Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Comment on Caller Requests No Lights or Sirens

Mystery Medic responds to my post Caller Requests No Lights or Sirens with the following –

Sorry, It’s been awhile since I bugged you. Let’s analyze the real reason for the request for no L&S for what we perceive as an emergent call. Is it because they don’t want the neighbors woken up at 3AM out of courtesy?

What misanthrope uses lights and sirens at 3 AM?

I realize that a lot of EMS does use lights and sirens, but is there an easier way to find those in the wrong field. There is generally nobody else on the road, so the person using the siren at 3 AM is not doing it to help anyone.

In the rare case of after midnight traffic congestion, there may be justification for sirens.

Is it because they don’t what they neighbors to know there is something wrong? After all it isn’t.

If nothing is going on, then there is no good reason to be waking people up at 3 AM. Maybe some of the people you are waking up do important work that would be performed better when their sleep is not interrupted.

Don’t worry if the pilot on your next flight is thinking no more clearly than the TSA groper treating you as you treat the residents of your community, when you drive through at 3 AM. Wouldn’t TSA love lights and sirens?

Lights and sirens – not because we should, but because we can.

Are they a private person and don’t want excess people in their home and more likely to get a no service from police if they felt they could intervene?

You seem to be suggesting that there is something wrong with people who don’t want 3 AM siren users invading their homes?

Are they frequent fliers who abuse the system and use chest pain to get an ambulance quicker but don’t want everyone to know?

We wouldn’t know that until afterward, but frequent fliers tend not to care what anyone else thinks, since they are usually focused on themselves.

If I get a dispatch for an ALS call even requesting no L&S then I respect that to a point.

As in I have respect for patients to a point. Once I find out that they are of the other political party, or they watch a TV show I do not like, or they can afford things I can’t afford, then my intolerance is completely justifiable. That kind of respect?

I respect that to a point?

WTF?

If there is a previous call history or if I been there before I might know the reason for the request. If I don’t I use L&S until a few blocks out unless it’s down the street and then kill it and drive down the street. I work almost all night shift so we can sneak in most of the time if those were the concerns.

Working night shift, why would you need to use lights and sirens?

Sneak in?

Do the sirens activate your medications, fine tune your laryngoscope, or is there something else mystical about unnecessary loud noises.

Some people just don’t want others to see that they have an ambulance or a Philly Fire Engine in front of their house idling. Patient privacy is part of our job.

There isn’t much we can do about vehicles idling in front of the residence, but that is completely different from using lights and sirens.

Now, if you call at 3AM for a toothache I’m gonna drive down your street with every light and siren I have on my truck and drive 4 houses past and park it with all the lights running plus the scene lights.

Should the police charge you with disorderly conduct for this kind of behavior?

Should you be suspended without pay for a week, or two?

What is the appropriate way to deal with this?

You hate the toothaches of other people and are willing to ruin the sleep of a lot of people, who have nothing to do with what is going on, just to make your point that you do not like the toothaches of other people.

Wonderful.

Wouldn’t it be nice if we were to actually assess a patient, before we decide what to do with the patient?

Is that asking too much?

Should we dismiss one of the atypical signs of a heart attack, because we don’t like the sound of the dispatch description.

Is there some reason for us to believe that a toothache cannot hurt as much as a broken arm or a broken leg?

If so, please explain the mechanism for that. Should we never receive any pain medicine for any dental procedure? This removes the credibility of the infamous torture scene from Marathon Man.

Then put all my gear on the stretcher and roll it down the street back to the house. Then roll it back from the house with you walking it with all the neighbors watching. Makes for good neighbor relations.

Research has consistently shown that we medics are horrible at identifying how sick our patients are

Some people just are not capable of telling the difference between the patient who ends up in the ICU and the patient who does not have a legitimate complaint.

Medics who tell you that they know who the fakers are are basing that claim on what?

Have these medics followed the hospital treatment of the patients they labeled as just system abusers?

Do these medics have any training in identifying system abusers?

Do these medics just believe the Everybody knows what a system abuser looks like nonsense?

What objective evidence is there for a medic to use any methods to determine that a patient is a system abuser?

Where is the evidence that these methods can be reproduced in a way that is capable of accurately identifying system abusers and does not miss any truly sick patients.

How many truly sick patients should we abuse to punish each system abuser?

Strike that. Reverse it.

How many system abusers should we punish to justify the abuse of one truly sick patient?

We should not be punishing those we think are system abusers. We have no consistent way of identifying system abusers.

We could study this. If we have some that we are certain are system abusers, we could identify them when we drop them off by something on the chart. We could ask our QA/QI/CYA department to track what happens to these alleged system abusers in the hospital. Obviously, a lot more would need to be done to attempt to blind everyone to which patients we have identified, so that the doctors and nurses would not prejudice the study either way.

How many will receive real treatment from the real doctor in the hospital?

How many will be admitted for continuing treatment?

When we can do this with a large number of patients, without incorrectly identifying any admitted patients as system abusers, then we may have a system that works. Then, we should not ever deviate from this system, because we will have no basis for any deviation, if we have not tested it.

Then we can publish our research.

Without research to support claims that we can identify system abusers, we are just exhibiting Confirmation Bias. We point to the cases that seem to support our claim, but we don’t look for any cases that would suggest that we are wrong. Not only do we not look for them, we make excuses for any cases that suggest that we are wrong, no matter how embarrassingly wrong we are.

We are easily fooled by our biases.

We seem to be proud of our foolishness.

In the absence of research to support our method of identifying system abusers, is this much different from accusing people of witchcraft?

How many system abusers should we punish to justify the abuse of one truly sick patient?

If we are comfortable mistreating real patients, just to punish some who might be system abusers, then endangering people by the use of lights and sirens after we are told that lights and sirens are not necessary, should not be surprising.

Respect my authority!

Is this different from insisting that, because we are paramedics, we need to be allowed to intubate?

.

Comments

  1. Ok, so I agree with about 99% of this. However you say :
    “We wouldn’t know that until afterward, but frequent fliers tend not to care what anyone else thinks, since they are usually focused on themselves.”
    in regards to the comment that was made about frequent fliers/system abusers using chest pain to get a quicker response. Anecdotally(for whatever 0% reliability there is inherently using only that), as I have no research to back it up, I wouldn’t say that’s a completely true statement. Instead, I’d say that there are definitely a good portion of that category of patients that don’t care about anything but themselves. Then there are those that want a quick response but perhaps they’re embarrassed in front of their neighbors, or they just don’t want the headache of a fire department and ambulance response but know otherwise they’ll be delegated to a low priority response. After all, they are system abusers/users/etc, and they’ve learned how to play the system. They know the phrases to say. Not saying it’s right to mistreat them, just some of them are so selfish that they want their cake(a quick response time) and to eat it too(no lights/sirens).

    • Can’t say, clowns will eat me,

      Ok, so I agree with about 99% of this. However you say :
      “We wouldn’t know that until afterward, but frequent fliers tend not to care what anyone else thinks, since they are usually focused on themselves.”
      in regards to the comment that was made about frequent fliers/system abusers using chest pain to get a quicker response. Anecdotally(for whatever 0% reliability there is inherently using only that), as I have no research to back it up, I wouldn’t say that’s a completely true statement.

      Hence the modifiers tend and usually.

      Instead, I’d say that there are definitely a good portion of that category of patients that don’t care about anything but themselves. Then there are those that want a quick response but perhaps they’re embarrassed in front of their neighbors, or they just don’t want the headache of a fire department and ambulance response but know otherwise they’ll be delegated to a low priority response. After all, they are system abusers/users/etc, and they’ve learned how to play the system. They know the phrases to say. Not saying it’s right to mistreat them, just some of them are so selfish that they want their cake(a quick response time) and to eat it too(no lights/sirens).

      And we still are only assuming that they are system abusers from the dispatch information and the location.

      Even after an assessment, too many of us in EMS are not capable of recognizing people who need to go to the emergency department.

  2. “What misanthrope uses lights and sirens at 3 AM?”

    There’s at least one volunteer squad in suburban Richmond VA that does exactly this, at least on the “main” roads. I lived far enough from such a road that its normal traffic noise didn’t wake me up, but the VRS 0230 lights-and-sirens-down-an-empty-road routine did, every time. I never complained officially*, but I held some pretty nasty thoughts in my heart.

    (*I did complain officially once, when one night at oh-dark-thirty they flipped on their opticon transmitter to change a light that was green for me but red for them. That’s a dumb thing to do when you’re driving a billboard with a big number on the side of it.)

    • PJ,

      I sometimes think that the motto of EMS should be, Abandon all sense, those who enter.

      We do things that are not expected to provide any benefit, but they do have risks, and we are insistent that we have to do these senseless things.

    • I have a hunch that I know exactly which VRS you’re referring to.

      I’ve never understood the allure of letting the siren wail continuously when it’s very late and there’s no traffic on the road… and on what is essentially a neighborhood street with no traffic signals.

      I understand that in the situation you mentioned, the driver used the Opticom inappropriately, but I actually think that using the Opticom to change signals *while on a call* is a good idea IN LIEU of going “Code 3” in low-traffic situations — the ambulance gets green lights but doesn’t incur the problems that come with driving with lights and sirens. The only issue I’ve had is that the Opticom system here rarely works well, so it’s not as useful as you might expect.

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