some of the data
behind the regular use of lights and sirens in EMS. This falls in the general category
of safety issues related to transportation. Throughout these vignettes I will
reveal more overall examples of the safety problems related to transportation,
but I will reveal a couple of shocking statistics. There are around 6,500
ambulance crashes per year. As far as transportation
deaths goes the average deaths per 100,000 are about 5 for the general public.
Police are at 10.8, fire at 9.3, and EMS tops all traditional public safety
entities at 12.7 transportation related deaths per 100,000. Besides the human
toll, it is estimated that EMS vehicle accidents account for around
$500,000,000 in costs. One study showed that 47% of EMS responders that
answered a survey had been in an ambulance crash before.
One study from Denver found that about 91% of ambulance
accidents occurred while driving emergent. Being in EMS for almost a decade I know that
people, usually young men in their early 20’s, turn on the lights and sirens
(L&S) and get tunnel vision, feel that they have an invincibility cloak,
and lose sight of medicine’s premier creed, “First, Do No Harm” or Primum Non
Nocere.
There are currently at least 4 studies out there that looked
at how long going L&S saved. Anecdotally I have followed ambulances in my
area non-emergent after bringing bariatric cots to responding crews, 3 ended up
leaving L&S. In 2 of those our ambulance was parked and the patient was
still being unloaded (a delay of around 30 seconds) when we came up to assist.
The 4 studies resulted in mean differences of 43.5 seconds (n=50), 1 min 46 seconds
(n=32), 3 min 1 seconds (n=64), and 3 minutes 38 seconds (n=67) from non-emergent
and L&S. All but the 1st response (43.5 seconds) was in an urban
environment.
With more and more evidenced-based-medicine (EBM) creeping
its way out of the hospital and into the back of the ambulance, and advanced
technologies like CPAP, ultrasound, capnography, and telemedicine also getting
into the hands of paramedics and EMTs, the days where simple “diesel” treatment
covered a large portion of runs is over. It is becoming increasing rare where
45 seconds to 4 minutes of quicker access to error-laden, super-bug prevalent,
and overflowing queues of an emergency department truly make a difference in
patient outcomes.
Granted there are times where those precious seconds in the
ED may make a difference, If a chest tube is needed for blunt trauma victim, uncontrolled
internal hemorrhaging from penetrating trauma, cardiac stent placement for a
STEMI, or delivery of clot-busting medications in an acute stroke. These above
examples are the easy ones, so… do you think EMS makes good decisions about
going emergent?
NO is the answer. In one of the above studies that looked at
around 75 cases, only 4 were found to have actually needed to go emergent.
Another study found that 39% of L&S use was appropriate. Two different studies,
one looking at pediatric transports and the other an analysis of Pennsylvania’s
more closely defined L&S protocol both reveal that only around 8% of
transports to the hospital should result in going emergent.
So, what can be done? The increased use of “opticom” systems
is a potential solution. Sirens that make different types of sounds, like a
Rumbler intersection clearing system, may also be a solution. In the end, when
you do go emergent, simply following some of the basic road safety rules will
prevent a large majority of serious accidents.
·
Clear intersections at the speed of which the Bureau
of Motor Vehicles gets your license renewed.
·
Always where your seatbelt. If you don’t have a
realistic system to belt in back, complain until something is done.
·
Have a sterile cockpit approach to your front
passenger area. Radio off, partner engaged, and having predetermined
terminology to help clear intersections (ie, clear instead of GO, which could
be interpreted as NO).
·
Generally driving with due regard to the safety
of yourselves, your patients, and the general public. Treat the road like every
vehicle you are around had YOUR family in it.
I hope that this has helped, I will try to add more shiny
objects (more pictures, videos, graphs, resource page) as I go. For now, thanks for reading, stay safe, and remember, First
Do No Harm!
Garrett Hedeen, the Naptown Medic
(Big thanks to Scott Matin and the Monoc Ambulance service on making the above video about the use of lights and sirens) Here is a link to more http://www.monoc.org/sirenPSA2.cfm?CFID=1596328&CFTOKEN=39634212&jsessionid=ce30aae820ba7537d4fd79487a30712b3605
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