Insanity Defined...

It's been said that the definition of insanity is repeating the same action over and over and expecting a different outcome.   In EMS, there are a few practices that based on that definition, are insane...   The next few "Insights" columns will address a few of these practices.

As professionals providing essential public services, you would think that we would have enough knowledge, foresight, and yes-even "Insight", to minimize the risks we pose to those we are supposed to be helping.   But yet, in one area of our service delivery, we routinely place the public at risk with little to no demonstrable proof that the action makes any difference in the patient's outcome.

Yes readers, I'm talking about the practice of HOT vehicle operations...

Like many of you, I am fortunate to receive the daily news clips courtesy of EMSNetwork.org.   Reading these daily news briefs, we all should be increasingly alarmed about the rash of news articles from around the country that highlight terrible emergency vehicle crashes.  

Thanks to the efforts of Nadine Levick, M.D., MPH of Objective Safety, more is known and published about the risks of emergency vehicle operation and emergency medical vehicle design than ever before.   A few years ago at an American Ambulance Association meeting, Dr. Levick presented a compelling program on the hazards of emergency ambulance operations.   Her presentation was filled with statistics, pictures, and video of the kinematics during an ambulance crash.   After more than 30 minutes of debate on why ambulances are designed so poorly and why federal ambulance specifications in the United States prevent safety improvements available in ambulances used in other countries, one of the participants asked the $64,000 question - ""What is the one improvement to ambulance design that would improve safety the most?"  

To this question, Dr. Levick gave the perfect answer, "Remove the red lights and siren."

The risks of HOT responses are all too predictable - just look at the headlines this past month...

Ambulance transporting infant crashes - Fresno County, California

4 injured when ambulance hits fire truck - Butler, Pennsylvania

Michigan Firefighter Charged With Homicide, Fire Truck Crash

Ambulance collides with minivan in Brooklyn Center - Minnesota

Three car crash in Yarmouth involving an ambulance - Massachusetts

Four hurt in ambulance crash - Eastland County, Texas

Fire truck and SUV collide; 3 killed - Baltimore, Maryland

Fire truck in fatal crash ran red light - Baltimore, Maryland

We see it every day...   Ambulances, fire trucks, and even police cars responding to "emergency" calls, or transporting "emergency" patients using red lights and siren.   In my own community, the local fire department responds to "automatic fire alarms" with 4 - 5 multi-ton vehicles screaming across the city with sirens blaring.   Just this morning multiple fire units responded lights and sirens during the height of rush hour to a busy intersection for the report of a "strange odor in the area".   Are you kidding me?  

It’' almost as bad in medical responses.   

During a recent ride along, the unit I was in (and the fire department) responded HOT to the following three "emergency" calls in a row:

1.       A 21 year old male who injured his knee playing basketball

2.       A 60 year old ETOH male who was kicked in the back

3.       A   43 year old female who slipped and fell on the sidewalk

The defining incident leading me to consider writing on this topic again came last evening when the fire department and our ambulance service was dispatched "HOT" by the 9-1-1 center for a woman with a rash on her leg - unbelievable!

While it may be 'cool' to use the lights and sirens, it is just not that important to risk the lives of our personnel and the public by responding HOT to a call simply to save one to two minutes getting to most calls.  

The "insanity" definition comes into play because we KNOW that the practice is dangerous and we KNOW that the vast majority of the calls we respond to are not time-life sensitive, but we continue the practice expecting that we are not going to crash.   But crash we do.   Hurt people, we do.  

Let's stop the insanity!!

Innovative agencies who are truly concerned about the safety of their personnel, the public, AND the patient, have taken the necessary steps to minimize risks inherent with HOT responses such as implementing emergency medical dispatch with response determinants.   Safety conscious fire departments are modifying their response policies and dispatching fire trucks COLD to automatic fire alarms.   Law enforcement agencies have curtailed their use of HOT pursuits in order to reduce the risks to the public.

Let's hope that Dr. Ledvick’s work on safe emergency operations and vehicle design continues to educate enough emergency service leaders that headlines such as Fire truck flips on its side after crashing into school bus no longer grace the pages of our daily EMSNetwork news clips.