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

- Rogue Medic

Response Times Lights Sirens and Liability



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.

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.

Go listen to the podcast.

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Comments

  1. 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,

      Rolling through intersections too fast to stop and too slow to get out of the way, is a sure formula for accidents.

      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.

      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/

      I agree and I like that post – Using Red Lights & Siren Only When Parked

      You wrote –

      If your Medics are competent they can handle the care needs for an extra two minutes. In one system I was proud to work in, asking to run hot to the hospital was tantamount to admitting you were helpless to manage patient care. We did use them, but it sure did not happen as often as another system I worked in years later.

      This can be done.

      It does require placing more emphasis on competence, rather than lowest common denominator rules.

      .

  2. 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,

      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.

      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.

      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.

      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.

      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.

      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) –

      2. The use of L&S during response or transport should not be confused with whether a patient had an emergency condition requiring urgent assessment, treatment, or transport by EMS providers. Many patients that require emergency assessment, treatment, and transport may be appropriately and safety cared for by EMS personnel without the use of a L&S response or transport.

      L & S use is generally NOT appropriate in the following circumstances:
      a. “Stand-bys” at the scene of any fire department-related incident that does not involve active interior structural attack, hazardous materials (see below), known injuries to firefighters or other public safety personnel or the need for immediate deployment of a rehabilitation sector.
      b. Carbon monoxide detector alarm activations without the report of any ill persons at the scene.
      c. Assist to another public safety agency when there is no immediate danger to life or health.
      d. Response to a hospital for immediate interfacility transport.
      e. Response to a medical alarm system activation.
      f. Response to patients who have apparently expired.
      g. EMS agencies should consider whether L&S should be used when responding to emergency requests for EMS at facilities where health care personnel are already available to patients who are not suspected to be in cardiac arrest – for example skilled nursing facilities and medical offices.
      h. EMS agencies should consider whether L&S should be used when responding to MVCs with unknown injuries.

      C. Patient transport:

      1. The EMS provider primarily responsible for patient care during transportation will advise the
      driver of the appropriate mode of transportation based upon the medical condition of the
      patient.

      2. In most situations, the use of L&S during patient transport is not indicated:4
      a. Emergent transport should be used in any situation in which the most highly trained EMS
      practitioner believes that the patient’s condition will be worsened by a delay equivalent to
      the time that can be gained by emergent transport. Medical command may be used to
      assist with this decision. The justification for using this criterion should be documented
      on the patient care report.
      b. Examples of Medical Conditions that May Benefit by L&S Transport
      1) Inability to obtain or maintain a patent airway
      2) Critically unstable patient with impending cardiac arrest.
      c. The vast majority of patient’s will not have better medical outcomes by decreasing transport time by the time saved by L&S transport.
      d. The patient’s physiologic responses to L&S use (increased tachycardia and blood pressure) may be detrimental to some patient’s medical conditions.
      e. When EMS providers are not restrained, the increased risk of EMS vehicle crash while using L&S may increase the risk of injury to EMS providers. The extremely poor prognosis for patients transported with CPR in progress does not justify the use of L&S transport for most patients in cardiac arrest.
      f. When in doubt, contact with a medical command may provide additional direction related to whether there is an urgent need to transport with L&S.

      3. No emergency warning lights or siren will be used when ALS care is not indicated (for example, ALS cancelled by BLS or ALS released by medical command).5

      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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