Re: Tragic Crash Kills 3 of our Best.

[Guest guest]

Dr. ,

THANK YOU for speaking up on this topic. It truly is one of the hidden secrets

we don't like to talk about. It isn't well reported and when it occurs we try

to downplay it and talk about how people should pay more attention when

ambulances are around and how it is always someone else's fault when it occurs.

The truth of the matter is, it is criminal and negligent for us to be

continually hurting citizens, our employees/volunteers, and our patients by

running emergency to and from calls no matter the justification.

I went to emsnetwork.org and reviewed their ambulance crash log. It took about

1/2 hour to review the accidents since January 1, 2005. Now remember that these

are the ones that have made the paper and after making the paper have been

picked up by the EMS Network...either by submission or internet searches. This

is by no means all the accidents:

Since January 1:

31 accidents

79 injuries

10 fatalities

That is an accident every 38 hours, an average of 2.5 injuries in each accident

and a fatality once every 5 days.

One other scary piece from reviewing this...of the 31 accidents so far this year

THREE (3) of them have been ambulance vs. train accidents resulting in 10

injuries and most recently 3 fatalities. This is outrageous.

How many places run hot to everything that they get dispatched to? My personal

favorite accident in this mix is the one that had 3 injuries while they were

rseponding hot to an ankle injury...and ankle injury???

Then the next piece is the one where patients get killed or seriously injured

while being transported. Like Dr. said about this accident

Saturday...what was so terribly wrong with this patient that we couldn't look

both ways before pulling across the train tracks???

How many agencies have protocols and SOP's regarding what patients get emergency

transport to the hospital? When is it worth the risk to our patients and

ourselves to run emergency?

Here is a challenge for those of you with some spare time on your hands. Start

following your ambulances running hot to the scene or hospital...but you obey

all traffic laws and signals. Do this for about 50 to 100 calls and get a good

feel for how much time you are saving by running emergency. I can tell you in a

suburban environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from the

hospital. 52 seconds???

So again, maybe it is my old age, maybe it is too many funerals from stupid

behavior behind the wheel, maybe it is too many promising careers cut short

because of stupid errors...but I have really grown to hate those sparkly lights

adn whooping noises...take them off, don't turn them on, and drive carefully.

That should just about do it for now. I would encourage anyone who reads this

to seriously question why you are running hot the next time you do it...what are

you saving...and is the minimal time saved really going to make any

difference??? If not, shut them off and drive responsibly to your destination.

Good night and be careful out there,

Dudley

PS: Here is one for you to ponder: " Why, in a paramedic environment, do we run

cardiac arrest patients emergency to the hospital??? "

Wait...one more: " What affect does the siren and additional maneuvering of the

vehicle have upon your conscious critical patient...who only thinks the siren

means things can't be good? "

[Guest guest]

Dr. ,

THANK YOU for speaking up on this topic. It truly is one of the hidden secrets

we don't like to talk about. It isn't well reported and when it occurs we try

to downplay it and talk about how people should pay more attention when

ambulances are around and how it is always someone else's fault when it occurs.

The truth of the matter is, it is criminal and negligent for us to be

continually hurting citizens, our employees/volunteers, and our patients by

running emergency to and from calls no matter the justification.

I went to emsnetwork.org and reviewed their ambulance crash log. It took about

1/2 hour to review the accidents since January 1, 2005. Now remember that these

are the ones that have made the paper and after making the paper have been

picked up by the EMS Network...either by submission or internet searches. This

is by no means all the accidents:

Since January 1:

31 accidents

79 injuries

10 fatalities

That is an accident every 38 hours, an average of 2.5 injuries in each accident

and a fatality once every 5 days.

One other scary piece from reviewing this...of the 31 accidents so far this year

THREE (3) of them have been ambulance vs. train accidents resulting in 10

injuries and most recently 3 fatalities. This is outrageous.

How many places run hot to everything that they get dispatched to? My personal

favorite accident in this mix is the one that had 3 injuries while they were

rseponding hot to an ankle injury...and ankle injury???

Then the next piece is the one where patients get killed or seriously injured

while being transported. Like Dr. said about this accident

Saturday...what was so terribly wrong with this patient that we couldn't look

both ways before pulling across the train tracks???

How many agencies have protocols and SOP's regarding what patients get emergency

transport to the hospital? When is it worth the risk to our patients and

ourselves to run emergency?

Here is a challenge for those of you with some spare time on your hands. Start

following your ambulances running hot to the scene or hospital...but you obey

all traffic laws and signals. Do this for about 50 to 100 calls and get a good

feel for how much time you are saving by running emergency. I can tell you in a

suburban environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from the

hospital. 52 seconds???

So again, maybe it is my old age, maybe it is too many funerals from stupid

behavior behind the wheel, maybe it is too many promising careers cut short

because of stupid errors...but I have really grown to hate those sparkly lights

adn whooping noises...take them off, don't turn them on, and drive carefully.

That should just about do it for now. I would encourage anyone who reads this

to seriously question why you are running hot the next time you do it...what are

you saving...and is the minimal time saved really going to make any

difference??? If not, shut them off and drive responsibly to your destination.

Good night and be careful out there,

Dudley

PS: Here is one for you to ponder: " Why, in a paramedic environment, do we run

cardiac arrest patients emergency to the hospital??? "

Wait...one more: " What affect does the siren and additional maneuvering of the

vehicle have upon your conscious critical patient...who only thinks the siren

means things can't be good? "

[Guest guest]

Dr. ,

THANK YOU for speaking up on this topic. It truly is one of the hidden secrets

we don't like to talk about. It isn't well reported and when it occurs we try

to downplay it and talk about how people should pay more attention when

ambulances are around and how it is always someone else's fault when it occurs.

The truth of the matter is, it is criminal and negligent for us to be

continually hurting citizens, our employees/volunteers, and our patients by

running emergency to and from calls no matter the justification.

I went to emsnetwork.org and reviewed their ambulance crash log. It took about

1/2 hour to review the accidents since January 1, 2005. Now remember that these

are the ones that have made the paper and after making the paper have been

picked up by the EMS Network...either by submission or internet searches. This

is by no means all the accidents:

Since January 1:

31 accidents

79 injuries

10 fatalities

That is an accident every 38 hours, an average of 2.5 injuries in each accident

and a fatality once every 5 days.

One other scary piece from reviewing this...of the 31 accidents so far this year

THREE (3) of them have been ambulance vs. train accidents resulting in 10

injuries and most recently 3 fatalities. This is outrageous.

How many places run hot to everything that they get dispatched to? My personal

favorite accident in this mix is the one that had 3 injuries while they were

rseponding hot to an ankle injury...and ankle injury???

Then the next piece is the one where patients get killed or seriously injured

while being transported. Like Dr. said about this accident

Saturday...what was so terribly wrong with this patient that we couldn't look

both ways before pulling across the train tracks???

How many agencies have protocols and SOP's regarding what patients get emergency

transport to the hospital? When is it worth the risk to our patients and

ourselves to run emergency?

Here is a challenge for those of you with some spare time on your hands. Start

following your ambulances running hot to the scene or hospital...but you obey

all traffic laws and signals. Do this for about 50 to 100 calls and get a good

feel for how much time you are saving by running emergency. I can tell you in a

suburban environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from the

hospital. 52 seconds???

So again, maybe it is my old age, maybe it is too many funerals from stupid

behavior behind the wheel, maybe it is too many promising careers cut short

because of stupid errors...but I have really grown to hate those sparkly lights

adn whooping noises...take them off, don't turn them on, and drive carefully.

That should just about do it for now. I would encourage anyone who reads this

to seriously question why you are running hot the next time you do it...what are

you saving...and is the minimal time saved really going to make any

difference??? If not, shut them off and drive responsibly to your destination.

Good night and be careful out there,

Dudley

PS: Here is one for you to ponder: " Why, in a paramedic environment, do we run

cardiac arrest patients emergency to the hospital??? "

Wait...one more: " What affect does the siren and additional maneuvering of the

vehicle have upon your conscious critical patient...who only thinks the siren

means things can't be good? "

[Guest guest]

This goes back to what I've always said. Driving is one of the skills we use the

most, but tarin with the least, I would like to see TEEX do aPre-conference

EVCO class followed by an instructors,s class. Driving is a skill where we can

pick up bad habits easily, and refresher work should be done yearly.

THEDUDMAN@... wrote:

Dr. ,

THANK YOU for speaking up on this topic. It truly is one of the hidden secrets

we don't like to talk about. It isn't well reported and when it occurs we try

to downplay it and talk about how people should pay more attention when

ambulances are around and how it is always someone else's fault when it occurs.

The truth of the matter is, it is criminal and negligent for us to be

continually hurting citizens, our employees/volunteers, and our patients by

running emergency to and from calls no matter the justification.

I went to emsnetwork.org and reviewed their ambulance crash log. It took about

1/2 hour to review the accidents since January 1, 2005. Now remember that these

are the ones that have made the paper and after making the paper have been

picked up by the EMS Network...either by submission or internet searches. This

is by no means all the accidents:

Since January 1:

31 accidents

79 injuries

10 fatalities

That is an accident every 38 hours, an average of 2.5 injuries in each accident

and a fatality once every 5 days.

One other scary piece from reviewing this...of the 31 accidents so far this year

THREE (3) of them have been ambulance vs. train accidents resulting in 10

injuries and most recently 3 fatalities. This is outrageous.

How many places run hot to everything that they get dispatched to? My personal

favorite accident in this mix is the one that had 3 injuries while they were

rseponding hot to an ankle injury...and ankle injury???

Then the next piece is the one where patients get killed or seriously injured

while being transported. Like Dr. said about this accident

Saturday...what was so terribly wrong with this patient that we couldn't look

both ways before pulling across the train tracks???

How many agencies have protocols and SOP's regarding what patients get emergency

transport to the hospital? When is it worth the risk to our patients and

ourselves to run emergency?

Here is a challenge for those of you with some spare time on your hands. Start

following your ambulances running hot to the scene or hospital...but you obey

all traffic laws and signals. Do this for about 50 to 100 calls and get a good

feel for how much time you are saving by running emergency. I can tell you in a

suburban environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from the

hospital. 52 seconds???

So again, maybe it is my old age, maybe it is too many funerals from stupid

behavior behind the wheel, maybe it is too many promising careers cut short

because of stupid errors...but I have really grown to hate those sparkly lights

adn whooping noises...take them off, don't turn them on, and drive carefully.

That should just about do it for now. I would encourage anyone who reads this

to seriously question why you are running hot the next time you do it...what are

you saving...and is the minimal time saved really going to make any

difference??? If not, shut them off and drive responsibly to your destination.

Good night and be careful out there,

Dudley

PS: Here is one for you to ponder: " Why, in a paramedic environment, do we run

cardiac arrest patients emergency to the hospital??? "

Wait...one more: " What affect does the siren and additional maneuvering of the

vehicle have upon your conscious critical patient...who only thinks the siren

means things can't be good? "

[Guest guest]

This goes back to what I've always said. Driving is one of the skills we use the

most, but tarin with the least, I would like to see TEEX do aPre-conference

EVCO class followed by an instructors,s class. Driving is a skill where we can

pick up bad habits easily, and refresher work should be done yearly.

THEDUDMAN@... wrote:

Dr. ,

THANK YOU for speaking up on this topic. It truly is one of the hidden secrets

we don't like to talk about. It isn't well reported and when it occurs we try

to downplay it and talk about how people should pay more attention when

ambulances are around and how it is always someone else's fault when it occurs.

The truth of the matter is, it is criminal and negligent for us to be

continually hurting citizens, our employees/volunteers, and our patients by

running emergency to and from calls no matter the justification.

I went to emsnetwork.org and reviewed their ambulance crash log. It took about

1/2 hour to review the accidents since January 1, 2005. Now remember that these

are the ones that have made the paper and after making the paper have been

picked up by the EMS Network...either by submission or internet searches. This

is by no means all the accidents:

Since January 1:

31 accidents

79 injuries

10 fatalities

That is an accident every 38 hours, an average of 2.5 injuries in each accident

and a fatality once every 5 days.

One other scary piece from reviewing this...of the 31 accidents so far this year

THREE (3) of them have been ambulance vs. train accidents resulting in 10

injuries and most recently 3 fatalities. This is outrageous.

How many places run hot to everything that they get dispatched to? My personal

favorite accident in this mix is the one that had 3 injuries while they were

rseponding hot to an ankle injury...and ankle injury???

Then the next piece is the one where patients get killed or seriously injured

while being transported. Like Dr. said about this accident

Saturday...what was so terribly wrong with this patient that we couldn't look

both ways before pulling across the train tracks???

How many agencies have protocols and SOP's regarding what patients get emergency

transport to the hospital? When is it worth the risk to our patients and

ourselves to run emergency?

Here is a challenge for those of you with some spare time on your hands. Start

following your ambulances running hot to the scene or hospital...but you obey

all traffic laws and signals. Do this for about 50 to 100 calls and get a good

feel for how much time you are saving by running emergency. I can tell you in a

suburban environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from the

hospital. 52 seconds???

So again, maybe it is my old age, maybe it is too many funerals from stupid

behavior behind the wheel, maybe it is too many promising careers cut short

because of stupid errors...but I have really grown to hate those sparkly lights

adn whooping noises...take them off, don't turn them on, and drive carefully.

That should just about do it for now. I would encourage anyone who reads this

to seriously question why you are running hot the next time you do it...what are

you saving...and is the minimal time saved really going to make any

difference??? If not, shut them off and drive responsibly to your destination.

Good night and be careful out there,

Dudley

PS: Here is one for you to ponder: " Why, in a paramedic environment, do we run

cardiac arrest patients emergency to the hospital??? "

Wait...one more: " What affect does the siren and additional maneuvering of the

vehicle have upon your conscious critical patient...who only thinks the siren

means things can't be good? "

[Guest guest]

This goes back to what I've always said. Driving is one of the skills we use the

most, but tarin with the least, I would like to see TEEX do aPre-conference

EVCO class followed by an instructors,s class. Driving is a skill where we can

pick up bad habits easily, and refresher work should be done yearly.

THEDUDMAN@... wrote:

Dr. ,

THANK YOU for speaking up on this topic. It truly is one of the hidden secrets

we don't like to talk about. It isn't well reported and when it occurs we try

to downplay it and talk about how people should pay more attention when

ambulances are around and how it is always someone else's fault when it occurs.

The truth of the matter is, it is criminal and negligent for us to be

continually hurting citizens, our employees/volunteers, and our patients by

running emergency to and from calls no matter the justification.

I went to emsnetwork.org and reviewed their ambulance crash log. It took about

1/2 hour to review the accidents since January 1, 2005. Now remember that these

are the ones that have made the paper and after making the paper have been

picked up by the EMS Network...either by submission or internet searches. This

is by no means all the accidents:

Since January 1:

31 accidents

79 injuries

10 fatalities

That is an accident every 38 hours, an average of 2.5 injuries in each accident

and a fatality once every 5 days.

One other scary piece from reviewing this...of the 31 accidents so far this year

THREE (3) of them have been ambulance vs. train accidents resulting in 10

injuries and most recently 3 fatalities. This is outrageous.

How many places run hot to everything that they get dispatched to? My personal

favorite accident in this mix is the one that had 3 injuries while they were

rseponding hot to an ankle injury...and ankle injury???

Then the next piece is the one where patients get killed or seriously injured

while being transported. Like Dr. said about this accident

Saturday...what was so terribly wrong with this patient that we couldn't look

both ways before pulling across the train tracks???

How many agencies have protocols and SOP's regarding what patients get emergency

transport to the hospital? When is it worth the risk to our patients and

ourselves to run emergency?

Here is a challenge for those of you with some spare time on your hands. Start

following your ambulances running hot to the scene or hospital...but you obey

all traffic laws and signals. Do this for about 50 to 100 calls and get a good

feel for how much time you are saving by running emergency. I can tell you in a

suburban environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from the

hospital. 52 seconds???

So again, maybe it is my old age, maybe it is too many funerals from stupid

behavior behind the wheel, maybe it is too many promising careers cut short

because of stupid errors...but I have really grown to hate those sparkly lights

adn whooping noises...take them off, don't turn them on, and drive carefully.

That should just about do it for now. I would encourage anyone who reads this

to seriously question why you are running hot the next time you do it...what are

you saving...and is the minimal time saved really going to make any

difference??? If not, shut them off and drive responsibly to your destination.

Good night and be careful out there,

Dudley

PS: Here is one for you to ponder: " Why, in a paramedic environment, do we run

cardiac arrest patients emergency to the hospital??? "

Wait...one more: " What affect does the siren and additional maneuvering of the

vehicle have upon your conscious critical patient...who only thinks the siren

means things can't be good? "

[Guest guest]

Dudley,

That was an impressive article that you wrote, and I strongly agree with

most of the things you wrote in there about driving emergency traffic.

Although, I wonder about taking a cardiac arrest pt. non-emergency to the

hospital, and what legal consequences would come from it? If I was a family

member, and one of my family members went down into a cardiac arrest I would

certainly not agree with not going emergency traffic. This is a very good

question, and I would have to see some of the legal implications of it, before I

could justify in agreeing with taking these types of pt.'s in non-emergency

traffic. Just my thought.

Binkley,

EMT-P

Fire Chief

Noonday Fire Department

[Guest guest]

Dudley,

That was an impressive article that you wrote, and I strongly agree with

most of the things you wrote in there about driving emergency traffic.

Although, I wonder about taking a cardiac arrest pt. non-emergency to the

hospital, and what legal consequences would come from it? If I was a family

member, and one of my family members went down into a cardiac arrest I would

certainly not agree with not going emergency traffic. This is a very good

question, and I would have to see some of the legal implications of it, before I

could justify in agreeing with taking these types of pt.'s in non-emergency

traffic. Just my thought.

Binkley,

EMT-P

Fire Chief

Noonday Fire Department

[Guest guest]

Dudley,

That was an impressive article that you wrote, and I strongly agree with

most of the things you wrote in there about driving emergency traffic.

Although, I wonder about taking a cardiac arrest pt. non-emergency to the

hospital, and what legal consequences would come from it? If I was a family

member, and one of my family members went down into a cardiac arrest I would

certainly not agree with not going emergency traffic. This is a very good

question, and I would have to see some of the legal implications of it, before I

could justify in agreeing with taking these types of pt.'s in non-emergency

traffic. Just my thought.

Binkley,

EMT-P

Fire Chief

Noonday Fire Department

[Guest guest]

" superbink1@n... " <superbink1@n...> wrote:

>

> If I was a family member, and one of my family members went down into

> a cardiac arrest I would certainly not agree with not going emergency

> traffic.

Even more criticism is going to come from police and fire agencies.

Ask any dispatcher how often they currently hear, " Can you get an ETA

on that ambulance? " That will increase exponentially when we slow down.

Don't get me wrong, I agree with what Dudley said. I am just saying

that there is more to it than simply improving emergency driving. It

is going to take a concerted educational effort which includes the

police and fire agencies we support, as well as the general public, to

make such a transition work. Otherwise, our attempts at making

emergency driving safer for all involved will result in so much

whining and bitching about " those ambulance drivers are just taking

their time! " that our image will be hurt more than it already is by

the accidents.

Rob

[Guest guest]

" superbink1@n... " <superbink1@n...> wrote:

>

> If I was a family member, and one of my family members went down into

> a cardiac arrest I would certainly not agree with not going emergency

> traffic.

Even more criticism is going to come from police and fire agencies.

Ask any dispatcher how often they currently hear, " Can you get an ETA

on that ambulance? " That will increase exponentially when we slow down.

Don't get me wrong, I agree with what Dudley said. I am just saying

that there is more to it than simply improving emergency driving. It

is going to take a concerted educational effort which includes the

police and fire agencies we support, as well as the general public, to

make such a transition work. Otherwise, our attempts at making

emergency driving safer for all involved will result in so much

whining and bitching about " those ambulance drivers are just taking

their time! " that our image will be hurt more than it already is by

the accidents.

Rob

[Guest guest]

You tell it bro. We run Code to pick up teams (transplant and

pedi/neo),to take them to the airport--(yeah like the plane is going

to leave without them?!?!?!?), to take them to other hospitals-- " we

told them we'd be there in 30 minutes " (at 5:30pm on a Friday), out

of town-- " the patient is intubated and being bagged " (good, airway is

secure), to clinics to pick up fevers, psychs,etc, etc.

I was skeptical at first when then El Paso EMS went to a triage

system. Calls deemed nonemergency were turfed out to private services

with the stipulation that they had 30 minutes to arrive and responded

no lights/siren. It makes sense now. Of course you still had the

few " I don't feel well " --because they were in V-tack with a pulse,

and MV/Motorcycle--thown 30-40 feet after impact at 35 mph, but it

seems a logical step. From what I understand it was supposed to help

free up EP EMS units, but the concept should still carry over. Run

hot only to true emergencies.

Eddie

> Dr. ,

>

> THANK YOU for speaking up on this topic. It truly is one of the

hidden secrets we don't like to talk about. It isn't well reported

and when it occurs we try to downplay it and talk about how people

should pay more attention when ambulances are around and how it is

always someone else's fault when it occurs.

>

> The truth of the matter is, it is criminal and negligent for us to

be continually hurting citizens, our employees/volunteers, and our

patients by running emergency to and from calls no matter the

justification.

>

> I went to emsnetwork.org and reviewed their ambulance crash log.

It took about 1/2 hour to review the accidents since January 1,

2005. Now remember that these are the ones that have made the paper

and after making the paper have been picked up by the EMS

Network...either by submission or internet searches. This is by no

means all the accidents:

>

> Since January 1:

> 31 accidents

> 79 injuries

> 10 fatalities

>

> That is an accident every 38 hours, an average of 2.5 injuries in

each accident and a fatality once every 5 days.

>

> One other scary piece from reviewing this...of the 31 accidents so

far this year THREE (3) of them have been ambulance vs. train

accidents resulting in 10 injuries and most recently 3 fatalities.

This is outrageous.

>

> How many places run hot to everything that they get dispatched to?

My personal favorite accident in this mix is the one that had 3

injuries while they were rseponding hot to an ankle injury...and

ankle injury???

>

> Then the next piece is the one where patients get killed or

seriously injured while being transported. Like Dr. said

about this accident Saturday...what was so terribly wrong with this

patient that we couldn't look both ways before pulling across the

train tracks???

>

> How many agencies have protocols and SOP's regarding what patients

get emergency transport to the hospital? When is it worth the risk

to our patients and ourselves to run emergency?

>

> Here is a challenge for those of you with some spare time on your

hands. Start following your ambulances running hot to the scene or

hospital...but you obey all traffic laws and signals. Do this for

about 50 to 100 calls and get a good feel for how much time you are

saving by running emergency. I can tell you in a suburban

environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from

the hospital. 52 seconds???

>

> So again, maybe it is my old age, maybe it is too many funerals

from stupid behavior behind the wheel, maybe it is too many promising

careers cut short because of stupid errors...but I have really grown

to hate those sparkly lights adn whooping noises...take them off,

don't turn them on, and drive carefully.

>

> That should just about do it for now. I would encourage anyone who

reads this to seriously question why you are running hot the next

time you do it...what are you saving...and is the minimal time saved

really going to make any difference??? If not, shut them off and

drive responsibly to your destination.

>

> Good night and be careful out there,

>

> Dudley

>

> PS: Here is one for you to ponder: " Why, in a paramedic

environment, do we run cardiac arrest patients emergency to the

hospital??? "

>

> Wait...one more: " What affect does the siren and additional

maneuvering of the vehicle have upon your conscious critical

patient...who only thinks the siren means things can't be good? "

[Guest guest]

You tell it bro. We run Code to pick up teams (transplant and

pedi/neo),to take them to the airport--(yeah like the plane is going

to leave without them?!?!?!?), to take them to other hospitals-- " we

told them we'd be there in 30 minutes " (at 5:30pm on a Friday), out

of town-- " the patient is intubated and being bagged " (good, airway is

secure), to clinics to pick up fevers, psychs,etc, etc.

I was skeptical at first when then El Paso EMS went to a triage

system. Calls deemed nonemergency were turfed out to private services

with the stipulation that they had 30 minutes to arrive and responded

no lights/siren. It makes sense now. Of course you still had the

few " I don't feel well " --because they were in V-tack with a pulse,

and MV/Motorcycle--thown 30-40 feet after impact at 35 mph, but it

seems a logical step. From what I understand it was supposed to help

free up EP EMS units, but the concept should still carry over. Run

hot only to true emergencies.

Eddie

> Dr. ,

>

> THANK YOU for speaking up on this topic. It truly is one of the

hidden secrets we don't like to talk about. It isn't well reported

and when it occurs we try to downplay it and talk about how people

should pay more attention when ambulances are around and how it is

always someone else's fault when it occurs.

>

> The truth of the matter is, it is criminal and negligent for us to

be continually hurting citizens, our employees/volunteers, and our

patients by running emergency to and from calls no matter the

justification.

>

> I went to emsnetwork.org and reviewed their ambulance crash log.

It took about 1/2 hour to review the accidents since January 1,

2005. Now remember that these are the ones that have made the paper

and after making the paper have been picked up by the EMS

Network...either by submission or internet searches. This is by no

means all the accidents:

>

> Since January 1:

> 31 accidents

> 79 injuries

> 10 fatalities

>

> That is an accident every 38 hours, an average of 2.5 injuries in

each accident and a fatality once every 5 days.

>

> One other scary piece from reviewing this...of the 31 accidents so

far this year THREE (3) of them have been ambulance vs. train

accidents resulting in 10 injuries and most recently 3 fatalities.

This is outrageous.

>

> How many places run hot to everything that they get dispatched to?

My personal favorite accident in this mix is the one that had 3

injuries while they were rseponding hot to an ankle injury...and

ankle injury???

>

> Then the next piece is the one where patients get killed or

seriously injured while being transported. Like Dr. said

about this accident Saturday...what was so terribly wrong with this

patient that we couldn't look both ways before pulling across the

train tracks???

>

> How many agencies have protocols and SOP's regarding what patients

get emergency transport to the hospital? When is it worth the risk

to our patients and ourselves to run emergency?

>

> Here is a challenge for those of you with some spare time on your

hands. Start following your ambulances running hot to the scene or

hospital...but you obey all traffic laws and signals. Do this for

about 50 to 100 calls and get a good feel for how much time you are

saving by running emergency. I can tell you in a suburban

environment in NE San the greatest time saved was 52

seconds...over 50 calls from varying distances (4 to 20+ miles) from

the hospital. 52 seconds???

>

> So again, maybe it is my old age, maybe it is too many funerals

from stupid behavior behind the wheel, maybe it is too many promising

careers cut short because of stupid errors...but I have really grown

to hate those sparkly lights adn whooping noises...take them off,

don't turn them on, and drive carefully.

>

> That should just about do it for now. I would encourage anyone who

reads this to seriously question why you are running hot the next

time you do it...what are you saving...and is the minimal time saved

really going to make any difference??? If not, shut them off and

drive responsibly to your destination.

>

> Good night and be careful out there,

>

> Dudley

>

> PS: Here is one for you to ponder: " Why, in a paramedic

environment, do we run cardiac arrest patients emergency to the

hospital??? "

>

> Wait...one more: " What affect does the siren and additional

maneuvering of the vehicle have upon your conscious critical

patient...who only thinks the siren means things can't be good? "

[Guest guest]

I appreciate your thoughts...but one of the things our Medical Director is

looking as is the need to transport while doing CPR. We are analyzing and

evaluating every patient we transport to the hospital with CPR in progress to

see if we had other options. For instance, if we sit on scene for 25 or 30

minutes doing ACLS with no reversable causes and the patient is as dead after

our treatment as they were before we arrived...what magic pill is the ED going

to deliver after another 15 to 20 minutes of getting them there???

Now, if we are having results and we just cannot keep the patient in ROSC

consistantly...those are the ones we are evaluating to see what we can

supplement our care with so that the need to " rush like mad-men " to the ED can

be even further minimalized...we are making great strides...when I got here 4

years ago we ran over 50% of our patients emergency to the hospital...now we are

doing less than 10%....

Now, if we can just get our dispatch issues corrected and we can start

minimilizing the number of times we respond emergency as well....

Keep safe,

Dudley

[Guest guest]

I appreciate your thoughts...but one of the things our Medical Director is

looking as is the need to transport while doing CPR. We are analyzing and

evaluating every patient we transport to the hospital with CPR in progress to

see if we had other options. For instance, if we sit on scene for 25 or 30

minutes doing ACLS with no reversable causes and the patient is as dead after

our treatment as they were before we arrived...what magic pill is the ED going

to deliver after another 15 to 20 minutes of getting them there???

Now, if we are having results and we just cannot keep the patient in ROSC

consistantly...those are the ones we are evaluating to see what we can

supplement our care with so that the need to " rush like mad-men " to the ED can

be even further minimalized...we are making great strides...when I got here 4

years ago we ran over 50% of our patients emergency to the hospital...now we are

doing less than 10%....

Now, if we can just get our dispatch issues corrected and we can start

minimilizing the number of times we respond emergency as well....

Keep safe,

Dudley

[Guest guest]

I appreciate your thoughts...but one of the things our Medical Director is

looking as is the need to transport while doing CPR. We are analyzing and

evaluating every patient we transport to the hospital with CPR in progress to

see if we had other options. For instance, if we sit on scene for 25 or 30

minutes doing ACLS with no reversable causes and the patient is as dead after

our treatment as they were before we arrived...what magic pill is the ED going

to deliver after another 15 to 20 minutes of getting them there???

Now, if we are having results and we just cannot keep the patient in ROSC

consistantly...those are the ones we are evaluating to see what we can

supplement our care with so that the need to " rush like mad-men " to the ED can

be even further minimalized...we are making great strides...when I got here 4

years ago we ran over 50% of our patients emergency to the hospital...now we are

doing less than 10%....

Now, if we can just get our dispatch issues corrected and we can start

minimilizing the number of times we respond emergency as well....

Keep safe,

Dudley

[Guest guest]

Rob,

I have to agree a little with the image thing...but here is the deal...running

emergency saves minimal time...we will not be getting there much slower...only

(hopefully) safer. The perception piece gets resolved in the dispatch piece

where not only the ambulance, but the 1st responders also go non-emergency

unless warrented...as well as a good public education campaign where the results

of our industry's bad behavior is publicized with the solution to the problem.

This is being done all over the country...and very successfully I might add...so

much so that you might be surprised who would show up to testify against your

agency when you kill the high school prom queen on the way to the ankle

injury...

Dudley

[Guest guest]

HoooBoooy.

Having been terrified in the back of a rig more times than I care to think

about, I have to part company about the emergency response statistic. There

are 2 issues.

1st, the " average " 52 seconds of time saved is not going to be clinically

signifigant...however, that is an average, and it is going to be clinically

signifigant in the cases where by driving ET through 6 stop light

intersections, you are delayed by 90 seconds at each of them. Being able to

proceed through traffic signals is where you save time, not by speed, and by

being aware and using established safety rules, I have never even had a

close call at an intersection while running hot. I have been hit broadside

driving normally, and all 3 of my accidents in ambulances were normal

traffic, incl. one where we were parked.

2nd is the expectation of the public, who are not going to tolerate

non-emergency responses, period. My system utilizes priority based dispatch,

which I like a lot, except that it doesn't differentiate " breathing

difficulty " from stuffy nose very well, but at least it buys me out of

risking my life and everybody else's for a stubbed toe sometimes. Having

said that, I have been caught a few times on some serious cases after having

taken a leisurely 15 minute drive to the scene.

There just isn't a good answer really, except for continued emphasis on

trying to combine speed and safety. The 2 things are not mutually exclusive,

we just have to train better. Fancy equipment, satellite trackers and firing

people for 2 occurrences of 36 in a 35 isn't even close to the answer

however.

Driving is dangerous.....at normal speeds and normal light rules, and life

ain't safe anywhere except in bed. My feeling is that the public expects us

to hurry right over, and its our job to figure out how to do it as safely as

we can.

Also, I think that the post-mortem on the crash in AK is a little

pre-mature. Anybody know for sure that L & S was even a contributing factor?

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>

> I appreciate your thoughts...but one of the things our Medical Director is

> looking as is the need to transport while doing CPR. We are analyzing and

> evaluating every patient we transport to the hospital with CPR in progress

> to see if we had other options. For instance, if we sit on scene for 25

> or 30 minutes doing ACLS with no reversable causes and the patient is as

> dead after our treatment as they were before we arrived...what magic pill

> is the ED going to deliver after another 15 to 20 minutes of getting them

> there???

>

> Now, if we are having results and we just cannot keep the patient in ROSC

> consistantly...those are the ones we are evaluating to see what we can

> supplement our care with so that the need to " rush like mad-men " to the ED

> can be even further minimalized...we are making great strides...when I got

> here 4 years ago we ran over 50% of our patients emergency to the

> hospital...now we are doing less than 10%....

>

> Now, if we can just get our dispatch issues corrected and we can start

> minimilizing the number of times we respond emergency as well....

>

> Keep safe,

>

> Dudley

>

>

>

>

>

[Guest guest]

AMR was the company that stuck my ass in an ambulance for the first time

driving emergency without the first barest hint of emergency drivers

training, and maybe if they'd pay more attention to teaching people how to

intubate correctly and less time on monitoring fancy driving gadgets and

firing people for one mile over the speed limit, esophageal intubations

wouldn't be such a problem, huh?

magnetass sends

Tragic Crash Kills 3 of our Best.

>

>

>

> I was with paramedics from Texarkana yesterday at the Eagles conference in

> Dallas when

> the news came in about the death of their paramedics in the tragic

> train-ambulance

> collision. We were all shocked and shaken.

>

> I have declared for years that there are 3 great sins in EMS. Horrible

> secrets that folks do

> not want to deal with.

>

> 1. Esophageal intubation

> 2. Not transporting patients that need our help

> 3. Careless driving.

>

> Death rates in EMS are as bad or worse than for fire fighters and police

> (18 deaths per

> 100,000 per year). The reason is the intersection. Speeding,

> inattention, preoccupation,

> code III (lights and sirens). In this case two paramedics (the driver and

> one other EMT)

> should have cleared the railroad crossing before proceeding. There is

> never, never, never,

> never a reason not to stop and look before crossing a railroad track.

> Rigs should NEVER

> go through red lights, and no one should ever go one mile per hour over

> the speed limit.

>

> At AMR we have installed detectors that track speed and red lights. If a

> driver speeds once

> he is warned. The second time he is fired. Period --- no recourse. This

> horrible crash

> did not have to happen. It was not an accident.

>

> I am heartbroken over these senseless deaths. We all need to take note

> and change our

> reckless driving habits. We need to make sure that everyone in our

> organization knows

> that we cannot help our patients if we die in the process.

>

> Larry MD

> Medical Director AMR San & Austin, Bulverde, Spring Branch,

> Blanco, and Devine.

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

What emergencies are you responding to where 2 minutes makes a difference?

As a rule, you can't get the sudden death cases in less than 8 minutes. We

now know that trauma patients have more time than we once thought. What

specifically does 2 minutes make a difference for? The adrenal glands?

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Re: Tragic Crash Kills 3 of our Best.

HoooBoooy.

Having been terrified in the back of a rig more times than I care to think

about, I have to part company about the emergency response statistic. There

are 2 issues.

1st, the " average " 52 seconds of time saved is not going to be clinically

signifigant...however, that is an average, and it is going to be clinically

signifigant in the cases where by driving ET through 6 stop light

intersections, you are delayed by 90 seconds at each of them. Being able to

proceed through traffic signals is where you save time, not by speed, and by

being aware and using established safety rules, I have never even had a

close call at an intersection while running hot. I have been hit broadside

driving normally, and all 3 of my accidents in ambulances were normal

traffic, incl. one where we were parked.

2nd is the expectation of the public, who are not going to tolerate

non-emergency responses, period. My system utilizes priority based dispatch,

which I like a lot, except that it doesn't differentiate " breathing

difficulty " from stuffy nose very well, but at least it buys me out of

risking my life and everybody else's for a stubbed toe sometimes. Having

said that, I have been caught a few times on some serious cases after having

taken a leisurely 15 minute drive to the scene.

There just isn't a good answer really, except for continued emphasis on

trying to combine speed and safety. The 2 things are not mutually exclusive,

we just have to train better. Fancy equipment, satellite trackers and firing

people for 2 occurrences of 36 in a 35 isn't even close to the answer

however.

Driving is dangerous.....at normal speeds and normal light rules, and life

ain't safe anywhere except in bed. My feeling is that the public expects us

to hurry right over, and its our job to figure out how to do it as safely as

we can.

Also, I think that the post-mortem on the crash in AK is a little

pre-mature. Anybody know for sure that L & S was even a contributing factor?

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>

> I appreciate your thoughts...but one of the things our Medical

> Director is looking as is the need to transport while doing CPR. We

> are analyzing and evaluating every patient we transport to the

> hospital with CPR in progress to see if we had other options. For

> instance, if we sit on scene for 25 or 30 minutes doing ACLS with no

> reversable causes and the patient is as dead after our treatment as

> they were before we arrived...what magic pill is the ED going to

> deliver after another 15 to 20 minutes of getting them there???

>

> Now, if we are having results and we just cannot keep the patient in

> ROSC consistantly...those are the ones we are evaluating to see what

> we can supplement our care with so that the need to " rush like

> mad-men " to the ED can be even further minimalized...we are making

> great strides...when I got here 4 years ago we ran over 50% of our

> patients emergency to the hospital...now we are doing less than 10%....

>

> Now, if we can just get our dispatch issues corrected and we can start

> minimilizing the number of times we respond emergency as well....

>

> Keep safe,

>

> Dudley

>

>

>

>

>

[Guest guest]

Bunches.....personally I have a few ROSCs that didn't have 2 minutes to

give, and just because you've decided that trauma patients have more time

than we once thought doesn't ever mean that taking our time to the ED is a

good idea. While the actual, literal number of optimal minutes that a trauma

patient has to recieve definitive surgery is speculative, I doubt that it

can be proven that granting a GSW to the chest or a fractured liver patient

an additional 15 minutes tooling along through town is the proper treatment.

If I had your kid in my rig with serious internal injuries from an accident,

and it took me 30 minutes pooting around stuck in traffic to deliver them to

a trauma surgeon, I sincerely doubt that you'd be out in the ambulance dock

congratulating me on a great job because I spent an additional 20 minutes

getting to the ER because " We now know that trauma patients have more time

than we once thought. "

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>

>

>>

>> I appreciate your thoughts...but one of the things our Medical

>> Director is looking as is the need to transport while doing CPR. We

>> are analyzing and evaluating every patient we transport to the

>> hospital with CPR in progress to see if we had other options. For

>> instance, if we sit on scene for 25 or 30 minutes doing ACLS with no

>> reversable causes and the patient is as dead after our treatment as

>> they were before we arrived...what magic pill is the ED going to

>> deliver after another 15 to 20 minutes of getting them there???

>>

>> Now, if we are having results and we just cannot keep the patient in

>> ROSC consistantly...those are the ones we are evaluating to see what

>> we can supplement our care with so that the need to " rush like

>> mad-men " to the ED can be even further minimalized...we are making

>> great strides...when I got here 4 years ago we ran over 50% of our

>> patients emergency to the hospital...now we are doing less than 10%....

>>

>> Now, if we can just get our dispatch issues corrected and we can start

>> minimilizing the number of times we respond emergency as well....

>>

>> Keep safe,

>>

>> Dudley

>>

>>

>>

>>

>>

[Guest guest]

Bunches.....personally I have a few ROSCs that didn't have 2 minutes to

give, and just because you've decided that trauma patients have more time

than we once thought doesn't ever mean that taking our time to the ED is a

good idea. While the actual, literal number of optimal minutes that a trauma

patient has to recieve definitive surgery is speculative, I doubt that it

can be proven that granting a GSW to the chest or a fractured liver patient

an additional 15 minutes tooling along through town is the proper treatment.

If I had your kid in my rig with serious internal injuries from an accident,

and it took me 30 minutes pooting around stuck in traffic to deliver them to

a trauma surgeon, I sincerely doubt that you'd be out in the ambulance dock

congratulating me on a great job because I spent an additional 20 minutes

getting to the ER because " We now know that trauma patients have more time

than we once thought. "

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>

>

>>

>> I appreciate your thoughts...but one of the things our Medical

>> Director is looking as is the need to transport while doing CPR. We

>> are analyzing and evaluating every patient we transport to the

>> hospital with CPR in progress to see if we had other options. For

>> instance, if we sit on scene for 25 or 30 minutes doing ACLS with no

>> reversable causes and the patient is as dead after our treatment as

>> they were before we arrived...what magic pill is the ED going to

>> deliver after another 15 to 20 minutes of getting them there???

>>

>> Now, if we are having results and we just cannot keep the patient in

>> ROSC consistantly...those are the ones we are evaluating to see what

>> we can supplement our care with so that the need to " rush like

>> mad-men " to the ED can be even further minimalized...we are making

>> great strides...when I got here 4 years ago we ran over 50% of our

>> patients emergency to the hospital...now we are doing less than 10%....

>>

>> Now, if we can just get our dispatch issues corrected and we can start

>> minimilizing the number of times we respond emergency as well....

>>

>> Keep safe,

>>

>> Dudley

>>

>>

>>

>>

>>

[Guest guest]

Let's look at your statement. Se comments in text:

Bunches.....(Must be Houston number--we don't have that in our north Texas

numbering system).

personally I have a few ROSCs that didn't have 2 minutes to give,

(How do you know? Where are your comparisons? The OPALS study has shown ALS

of no benefit in cardiac arrest--just defibrillation.)

----------------------------------------------------------------------------

----

Advanced cardiac life support in out-of-hospital cardiac arrest.

Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, Nichol G,

Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone

E, Lyver M; Ontario Prehospital Advanced Life Support Study Group.

Department of Emergency Medicine, Ottawa Health Research Institute,

University of Ottawa, Ottawa Ont, Canada. istiell@...

BACKGROUND: The Ontario Prehospital Advanced Life Support (OPALS) Study

tested the incremental effect on the rate of survival after out-of-hospital

cardiac arrest of adding a program of advanced life support to a program of

rapid defibrillation. METHODS: This multicenter, controlled clinical trial

was conducted in 17 cities before and after advanced-life-support programs

were instituted and enrolled 5638 patients who had had cardiac arrest

outside the hospital. Of those patients, 1391 were enrolled during the

rapid-defibrillation phase and 4247 during the subsequent

advanced-life-support phase. Paramedics were trained in standard advanced

life support, which includes endotracheal intubation and the administration

of intravenous drugs. RESULTS: From the rapid-defibrillation phase to the

advanced-life-support phase, the rate of admission to a hospital increased

significantly (10.9 percent vs. 14.6 percent, P<0.001), but the rate of

survival to hospital discharge did not (5.0 percent vs. 5.1 percent,

P=0.83). The multivariate odds ratio for survival after advanced life

support was 1.1 (95 percent confidence interval, 0.8 to 1.5); after an

arrest witnessed by a bystander, 4.4 (95 percent confidence interval, 3.1 to

6.4); after cardiopulmonary resuscitation administered by a bystander, 3.7

(95 percent confidence interval, 2.5 to 5.4); and after rapid

defibrillation, 3.4 (95 percent confidence interval, 1.4 to 8.4). There was

no improvement in the rate of survival with the use of advanced life support

in any subgroup. CONCLUSIONS: The addition of advanced-life-support

interventions did not improve the rate of survival after out-of-hospital

cardiac arrest in a previously optimized emergency-medical-services system

of rapid defibrillation. In order to save lives, health care planners should

make cardiopulmonary resuscitation by citizens and rapid-defibrillation

responses a priority for the resources of emergency-medical-services

systems. Copyright 2004 Massachusetts Medical Society

----------------------------------------------------------------------------

-------------

and just because you've decided that trauma patients have more time than we

once thought doesn't ever mean that taking our time to the ED is a good

idea. While the actual, literal number of optimal minutes that a trauma

patient has to recieve definitive surgery is speculative, I doubt that it

can be proven that granting a GSW to the chest or a fractured liver patient

an additional 15 minutes tooling along through town is the proper treatment.

(There you are wrong and most of the evidence comes from Houston. People die

from trauma in a trimodal distribution. The first die within minutes and

are, for the most part, unsalvageable. The survival rate in this group has

not changed since the Crimean war despite trauma centers, helicopters, EMS.

The second group dies within hours [2-4] and this is where we can make a

difference. But, for most patients 1-2 [or even 10-15] minutes does not make

a difference. Survival in Iraq is better because of the practice of

permissive hypotension, fluid restriction, stabilizing care in the field

care station, and rapid transfer to definitive care at hospitals in Germany

[ask Ken Mattox]). The third group dies within days to weeks and EMS can

make a difference here with proper care--not speed)

(Take your GSW to the chest. It hit the heart or the great vessels, then

they are dead and there is little anybody can do. If it hit other structures

you have some time and a minute or two will not make a difference. The

splenic rupture will do best with judicious fluids and transport. How long

will it take the trauma center to scan or CT the abdomen, prep them for the

OR and then operate--almost always more than an hour. In pediatric trauma,

we rarely operate anymore. You should guide you care based on physiologic

parameters. Princess might be alive if they had recognized that she

had a pulmonary vein bleed and unstable vital signs.)

(Nobody is saying that timing is not important--it is just not as crucial as

we once thought and the Golden Hour is a myth. What is the time interval?

Nobody knows for sure, but the vital signs should guide you.)

If I had your kid in my rig with serious internal injuries from an accident,

and it took me 30 minutes pooting around stuck in traffic to deliver them to

a trauma surgeon, I sincerely doubt that you'd be out in the ambulance dock

congratulating me on a great job because I spent an additional 20 minutes

getting to the ER because " We now know that trauma patients have more time

than we once thought. "

(or be killed in an accident due to speed. Are you saying that lights and

sirens get you there 3 times faster? The literature does not support this.

In a Syracuse study, lights and siren reduced transport time by only 1

minute and 46 seconds--a time deemed not clinically significant [brown et

al, " Do warning lights and sirens reduce ambulance response times? " Prehosp

Emerg Care. 2000 Jan-Mar;4(1):70-4.] In a Minneapolis study (where ice can

keep traffic snarled) the response time was 38% faster with red lights and

sirens [less than the 200% you postulate] [Ho, et al. " Time saved with use

of emergency warning lights and sirens during response to requests for

emergency medical aid in an urban environment. " Ann Emerg Med. 1998

Nov;32(5):585-8.] In Greenville, NC lights and sirens saved only 43.5

seconds. [Hunt, et al. Is ambulance transport time with lights and siren

faster than that without? Ann Emerg Med. 1995 Apr;25(4):507-11.]

(Most kids do not need surgery--in fact, the surgeons are debating the fact

as to whether pediatric trauma is still a surgical disease) [Acerno et al,

" Is pediatric trauma still a surgical disease? Patterns of emergent

operative intervention in the injured child. " J Trauma. 2004

May;56(5):960-4.] In my mind it still is, but much less so)

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>

>

>>

>> I appreciate your thoughts...but one of the things our Medical

>> Director is looking as is the need to transport while doing CPR. We

>> are analyzing and evaluating every patient we transport to the

>> hospital with CPR in progress to see if we had other options. For

>> instance, if we sit on scene for 25 or 30 minutes doing ACLS with no

>> reversable causes and the patient is as dead after our treatment as

>> they were before we arrived...what magic pill is the ED going to

>> deliver after another 15 to 20 minutes of getting them there???

>>

>> Now, if we are having results and we just cannot keep the patient in

>> ROSC consistantly...those are the ones we are evaluating to see what

>> we can supplement our care with so that the need to " rush like

>> mad-men " to the ED can be even further minimalized...we are making

>> great strides...when I got here 4 years ago we ran over 50% of our

>> patients emergency to the hospital...now we are doing less than 10%....

>>

>> Now, if we can just get our dispatch issues corrected and we can start

>> minimilizing the number of times we respond emergency as well....

>>

>> Keep safe,

>>

>> Dudley

>>

>>

>>

>>

>>

[Guest guest]

Let's look at your statement. Se comments in text:

Bunches.....(Must be Houston number--we don't have that in our north Texas

numbering system).

personally I have a few ROSCs that didn't have 2 minutes to give,

(How do you know? Where are your comparisons? The OPALS study has shown ALS

of no benefit in cardiac arrest--just defibrillation.)

----------------------------------------------------------------------------

----

Advanced cardiac life support in out-of-hospital cardiac arrest.

Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, Nichol G,

Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone

E, Lyver M; Ontario Prehospital Advanced Life Support Study Group.

Department of Emergency Medicine, Ottawa Health Research Institute,

University of Ottawa, Ottawa Ont, Canada. istiell@...

BACKGROUND: The Ontario Prehospital Advanced Life Support (OPALS) Study

tested the incremental effect on the rate of survival after out-of-hospital

cardiac arrest of adding a program of advanced life support to a program of

rapid defibrillation. METHODS: This multicenter, controlled clinical trial

was conducted in 17 cities before and after advanced-life-support programs

were instituted and enrolled 5638 patients who had had cardiac arrest

outside the hospital. Of those patients, 1391 were enrolled during the

rapid-defibrillation phase and 4247 during the subsequent

advanced-life-support phase. Paramedics were trained in standard advanced

life support, which includes endotracheal intubation and the administration

of intravenous drugs. RESULTS: From the rapid-defibrillation phase to the

advanced-life-support phase, the rate of admission to a hospital increased

significantly (10.9 percent vs. 14.6 percent, P<0.001), but the rate of

survival to hospital discharge did not (5.0 percent vs. 5.1 percent,

P=0.83). The multivariate odds ratio for survival after advanced life

support was 1.1 (95 percent confidence interval, 0.8 to 1.5); after an

arrest witnessed by a bystander, 4.4 (95 percent confidence interval, 3.1 to

6.4); after cardiopulmonary resuscitation administered by a bystander, 3.7

(95 percent confidence interval, 2.5 to 5.4); and after rapid

defibrillation, 3.4 (95 percent confidence interval, 1.4 to 8.4). There was

no improvement in the rate of survival with the use of advanced life support

in any subgroup. CONCLUSIONS: The addition of advanced-life-support

interventions did not improve the rate of survival after out-of-hospital

cardiac arrest in a previously optimized emergency-medical-services system

of rapid defibrillation. In order to save lives, health care planners should

make cardiopulmonary resuscitation by citizens and rapid-defibrillation

responses a priority for the resources of emergency-medical-services

systems. Copyright 2004 Massachusetts Medical Society

----------------------------------------------------------------------------

-------------

and just because you've decided that trauma patients have more time than we

once thought doesn't ever mean that taking our time to the ED is a good

idea. While the actual, literal number of optimal minutes that a trauma

patient has to recieve definitive surgery is speculative, I doubt that it

can be proven that granting a GSW to the chest or a fractured liver patient

an additional 15 minutes tooling along through town is the proper treatment.

(There you are wrong and most of the evidence comes from Houston. People die

from trauma in a trimodal distribution. The first die within minutes and

are, for the most part, unsalvageable. The survival rate in this group has

not changed since the Crimean war despite trauma centers, helicopters, EMS.

The second group dies within hours [2-4] and this is where we can make a

difference. But, for most patients 1-2 [or even 10-15] minutes does not make

a difference. Survival in Iraq is better because of the practice of

permissive hypotension, fluid restriction, stabilizing care in the field

care station, and rapid transfer to definitive care at hospitals in Germany

[ask Ken Mattox]). The third group dies within days to weeks and EMS can

make a difference here with proper care--not speed)

(Take your GSW to the chest. It hit the heart or the great vessels, then

they are dead and there is little anybody can do. If it hit other structures

you have some time and a minute or two will not make a difference. The

splenic rupture will do best with judicious fluids and transport. How long

will it take the trauma center to scan or CT the abdomen, prep them for the

OR and then operate--almost always more than an hour. In pediatric trauma,

we rarely operate anymore. You should guide you care based on physiologic

parameters. Princess might be alive if they had recognized that she

had a pulmonary vein bleed and unstable vital signs.)

(Nobody is saying that timing is not important--it is just not as crucial as

we once thought and the Golden Hour is a myth. What is the time interval?

Nobody knows for sure, but the vital signs should guide you.)

If I had your kid in my rig with serious internal injuries from an accident,

and it took me 30 minutes pooting around stuck in traffic to deliver them to

a trauma surgeon, I sincerely doubt that you'd be out in the ambulance dock

congratulating me on a great job because I spent an additional 20 minutes

getting to the ER because " We now know that trauma patients have more time

than we once thought. "

(or be killed in an accident due to speed. Are you saying that lights and

sirens get you there 3 times faster? The literature does not support this.

In a Syracuse study, lights and siren reduced transport time by only 1

minute and 46 seconds--a time deemed not clinically significant [brown et

al, " Do warning lights and sirens reduce ambulance response times? " Prehosp

Emerg Care. 2000 Jan-Mar;4(1):70-4.] In a Minneapolis study (where ice can

keep traffic snarled) the response time was 38% faster with red lights and

sirens [less than the 200% you postulate] [Ho, et al. " Time saved with use

of emergency warning lights and sirens during response to requests for

emergency medical aid in an urban environment. " Ann Emerg Med. 1998

Nov;32(5):585-8.] In Greenville, NC lights and sirens saved only 43.5

seconds. [Hunt, et al. Is ambulance transport time with lights and siren

faster than that without? Ann Emerg Med. 1995 Apr;25(4):507-11.]

(Most kids do not need surgery--in fact, the surgeons are debating the fact

as to whether pediatric trauma is still a surgical disease) [Acerno et al,

" Is pediatric trauma still a surgical disease? Patterns of emergent

operative intervention in the injured child. " J Trauma. 2004

May;56(5):960-4.] In my mind it still is, but much less so)

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>

>

>>

>> I appreciate your thoughts...but one of the things our Medical

>> Director is looking as is the need to transport while doing CPR. We

>> are analyzing and evaluating every patient we transport to the

>> hospital with CPR in progress to see if we had other options. For

>> instance, if we sit on scene for 25 or 30 minutes doing ACLS with no

>> reversable causes and the patient is as dead after our treatment as

>> they were before we arrived...what magic pill is the ED going to

>> deliver after another 15 to 20 minutes of getting them there???

>>

>> Now, if we are having results and we just cannot keep the patient in

>> ROSC consistantly...those are the ones we are evaluating to see what

>> we can supplement our care with so that the need to " rush like

>> mad-men " to the ED can be even further minimalized...we are making

>> great strides...when I got here 4 years ago we ran over 50% of our

>> patients emergency to the hospital...now we are doing less than 10%....

>>

>> Now, if we can just get our dispatch issues corrected and we can start

>> minimilizing the number of times we respond emergency as well....

>>

>> Keep safe,

>>

>> Dudley

>>

>>

>>

>>

>>

[Guest guest]

OK, then, explain to me why there is EMS in the first place? Why did you

bother to write textbooks for something that apparently has no clinical

signifigance? Obviously the patient in the accident in Arkansas didn't need

an ambulance since she survived a CVA and a multi-fatality accident only to

be driven to the hospital by her family. What is it exactly that we all

doing hanging out at your house every year talking about something that

every study you just posted just said was useless? I guess drinking and

eating chilli is as of much use as anything else we do. It looks to me like

I could just drive around and pick people up in my car and do just as much

good for them as I could in my ambulance.

If this is all just one giant waste of time and money, why are we doing it?

magnetass sends

Re: Tragic Crash Kills 3 of our Best.

>>

>>

>>>

>>> I appreciate your thoughts...but one of the things our Medical

>>> Director is looking as is the need to transport while doing CPR. We

>>> are analyzing and evaluating every patient we transport to the

>>> hospital with CPR in progress to see if we had other options. For

>>> instance, if we sit on scene for 25 or 30 minutes doing ACLS with no

>>> reversable causes and the patient is as dead after our treatment as

>>> they were before we arrived...what magic pill is the ED going to

>>> deliver after another 15 to 20 minutes of getting them there???

>>>

>>> Now, if we are having results and we just cannot keep the patient in

>>> ROSC consistantly...those are the ones we are evaluating to see what

>>> we can supplement our care with so that the need to " rush like

>>> mad-men " to the ED can be even further minimalized...we are making

>>> great strides...when I got here 4 years ago we ran over 50% of our

>>> patients emergency to the hospital...now we are doing less than 10%....

>>>

>>> Now, if we can just get our dispatch issues corrected and we can start

>>> minimilizing the number of times we respond emergency as well....

>>>

>>> Keep safe,

>>>

>>> Dudley

>>>

>>>

>>>

>>>

>>>