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

- Rogue Medic

Does use of Lights and Sirens save lives?

AmboLights
 

A recent Fire Chief Magazine and the current JEMS have some articles on the use of lights and sirens and the effect on patient outcomes. Doug Wolfberg, one of the EMS lawyers who might be trying to defend your choice on use of lights and sirens, states –
 

Few cows are more sacred in fire service based EMS than the ones that flash, wail and yelp. The use of emergency lights and sirens is an inseparable part of everyday EMS life.[1]

 

and –
 

Yet when we look at the actual evidence, a few things become apparent about RLS use. First, it’s proven to be dangerous. Second, it’s not proven to be beneficial.[2]

 

In another article, several of the top medical directors in the country state –
 

Unlike fire emergencies, which can grow exponentially and spread quickly, only a small subset of medical emergencies is truly time sensitive. Most don’t dramatically worsen in the course of a very few minutes, and they don’t spread from person to person.[3]

 

In rare cases, such as those where we are not able to control bleeding, or breathing, and the hospital is close enough that the patient won’t be dead by the time we get there, does use of lights and sirens save lives? In those rare cases? Sometimes.

Wouldn’t it be better to improve the quality of the people treating these patients, rather than increase the speed of transport?

When is the last time you transported a patient to the emergency department for something that needed to be done immediately to save the life of the patient?

Why not do that before transport?

Was it out of your scope of practice, did you not know what was going on, did you not feel comfortable performing the skill, could you not make up your mind about what to do, . . .?

Can’t place an endotraceal tube successfully? Use an LMA (Laryngeal Mask Airway), King Airway, BVM (Bag Valve Mask or resuscitator bag), stimulate the patient to breathe for himself, . . .

Can’t place an IV successfully? The IV is not a life line, but you can place an IO (IntraOssesous) line, apply direct pressure to bleeding, lay the patient flat (Trendelenberg does not improve things for the patient, although it might make you feel like you are doing something good), consider IM (IntraMuscular) or IN (IntraNasal) administration of medication, . . .

But it is an emergency!
 

We used to drive cardiac arrests to the hospital quickly, because we thought that was better.

We were wrong. If we do not resuscitate people prior to arrival at the hospital, they will probably stay dead. Driving fast just increases the odds that we will be as dead as the patient.

There has never been any good evidence to support driving fast.

We need to develop a better understanding of the treatment we provide. We need to provide better assessments (and continue to assess). We need to provide appropriate treatment on scene prior to transport. We need to rush less.
 

Do you believe in frequent lights and sirens transport?

Here is a dare for you.

Keep track of the times you transport with lights and sirens (these should be sentinel events) and document the actual life saving treatment provided in the emergency department in the first 10 minutes.

Keep track of this for a month, or a year.

Do you have anything?

Was it really something that saved the patient’s life?

If you do come up with something, does it amount to more than 1% of lights and sirens transports?

If we have almost always beenwrong about what is going on, should we be endangering everyone on the road to cover for our ignorance?

Footnotes:

[1] Why running lights and sirens is dangerous
Fire Chief
June 5, 2016
By Douglas M. Wolfberg, Esq.
Article

[2] Pro Bono: EMS Use of Red Lights and Siren Offers High Risk, Little Reward
JEMS
Wed, Feb 1, 2017
Doug Wolfberg
Article

[3] The Case Against EMS Red Lights and Siren Responses
JEMS
Wed, Feb 1, 2017
S. Marshal Isaacs, MD, FACEP, FAEMS , Carla Cash, MD , Osama Antar, MD , Raymond L. Fowler, MD, FACEP, DABEMS
Article

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An 85 Mile Per Hour Speed Limit?

 

An 85 mph speed limit sign is placed on the 41-mile-long toll road in Austin, near the increasingly crowded Interstate between Austin and San Antonio, Texas on Thursday, Sept. 6, 2012. While some drivers will want to test their horsepower and radar detectors, others are asking if safety is taking a backseat to pure speed.
Photo: Statesman.com, Ricardo B. Brazziell / AP
[1]

 

85 Miles an hour?
 

In the wide open plains of central Texas, a new addition to State Highway 130 opened for business this week with a compelling marketing hook: Its speed limit of 85 MPH is the highest in America. The 41-mile toll road connects Seguin to Mustang Ridge.[2]

 

That’s insane!

Speed kills!
 

There were 32,310 traffic fatalities in 2011, the fewest there have been since 1949. More importantly, fatality rates per 100 million vehicle miles traveled have dropped substantially over the years, falling from 24.09 in 1921 to 1.09 in 2011.[2]

 

Why mess with a good thing.

If we raise the speed limits, the highways will become death traps.

Just listen to common sense.

Everybody knows that speed kills.
 

In addition, while interstate highway speed limits have risen since Congress repealed all federally imposed speed limits in 1995, fatalities categorized as “speeding-related” by the National Highway Traffic Safety Administration (NHTSA) have declined since then. Specifically, there were 13,414 speeding-related fatalities in 1995 and 10,591 in 2011. Of the 10,591 speeding-related fatalities in 2011, just 964 occurred on interstate highways with speed limits “over 55 MPH.”[2]

 

Maybe we should stop listening to the conventional wisdom, the old wives’ tales, and common sense, because the only thing that seems to be reliable about them is that they will be wrong.

Why base traffic laws on mythology?

There are many factors that affect the outcome of a traffic collision. Speed is just one of those factors.

Wouldn’t it be nice to know what the actual speed limit is, rather than seeing many drivers passing a State Trooper parked on the median, monitoring the speed of the passing traffic, with drivers regularly passing by the Trooper at 75 MPH and not being stopped.

Meanwhile there are people driving at what they think is an acceptable speed in the number 1 lane (lane farthest to the left) making the road less safe, because they cause other drivers to change lanes around them. The irony is that many of these drivers are also exceeding the speed limit, but they apparently feel that their level of comfort should be forced on others to make them feel better about whatever.

Then there are those who are just unaware of how to behave on the road. Keep to the right, except to pass. That means that we should only move to the left to pass someone, and only when it can be done safely. That does not mean that passing on the right is a traffic violation.

Driving wherever our whims might motivate us is actually encouraged in Florida –
 

Governor Bush vetoed 2005 SB732, which would have reserved the left lane for passing, saying that drivers blocking the left lane are “cautious and careful.”[3]

 

No. Governor Bush does not understand “cautious and careful.” If these drivers were cautious and careful, they would keep to the right, as I do, rather than go looking for conflict at highway speeds.
 

A few states permit use of the left lane only for passing or turning left. These have “yes” in the “keep right” column. Six states require drivers to move right if they are blocking traffic in the left lane. Most states follow the Uniform Vehicle Code and require drivers to keep right if they are going slower than the normal speed of traffic (regardless of the speed limit; see below).[3]

 

So if you are from a state, such as Florida, that encourages the slowest people to hold everyone else back, you might not want to do your Luddite driving in other states. It probably is not even safe for you to leave your state under any circumstances, after all you can’t be too safe. 😳
 

Motorists may drive Segments 5 and 6 of SH 130 for free until November 11. Beginning November 11, the toll rate will be set at $0.15 per mile for passenger vehicles using TxTag. Cars and trucks without a TxTag may also use the road and will be billed via TxTag’s Pay-By-Mail service.[4]

 

If we don’t want to drive on that toll road, we don’t have to, but there is no good reason to assume that it is any less safe than the roads we would travel on to get to the toll road.
 

The speed limit is 80 mph on the existing portion of the toll road, which connects Georgetown to south Austin. Open for several years, it’s operated by the Texas Department of Transportation.[1]

 

Maybe I should let Huey Lewis explain the irony –
 


 

Is it ironic to tell people that 85 MPH is just too darn fast?

What about 88 MPH? 😉

Footnotes:

[1] Can’t drive 55? On Texas 130, you soon can go at 85 mph
By Vianna Davila
Updated 1:11 a.m., Friday, September 7, 2012
MySanAntonio.com
Article

[2] Time to Raise the Speed Limit in America?
By Reason Foundation
Thu, October 25, 2012
Article

[3] State “keep right” laws
MIT.edu
Web page.

[4] 41-Mile Extension of State Highway 130 Opens Ahead of Schedule in Central Texas – Public-private partnership completed at no cost to the State Highway Fund, more than 150 Texas-based firms employed
130 Toll News
Article

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