Paramedics: Lights & Sirens & Bells & Whistles

Photo 22 Ambulance Crash (yellow)
This happens five times a day- every day of the year . . .

“EMS personnel have an occupational fatality rate of 9.6 per 100,000 workers per year, in transportation-related incidents. The death rate is 6.3 for police; 4.5 for firefighters and 2 for average citizens.” (National Institute for Occupational Safety & Health)

You think Code-3 driving saves lives?
You think Code-3 driving saves lives?

Because you chose us for your daily dose of reality therapy, we will inform you right now that Code-3 (lights & siren) ambulance responses happen thousands of times a day for no good reason. In spite of what plenty of fine folks have come to believe – maybe even you – the fact is EMS ‘shock & awe’ is rarely a significant influencer in saving lives by getting to the patient faster. Neither does it usually improve patient outcomes by getting them to the ER a blink or two quicker. More than a few studies have shown that – contrary to the convictions of the EMS world – Code-3 driving puts medics; their patients; other responders and the public in unnecessary peril. So much so that, by all measurable criteria, the routine practice quite possibly generates as much trauma and death as it prevents. Now, how smart can that be really?

Photo 29 - Ambulance Crash
This one killed a Medic and a patient . . .

        The tradition of flipping on lights & sirens by ambulance teams has, over seven decades, morphed into a reflex so axiomatic that few people on either side of the EMS equation give it much real thought. It just is. Code-3 has been elevated to a sacramental practice which now sports all the hallmarks of – as comedian Stephen Colbert likes to say – ‘truthiness.’ It must be right because it feels right.

Code-3 is religious dogma because, well, by God, it’s an emergency. It appeals to our sense of righteousness.

Trust us. We've seen it all . . .
Trust us. We’ve seen it all . . .

“Let’s go! Fast is good, faster is better!”

No, actually, it isn’t.

Just because something feels like warm and fuzzy common sense, doesn’t mean that it is. In five out of eight lights & siren responses you happen to witness on city streets on a given day, those fine folks in uniform are dashing off to no true emergency at all. In nearly every one of the other three cases, arriving one, two or three minutes later would have no downside whatsoever.

Photo 28 - Ambulance Crash
This ambulance didn’t save anybody. It killed three, and left a heart patient waiting at home for yet another rescue team . . .

        As far back as 20 years ago, research conducted for the Annals of Emergency Medicine determined that the time getting from the scene of an incident to the emergency room, in a given city, was 43 seconds slower without lights and sirens. And while this difference in ambulance time may seem important to the citizenry – it is certainly not important medically.

50 times a year we run into each other . . .

        In layman’s terms, delivering you to the ER 43 seconds faster, does not mean hospital staff can work magic within those extra seconds to improve your situation. In fact, 5-10 minute delays are almost never clinically important either.

Still think Code 3 saves more people than it hurts?
Still think Code 3 saves more people than it hurts?

        A few minutes saved were probably once clinically valuable in a fraction of cases, in the era when speed was all an ambulance had to offer. For the most part, detailed physical assessment and advanced-level intervention just did not happen with unskilled care providers of the times. But today there exists practically no circumstance where “a minute lost is a patient lost.” In fact and in most cases, the first half-dozen things that a doctor and nurse would do, have already been done. That is what basic and advanced life support gets you. It’s why we master medicine instead of drag racing.

        For nigh on 40 years the eight-minute response time has been the platinum standard for the value of EMS to its community. The “we’re quicker than the other guys” mentality has dominated practically every    EMS contract conversation since Emergency.

        In the era of the Gold Rush the mantra of the macho was, “who’s the fastest gun in the West?” In the outré world of EMS, it still is. Playing the speedy-medic card is – to a great extent – exactly how the largest EMS provider in the U.S. won all those lucrative contracts. American Medical Response succeeded in leveraging the fuzzy math of quicker ambulances, to convince 2,000+ communities that parking Paramedics on street corners means faster times and by default, a better way to do things.

        Not even close. Quite the opposite, in fact. The unintended consequences are astronomical.

        What it guarantees instead is a never-ending stream of twenty-something burned-out medics with often not much in the life-experience bucket, using the revolving door of AMR to gain a modicum of street-cred while they shop for a ‘real’ job. And real positions – if you ask them, anyway – mean you’re not parked at Poco Taco assuaging your stress with a burrito after treating a bloody mess. To the contrary, rescuers should be afforded the simple decency of being allowed to return to a crew quarters; take a shower and decompress from the god-awful mess they just experienced. Mind you, medics don’t require much in order to do the job properly. A shower and a bunk, a fresh shirt and a padded cell would cut staff turn-over by 90%.

        In the bizarre world of EMS, this nation’s largest care provider subscribes to the same theory of staff hiring and turnover as McDonald’s hamburgers: mediocrity works just fine, and they can always find new medics for less money when the experienced ones can’t take it anymore.

        Our antiquated, arranged marriage of ‘quick response’ to ‘the best interest of the public’ is but one aspect of health care that turns logic on its dizzy head. Distilled to its lowest common denominator, private carrier EMS has convinced you of this little mind-bend:

        “Don’t worry. We’ll save you, even if it ends careers; trashes a noble profession; bankrupts half of us and kills people.”

        And it certainly does.

(Excerpt from the book, “The Paramedic Heretic.”)

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