A simple three-step dispatch rule may reduce lights and sirens responses to motor vehicle crashes

Isenberg, Derek; Cone, David C.; Stiell, Ian G.

doi:10.1136/emermed-2011-200133

Cited by 12 publications

(15 citation statements)

References 28 publications

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“…All of the studies that aimed to research how much time was saved by the use of L&S found that they do make a difference, although the time saved can vary to as little as 43 seconds. 10 Commercially developed dispatch systems can account for initial call type and priority, thus providing better guidance on when L&S response is most appropriate. Variability in time saved was seen across the published studies, and one possible cause of this is geographical differences.…”

Section: Discussionmentioning

confidence: 99%

“…One factor is the effectiveness in reducing the ambulance response time (dispatch-to-scene-arrival interval) and the transport time (scene-departure-to-hospital-arrival interval). 10 Most of the current literature regarding L&S use focuses on EMS operational aspects such as the time saved by using them during response and/or transport. This is because prior to an ambulance arrival on scene, there is usually no health care professional there to care for the patient, and also limited information on the nature of said patient's injury/illness.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature

Murray

Kue

2017

Prehosp. Disaster med.

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The benefits of emergency lights and sirens (L&S) use as warning devices by ambulances continue to be a debated topic in Emergency Medical Services (EMS). While the most widely studied aspect of L&S use has been related to their effect on ambulance response and transport times, the literature suggests minimal time savings with more questionable impact on actual patient outcomes. As L&S use has been shown to increase the risk for vehicle crashes, the secondary concern of ambulance design and safety also becomes an important aspect on potential design recommendations that could mitigate the effects of a crash on patients, EMS providers, and the general public. The least studied aspect of L&S use (and probably the most important) is their effect on patient outcomes and quality of medical care during transport. The current evidence suggests no significant improvement on patient outcomes and potential worsening to certain aspects of patient care during transport. The purpose of this review was to examine the current literature regarding ambulance L&S use and the risks they pose to EMS providers, patients, and the general public. In doing so, it will provide sound background for EMS leaders to better develop policies governing the use of L&S by ambulances and promote better research in the patient outcomes effect associated with their use. This review offers some strategies in mitigating the risks associated with L&S use, such as ways to reduce their overall use and modifying other related factors to emergency medical vehicle collisions (EMVCs). Murray B , Kue R . The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: a comprehensive review of the literature. Prehosp Disaster Med. 2017;32(2):209-216.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature

Murray

Kue

2017

Prehosp. Disaster med.

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“…Furthermore, Priority 1 dispatch comprised 53% of all cases. On the one hand, this large allocation of Priority 1 dispatch relative to the number of time‐critical patients could be accepted as being consistent with the risk‐averse nature of ambulance dispatch systems, in erring towards higher priority dispatch unless good evidence supports lower priority dispatch . However, although accepting that some over‐triage is necessary because of uncertainties around patient condition (and how it might change), it is important to be mindful of the costs of high priority dispatch.…”

Section: Discussionmentioning

confidence: 89%

“…Previous studies have shown the value of this approach within specific chief complaints, identifying potential improvements in discriminating patient acuity within the chief complaints of 'seizures', 4 'falls', 7 'breathing problems', 8 'chest pain', 1 'unknown problems' 9 and 'traffic accidents'. 10 However, few published studies have analysed variation in the accuracy of dispatch priority between chief complaints at a system-wide level. [11][12][13] In the present study, we take a system-wide approach to analysing the match between dispatch priority of ambulance calls and patient condition.…”

Section: Introductionmentioning

confidence: 99%

Association between ambulance dispatch priority and patient condition

Ball

Williams

Smith

et al. 2016

Emerg Medicine Australasia

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“…A large multicenter study published in 2010 examining 3656 trauma patients with unstable vital signs found no association between EMS activation, response, on-scene, transport or total time and patient mortality (17). In light of these considerations, several EMS agencies have instituted protocols designed to reduce the use of RLS (18–20). The majority, however, do not offer clearly articulated guidelines and depend solely on the discretion of the EMS provider.…”

Section: Introductionmentioning

confidence: 99%

Unnecessary Use of Red Lights and Sirens in Pediatric Transport

Burns¹,

Hansen

Valenzuela

et al. 2016

Prehospital Emergency Care

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Introduction Approximately 25.5 million pediatric patients are treated in Emergency Departments around the United States annually. Roughly 7% of these patients are transported by ambulance; of these, about 7% arrive in ambulances running red lights and sirens (RLS). Compared to those transporting without RLS, emergency vehicles employing RLS are involved in more accidents and are associated with more fatalities. Objective To characterize the use of RLS in pediatric transports and identify factors associated with unnecessary use of RLS. Methods As part of the Children’s Safety Initiative (CSI-EMS), a large, multi-phased National Institutes of Health-funded study, we conducted a medical record review of all pediatric RLS transports in an urban EMS system over a 4-year period (2008–2011). A standardized chart abstraction tool was adapted for the out-of-hospital setting and pilot tested. Charts were independently reviewed by physicians and paramedics, with disagreements arbitrated by a pediatric emergency physician. Reviewers were asked to judge whether RLS transport was necessary and to provide comments justifying their position. Descriptive statistics were used to measure the frequency of unnecessary transports and logistic regression analysis was employed to identify factors associated with unnecessary use of RLS. Results Of 490 RLS transports, experts identified 96 (19.6%) as unnecessary use of RLS. Necessary and unnecessary RLS transports had similar patient sex and duration of transport, though unnecessary use of RLS tended to increase with patient age. The call reasons that represented the largest proportion of unnecessary RLS transports were trauma (49.0%), respiratory distress (16.7%), and seizure/altered mental status (11.5%). Compared with necessary RLS transports, unnecessary RLS transports were less likely to require resuscitation, airway management, or medication administration. Univariate analysis revealed that patient vital signs within normal limits were associated with increased risk of unnecessary RLS transport, with the most pronounced effect seen in the normal GCS score group (odds ratio 7.74, p-value 0.001). Conclusions This analysis identified patient and transport characteristics associated with unnecessary use of RLS. Our results could help serve as the basis for designing and prospectively evaluating protocols for use of RLS, potentially mitigating the risk associated with transport in pediatric patients.

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A simple three-step dispatch rule may reduce lights and sirens responses to motor vehicle crashes

Abstract: A simple three-step dispatch rule for MVCs can safely reduce L&S responses by one-third, as judged by need for transport to a trauma centre or use of trauma centre resources. Prospective validation is needed.

Cited by 12 publications

References 28 publications

The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature

The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature

Association between ambulance dispatch priority and patient condition

Unnecessary Use of Red Lights and Sirens in Pediatric Transport

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