LDS Emergency Preparedness

Be Prepared, Not Scared!

Should Your Ambulance Slow Down?

Posted by Elise on August 19, 2010

Kriss Szkurlatowski (sxc.hu)

Your husband is cleaning gutters and falls off the ladder, losing consciousness briefly, and it looks like he broke his leg. Or you awaken one morning and you can’t speak clearly or move the right side of your face — you suspect stroke and know you need medical attention fast. The right response in both these situations, and countless other medical emergencies, is to call 9-1-1 so that you can be raced to the hospital by ambulance — lights flashing, sirens blaring, no time to stop for traffic signals. Right?

Actually — not. New initiatives in many communities are challenging the wisdom of using lights and sirens during most ambulance transports. According to Robert Suter, DO, MH, professor of emergency medicine at the University of Texas Southwestern Medical Center, ambulance drivers are increasingly being urged to cool it, since “running hot,” which is EMT jargon for using lights and sirens and driving as fast as possible, may make matters worse. At the request of the American College of Emergency Physicians (of which he is former president), Dr. Suter recently studied this issue and concluded that there’s a need for clearer guidelines identifying which medical situations merit running hot.

Running Hot Creates Problems

Dr. Suder said that there are very good reasons to question the wisdom of having ambulance drivers pull out all stops to get patients to the hospital as fast as they can…

  • It doesn’t save a lot of time. When compared with “cold” transport, it was found that running hot saved, on average, from one minute and 43 seconds to 3.02 minutes, depending on variables such as traffic and city size.
  • Research doesn’t support running hot for the average patient. For certain conditions (such as stroke and hemorrhagic shock), speedy transport is important — but no research supports the benefit of running hot for the average patient’s survival or recovery.
  • Running hot makes it harder for EMTs to care for the patient. The jerky motions and shrill sounds of an ambulance speeding through traffic make it hard to take a patient’s pulse or insert an IV, and they make it hard to hear heart and lung sounds or take blood pressure.
  • Patients are stressed when ambulances run hot. Flashing lights and loud sirens can lead to increased blood pressure and heart rate and other physiological changes that can potentially hinder recovery and worsen outcome.

Dr. Suter pointed out that today’s ambulances are equipped with more sophisticated medical equipment and staffed by highly trained personnel — and that this wasn’t the case when ambulances first began to run hot. More moderate transport makes it easier to do all sorts of procedures. Quick but “warm” transport is sufficient for most patients, even the ones who need lifesaving blood, surgical procedures and clot-busting drugs. This also reduces the likelihood of an ambulance crash, 74% of which occur while running hot.

What to do?

If you or someone you care about requires ambulance transport to the hospital and — given what you now know — you don’t think that hot transport is necessary, you can ask that it not be done. There’s no need to add yet more danger to the medical problem that led you to call the ambulance in the first place!

Source:  Robert Edward Suter, DO, MH, professor of emergency medicine, The University of Texas Southwestern Medical Center, Dallas. He is former president of the American College of Emergency Physicians.

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