GARY LUDWIG
It’s four o’clock on a weekday afternoon and you are toned out for a patient with shortness of breath, turning cyanotic and with a history of chest pain. During the five-minute response, you race across town, weaving in and out of rush-hour traffic with your emergency lights flashing and siren blaring.
As you arrive on the scene, immediately you know there cannot be too much urgency to the call, since two of the three members of the first-responder engine company are standing outside the residence. Once inside the residence, you discover why the engine company seemed nonchalant. Sitting in a chair in no apparent distress with his coat on is your patient, all of his pill bottles in a large plastic bag on his lap.
You look at the member of the engine company who did the initial assessment of the patient and she rolls her eyes. You ask the patient what is wrong and he tells you, “I called my doctor and he said I should go to the emergency room. He’s going to meet me there.” In response, you ask, “Why did you call your doctor?” He answers, “I ran out of my asthma medication and I was feeling a little short of breath his morning.” You then ask, “Do you have a history of heart disease?” “Yes,” replies the patient, “I had a heart attack about four years ago.”
Does this sound familiar? It should. It happens countless times probably every day in this country – the urgent response of an ambulance when there is no true emergency.
Recently while heading through the Pittsburgh airport, I happened to glance at a copy of USA Today. Right on the front page, the headline on the cover story was, “Speeding to the rescue can have deadly results,” with an overexposed blurry picture of an ambulance, designed to represent a rapid speed. The article included some chilling statistics. According to a 1993 Houston study, ambulances are 13 times more likely to be involved in an accident than other vehicles in terms of the number of accidents per mile driven. The Houston study also showed that ambulances are five times more likely to be involved in a crash that causes an injury.
USA Today conducted an analysis of the National Highway Traffic Safety Administration (NHTSA) database and found, “In fatal, multi-vehicle ambulance crashes between 1980 and 2000, the number killed in the other vehicle was 21 times greater than the number of ambulance drivers (their words, not mine, but see my editorial comment at the end of this column) who died.” The analysis also showed more than three-fourths of the fatalities were people who were not in the ambulance. Additionally, there were 33 fatalities in 2000 associated with ambulance crashes. Finally, some estimate that there are 15,000 ambulance crashes per year in the United States, or roughly 41 each day.
Several years ago, then-St. Louis Fire Chief Neil Svetanics instituted an “On-the-Quiet” policy (no lights and sirens) after the St. Louis Fire Department experienced three apparatus accidents in one day. The policy was intended to stop “lights-and-sirens” runs to incidents that involved no true life or property emergency (such as dumpster and weed fires and sprinkler alarms). This policy also carried over to EMS calls. If the communications center received any additional 911 calls that indicated there was a real threat to property or life, the alarm was upgraded. One year later, the program was evaluated and the end result was 62% fewer accidents and an 81% reduction in injuries.
More and more cities apparently are seeing the value of prioritizing EMS runs. A recent 200-city survey conducted by the Journal of Emergency Medical Services (JEMS) found that only 32% of the 200 largest (by population) cities in the United States responded to all calls with lights and sirens. This figure was down by 37% from the previous year. The survey also found that 36% of those 200 cities prioritize calls by determining the urgency of each medical situation.
The key to the success of any response when not using lights and sirens rests on the dispatchers in the communications center. That is why many communication centers have begun using standardized protocols for evaluating or screening 911 calls. Currently, at least three companies sell standardized EMS protocols to public safety communication centers.
Several studies have shown very little decrease in response times when no lights or sirens are used. In many of the studies, using lights and sirens saved less than one minute, 30 seconds on response times.
Decreasing accidents and injuries involves more than just slowing down. The success is a combination of slowing down, good driving judgment, defensive driving programs, good maintenance programs and attention to road conditions. After all, the goal should be the make sure everyone goes home at the end of their shifts.
(Editorial comment: To Robert Davis, author of the USA Today article on ambulance crashes – Your repeated use of the word “ambulance driver” is no longer applicable. Ernest Hemingway was an “ambulance driver” in World War I. The term died when EMTs and paramedics started receiving their training and licenses in the late 1960s.)
Related:
Emergency Medical Runs: Urgent Vs. Non-Urgent