Words By: Nick Abussi CCP
Paramedics love a good clinical intervention. A skill, a drug, a procedure, some even judge their value and worth based on what they can provide. However, identifying the patients that will benefit from interventions is only half the battle. A good clinician will do this well. A great clinician will be able to balance the interventions benefit against the interventions risk.
Everything we do comes with risk. For example, aspirin can cause gastrointestinal bleeds, a poorly placed cannula can cause life threatening sepsis and sedation can lead to apnoea. I’d like to think that we are pretty good at identifying the benefit, but sometimes we down play or ignore the risks. One such intervention where this occurs is transporting under operational lights and sirens to hospital.
The Perceived Benefit
Transporting under lights and sirens should be considered a clinical intervention. It is employed to get our patients to higher clinical care faster to improve their outcome. But for this to be true, we are assuming two things. Firstly, that there are interventions that we can’t provide and secondly, that the interventions are time critical.
Firstly, let’s consider that there are interventions we can’t provide. The idea of transporting under lights and sirens began decades ago when clinical care outside of hospitals was limited. Our practice has grown exponentially since then and we have a wider scope of clinical care to offer our patients. Whilst there are critically unwell patients who require interventions beyond our scope, there are certainly not as many as there used to be.
Secondly, let’s consider that the clinical interventions are time critical. We assume that the sooner our patient receives the intervention, the better, otherwise why would speed and run red lights. How much time do we really save? Some studies suggest a mere two minutes (1).
The Risk
We may think that our uniform, reflective ambulance, and four days of driver training are enough to keep us safe. However, a review of 19 million cases in the US paints a different picture. When driving to a scene, crashes occur at a rate of 4.6 per 100,000 (road speed) and 5.4 per 100,000 (lights and sirens). When transporting to hospital, the crash rate goes from 7.0 per 100,000 (road speed) to 17.0 per 100,000 (lights and sirens) (2).
On average, a paramedic is seriously injured in a traffic accident every month in this country. Every two years, a paramedic is killed. In Australia, the vehicle fatality rate is eleven times higher for paramedics compared to all other workers (3).
Think back to some of the lights and siren transports you’ve done in the past. The driver was probably distracted by what was going on in the back. They were most likely speeding, and in the driver’s seat was probably the most inexperienced clinician. Added to this, you can almost guarantee that due to the clinical interventions, the paramedics in the back and the patient were likely not properly restrained.
No Guidelines Exist
Usually, interventions that carry both risk and benefit are carefully managed through developed clinical protocols or guidelines. This enhances the safety of our decision making. Unfortunately for this intervention, neither exist.
Currently, the decision to transport someone under lights and sirens, a decision that could kill or seriously injure you, your partner, the patient or an innocent member of the public, is based on the opinion of the treating clinician.
If we are going to commit to the risk of transporting under lights and sirens, as a profession we need to develop guidelines that support the identification of patients who genuinely require urgent hospitalisation despite our clinical care. There are patients who are truly time critical but perhaps not as many as we think.
Reflecting on my personal career, I have transported patients to hospital under lights and sirens who in hindsight, didn’t need to be. The paramedics including myself in the back were not wearing seatbelts because, let’s be honest, we couldn't treat if we were restrained and the driver was the most inexperienced member of our team.
I’m writing this because I want to encourage our profession to reflect on our own practice. I want my mistakes to be a learning opportunity for others. I want you to ask yourself next time you’re in this situation, is it necessary?
We all want what is best for our patients and we all want to go home safe at night. Transporting under lights and sirens to hospital might save two minutes, but it may also result in life altering consequences. All of the clinical interventions aside, the clinical cares mean nothing if we don’t arrive at our destination safely.
Remember the first lesson in medicine. Do no harm.
References
1. Murray B , Kue R . The Use of Emergency Lights and Sirens byAmbulances and Their Effect on Patient Outcomes and Public Safety: AComprehensive Review of the Literature. Prehosp Disaster Med. 2017;32(2):209–216.
2. Watanabe BL, Patterson GS, Kempema JM, Magallanes O,Brown LH. Is Use of Warning Lights and Sirens Associated With Increased Risk ofAmbulance Crashes? A Contemporary Analysis Using National EMS InformationSystem (NEMSIS) Data. Ann Emerg Med. 2019;74(1):101‐109.
3. MaguireBJ, O'Meara PF, Brightwell RF, O'Neill BJ, Fitzgerald GJ. Occupational injuryrisk among Australian paramedics: an analysis of national data. Med J Aust.2014;200(8):477‐480.
Cite this article
Abussi, N., 2021. Red Light, Blue Light, No Light. The Shift Extension - ParamedicPublishing. Available at: https://www.theshiftextension.org/blog/red-light-blue-light-no-light