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Last night on EMS Office Hours Jim Hoffman, Josh Knapp, Tom Bouthillet, and I discussed response times, but really wandered off into the topics of whether a full stop should be required at a red light and how we can balance judgment with fear of litigation.
Responding Lights and Sirens, Due Regard and Expectations
Our main point of disagreement was the topic of a mandatory full stop at a red light.
I think that we need to require that drivers be responsible for the operation of the vehicle. An important part of any responsibility is the use of judgment.
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Tom suggests that this is similar to the use of checklists, which is something that we agree is helpful. I do not see the connection. Checklists are to make sure that we remember essential things that we might otherwise forget.
Are we going to forget to slow down to a safe speed to cross the intersection if we do not come to a full stop?
No.
The only real differences are that when we approach a full stop, we often do not pay attention to cross traffic. When we approach a yield, we should be looking for the appropriate rate of travel to merge seamlessly with the traffic. This is more complicated with lights and sirens, since people behave less predictably when they notice the lights and sirens.
There is also an obligation for any emergency vehicle operator to use judgment, rather than to assume that, As long as I come to a full stop, I do not have any responsibility. We are always responsible for our actions. We need to get drivers to think about the way they are driving and the way that they are interacting with the other vehicles on the road.
Currently, many places require a full stop at a red light during lights and sirens driving.
Do these rules prevent drivers of emergency vehicles from driving through the lights without slowing down?
No. And nobody on the podcasts suggests that they do.
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They do claim that these rules allow some sort of legal protection, which may be true, but it is probably greatly exaggerated. Assume that an organization has a rule that forbids driving through a red light without a full stop, but there are plenty of cases of the organization’s vehicles being driven through red lights without slowing down.
Is a plaintiff’s lawyer going to say, I won’t sue them. They have a rule that they do not enforce.
I don’t think so. If anything, this may provide evidence that the organization created an environment that encouraged employees to ignore the rule. The lawyer is probably going to focus on whether management was aware of the lack of enforcement of the rule.
On the other hand, suppose the organization requires that the driver of an emergency vehicle use judgment while traveling through a red light with the lights and sirens on, and educates the drivers about the difficulty in stopping a large vehicle suddenly, even at moderate speeds. Suppose that organization puts cameras in the vehicles to review the driving patterns, not for punishment, but for education and improvement.
Is the second organization going to face greater liability than the first?
Nobody knows. The same case can be presented to different juries and have different outcomes. The way the case is presented also affects the outcome. Individual bits of evidence will also affect the outcome.
It is suggested that an organization has a limited budget and might not think that training and/or cameras is an appropriate use of funds. Since vehicular collisions are at the top of the liability exposure for emergency organizations – police, fire, and EMS – this appears to be a silly argument.
Money spent to prevent crashes is money well spent.
Less time with experienced personnel out of work on disability. Less overtime to cover those shifts. less repair/replacement cost for emergency vehicles. Less of a black eye in the perception of the public for a preventable collision. Less of the costs for the injuries to civilians and damage to their property. And then there is the problem of the emergency response being complicated by fewer responders and a greater need for responders with the multiplication of incidents. If the vehicle was responding to a cardiac arrest, we should assume that the patient will not be resuscitated due to the prolonged response of the next due vehicle.
Will better oversight and better judgement eliminate collisions?
No, but it should result in fewer and less serious collisions.
Has anyone studied different organizations using different rules to see what the effect on the number of collisions and the severity of collisions would be?
This research is something that we should do.
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Rolling through intersections too fast to stop and too slow to get out of the way, is a sure formula for accidents. I think we could easily cut lights and siren responses and transports by half without anyone being harmed. http://phillydan.wordpress.com/2011/06/10/using-red-lights-siren-only-when-parked/
Dan,
Either speed problem should only be the case if the ambulance is moving faster than what the driver can see coming.
Moving too slowly to be able to clear the intersection is going to be a given, if the ambulance is stopped. We cannot always see all of the traffic approaching the intersection before we enter the intersection. Roosevelt Boulevard with a couple of truck or busses in the traffic will prevent you from seeing all of the approaching traffic. If you can’t see them, they probably cannot see you. Clearing these intersections requires moving forward enough to be able to see if traffic is coming through each open lane, which can always change as long as there is no vehicle blocking the lane.
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I agree and I like that post – Using Red Lights & Siren Only When Parked
You wrote –
This can be done.
It does require placing more emphasis on competence, rather than lowest common denominator rules.
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Here in Pennsylvania, it really does not matter what an individual organization’s policy says about stopping or slowing down as the ambulance moves through a RED signal. The motor vehicle code here is very clear about the subject:
PA Title 75, Section 3105, Part b: Ambulances, blood delivery vehicles and human organ delivery vehicles.–The driver of an ambulance, blood-delivery vehicle or human organ delivery vehicle shall comply with maximum speed limits, red signal indications and stop signs. After ascertaining that the ambulance, blood-delivery vehicle or human organ delivery vehicle will be given the right-of-way, the driver may proceed through a red signal indication or stop sign.
I would reason that most other states have similar provisions and remind that an individual organization has no authority to circumvent the statues of the State.
Additionally, here in Pennsylvania (at least some parts) the idea of limiting the use of L&S when responding to an incident and transporting to the hospital is becoming more accepted. Even though it has a been a limited time (and I do not have any studies / statistics to back this up) I personally have seen very little impact on overall response times.
Stay Safe, -Bruce
Bruce,
That is true.
That is one of the reasons I used the video I included. If I recall correctly, that is from Philadelphia. If not, there was a very similar collision in Philadelphia not too many years ago.
State laws can be changed. Some states, and I think Pennsylvania is one of them, have to change the state law to change the medications in the paramedic scope of practice. Drugs are added, or removed, every couple of years.
As you can see from what you cited, Pennsylvania also prohibits ambulances from driving faster than the speed limit when using lights and sirens. The result of enforcement of speed limits would be interesting.
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This is true, but not all states have the same laws and laws can be changed, just as policies can be changed. I am advocating for both.
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That was something that we did not get around to in the podcast. This is a topic that covers a lot of material. The Pennsylvania protocols include the following recent changes (the changes are in italics) –
Pennsylvania is doing a lot to apply the results of research on patient care and the transport that can have such a large effect on patient care. Dr. Kupas is doing a great job at dragging us out of the Dark Ages.
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