Hi All,


I'm looking for some help with one of those great on going arguments I'm having with one of the services I work for. I come from a small area in Vermont. Never heard of it? It's in New England with a total state population of less than 1 million.


My service's SOP is that we respond Code 3 to every call. Yes, every call. It's a battle I've been fighting for some time now. I was wondering if anyone had any literature or articles, etc to help me try to convince some people that it is probably not the greatest policy. I would like to help them realize this before something happens.




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It all depends on what you agency is doing...


Here we run CAT A (Code 3) until proven otherwise as our KPI's state that a vehicle must be dispatched within 45 seconds of receiving the call. So we will not know the triage until 3 or 4 minutes later. This creates the scenario where we take off down the road on lights and sirens and then 30 seconds later switch them off because a call has been graded as non urgent. 


So does your agency triage calls into predefined categories by the dispatchers using AMPDS or equivalent? 


That being said, here the use of Lights and Sirens are down to the discretion of the driver of the vehicle at the time. Even if the call has been triaged as code 3, the driver can determine that he will not drive emergency conditions for safety and even then can determine the speed at which the ambulance is driven there is no requirement to exceed the speed limit. 

Code 3 is Lights and Sirens or no Lights and Sirens?


Either way, it should be based on the severity of the Complaint (Priority Dispatching). Response for a Unresponsive versus a Broken Ankle are different. However, there have been many cases where insufficient information were gathered and the "no lights, with lights" is difficult to determine. In addition, the complaint was for a fall but the patient was Unconcious as a result. Emergencies are assumed to be the worst case senario until the EMS crew arrives but that could be troublesome too.


It's difficult to compare regions and locales. In NYC, they have Segments for Call Types. All Segments from 1-7; you use Lights and Sirens. Segments 8-9; you use no Lights and Sirens; as the words of the immortal Will Smith, "2MPH, so everybody sees you."


Hope this helps...

USFA paper with a decent summary of the research.

NAEMSP/NASEMSD joint position paper.

Interesting Powerpoint with some dollar-sign statistics lacking in the other 2 sources.

Nadine Levick's Objective Safety site undoubtedly has something you can use, though I've not trolled through all its subpages in a while.

I could make a strong argument that running hot to every call is "negligence per se" and perhaps "gross, wanton, and willful negligence."  There is plenty of literature out there that "hot response" equals increased danger to medic, patient, and civilian.
I agree with Skip...unfortunately its the accidents and mistakes in life that everyone focuses on, not the other 99% of the time when you do something right and of course one person's error labels the entire industry.  I would think that Standard of Care would play into response protocols as well.
Here are a number of resources you may wish to consult when formulating your argument. 
Auerbach PS, Morris JA, Phillips JB Jr., et al: An analysis of ambulance accidents in Tennessee. JAMA 1987; 258:1487-1490
Kahn CA, Pirrallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis. Prehosp Emerg Care 2001;5:261--9
Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med 2002;40:625--32
Hunt RC, et al.  Is ambulance transport time with lights and siren faster than that without. Ann Emerg Med April 1995
Kupas DF, et al.  Patient outcome using medical protocol to limit “lights and siren” transport.  Prehospital and Disaster Medicine, Oct-Dec 1994
National Association of Emergency Medical Service Physicians.  Prehospital and Disaster Medicine, Apr-Jun 1994.
George JE, Quattrone MS: Above all do no harm. Emerg. Med. Tech. Legal Bull. 1991; 15:4
Victims of Hubris, JEMS.com, June 20, 2006
Tricks of the Trade: STOP! I See Dead People, JEMS, December 2005
Have We Set The Bar Too High, JEMS, March 2007
Good luck,

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