Hatzolah Ambulance Manhattan 1

[vc859]

New York State Vehicle and Traffic Law https://www.health.ny.gov/professionals/ems/pdf/srgvat.pdf


Section 1104 © Authorized Emergency Vehicles


Except for an authorized emergency vehicle operated as a police vehicle, the exemptions herein granted to an authorized emergency vehicle shall apply only when audible signals are sounded from any said vehicle while in motion by bell, horn siren, electronic device or exhaust whistle as may be reasonably necessary, and when the vehicle is equipped with at least one lighted lamp so that from any direction, under normal atmospheric conditions from a distance of five hundred feet from such vehicle, at least one red light will be displayed and visible.


Of course, like most laws it is really vague. What does "as reasonably necessary mean" is it "reasonably necessary" to use sirens on an empty road at 3AM responding to a stubbed toe or other Alpha level complaint

 

[CHIEFOPS]

The stubbed toe doesn't legally justify 'emergency operation' i.e, lights and siren.


I re-iterate, in NYS, if you get into an MVA while running lights and no siren (or siren with no light) you have no defense because in hindsight it would have been reasonably necessary to have it on.


The siren is a warning device, if it wasn't on while responding to an emergency then the car/pedestrian you hit or hit you wasn't warned you were coming.

 

[FollowingNFront]

The stubbed toe doesn't legally justify 'emergency operation' i.e, lights and siren.

I re-iterate, in NYS, if you get into an MVA while running lights and no siren (or siren with no light) you have no defense because in hindsight it would have been reasonably necessary to have it on.


The siren is a warning device, if it wasn't on while responding to an emergency then the car/pedestrian you hit or hit you wasn't warned you were coming.

Are you sure you know how the 911 system works? Because you should know how the jobs come over. You keep saying that a stubbed toe doesn't justify lights and sirens, but if the call taker/dispatcher puts it in as a priority 1-6 we HAVE TO respond lights and sirens i.e., 'emergency operation'. We don't decide what an "emergency" is or not. We have to respond according to the priorities. V&T ain't going to get me out of an NOI/disciplinary action!


Let me play devil's advocate and say, what if I'm driving down 2nd Avenue and all down the Ave., there are all green lights. I'm driving with just lights and a guy comes barreling across the avenue because he ran a red light and he T-bones me.... Is it MY fault because I didn't warn him that I was going through a green light? If he didn't see the red light, would my siren have stopped him?

 

[CHIEFOPS]

FDNY policy, or any agency policy, does not supercede the law. You as the emergency vehicle operator still have to drive with due care.


In your devil's advocate scenario, (which exactly happened to me beginning my last year in the NYPD) the onus is still on you as the emergency vehicle operator. If you were properly using your warning equipment the other driver can't shift the blame to you as easily if you weren't.


In my own ambulance experience, in real non-emergency cases I went no lights and siren, on 'tour 1'(midnight shift for non-NYC EMS folk) calls that were "semi" emergencies I went light and siren at reduced speed.


Remember we're talking about civil liability here where people sit on juries and see you and your employer as having deep pockets. You will still likely be found negligent for the MVA and the agency negligent for requiring a CODE 3 response to a non-emergency condition. That's why these cases are usually settled instead of going to a verdict. But do you want to be the case that goes all the way?


Oh, in my case I referenced above, even though:


1. the other driver was unlicensed,


2. unregistered,


3. uninsured,


4. excessively speeding,


5. civilian witnesses corroborated green light for me and red light for him,


6. civilian witnesses corroborated I was using lights and siren,


7. I was miraculously found "not at fault" by the NYPD Accident Investigation Squad and the Supervisory investigation,


the NYC Corporation Counsel lost it's nerve as the jury was being seated and settled with the 2 plaintiffs.

 

[FollowingNFront]

FDNY policy, or any agency policy, does not supercede the law. You as the emergency vehicle operator still have to drive with due care.

In your devil's advocate scenario, (which exactly happened to me beginning my last year in the NYPD) the onus is still on you as the emergency vehicle operator. If you were properly using your warning equipment the other driver can't shift the blame to you as easily if you weren't.


In my own ambulance experience, in real non-emergency cases I went no lights and siren, on 'tour 1'(midnight shift for non-NYC EMS folk) calls that were "semi" emergencies I went light and siren at reduced speed.


Remember we're talking about civil liability here where people sit on juries and see you and your employer as having deep pockets. You will still likely be found negligent for the MVA and the agency negligent for requiring a CODE 3 response to a non-emergency condition. That's why these cases are usually settled instead of going to a verdict. But do you want to be the case that goes all the way?


Oh, in my case I referenced above, even though:


1. the other driver was unlicensed,


2. unregistered,


3. uninsured,


4. excessively speeding,


5. civilian witnesses corroborated green light for me and red light for him,


6. civilian witnesses corroborated I was using lights and siren,


7. I was miraculously found "not at fault" by the NYPD Accident Investigation Squad and the Supervisory investigation,


the NYC Corporation Counsel lost it's nerve as the jury was being seated and settled with the 2 plaintiffs.

The thing is, you dont know what youre going to arrive to. The text can say stubbed toe and come on scene to an amputation of the whole foot. So there is really no way of saying "this call didnt warrant the use of lights and sirens". Ive been to more calls that are completely different than the text states than I have where the text was right.


Hell, even just now i responded to a "sick female on the corner vomiting".... And we pull up and she is a homeless intox that did NOT vomit, instead she dropped her beer and the ground was wet and some good samaritan from across the street thought it was vomit. Completely different right?

 

[CHIEFOPS]

The response has to be dictated by the call-type, not by what-ifs.


By your standard, there's no reason for an ambulance service to obtain any further information from a caller beyond "we need an ambulance" and every call is a life or death emergency. That's why priority medical dispatching exists and why your agency has call segments or whatever FDNY calls their call priorities today.

 

[FollowingNFront]

The response has to be dictated by the call-type, not by what-ifs.
By your standard, there's no reason for an ambulance service to obtain any further information from a caller beyond "we need an ambulance" and every call is a life or death emergency. That's why priority medical dispatching exists and why your agency has call segments or whatever FDNY calls their call priorities today.

The only exception in the VTL with respect to sirens during emergency operation is for police vehicles, in NYS, 'call segments' or 'priorities' don't exempt you from the VTL. Your example of a stubbed toe is not an emergency so neither lights or siren are legally justified.

This whole time I was saying that even if the call is bullshit when you get there, or it looks like bullshit from what you read in the text, you still have to respond appropriately to the priority/call-type, NOT what-ifs.... I remember saying that if it comes over as a 6 and says stubbed toe, I still HAVE to respond with lights and sirens because the priority is a 1-6.


Maybe the call taker knows something that I don't? Maybe they have a suspicion that it might be more.... But what you said about a "stubbed toe" not being an emergency so you wouldn't run lights is actually a "what-if".... Even if it comes over as a "NON-CRITICAL INJURY" and shows a priority 5 and says "stubbed toe" in the text, you still have to respond appropriately for a priority 5. That's all I'm saying...


I get what you mean about the VTL. The Fire Dept. tells us to run sirens when the lights are on too. And we do..... Just not every single second.

 

[CHIEFOPS]

This whole time I was saying that even if the call is bullshit when you get there, or it looks like bullshit from what you read in the text, you still have to respond appropriately to the priority/call-type, NOT what-ifs.... I remember saying that if it comes over as a 6 and says stubbed toe, I still HAVE to respond with lights and sirens because the priority is a 1-6.

Maybe the call taker knows something that I don't? Maybe they have a suspicion that it might be more.... But what you said about a "stubbed toe" not being an emergency so you wouldn't run lights is actually a "what-if".... Even if it comes over as a "NON-CRITICAL INJURY" and shows a priority 5 and says "stubbed toe" in the text, you still have to respond appropriately for a priority 5. That's all I'm saying...


I get what you mean about the VTL. The Fire Dept. tells us to run sirens when the lights are on too. And we do..... Just not every single second.

You're not grasping what i'm saying- the FDNY's policy, any ambulance service's policy of running light and siren to all


calls is irresponsible from a liability standpoint, I don't know how they've gotten away with it for so long.


No reasonable person, certainly not an ambulance service can consider a "stubbed toe" an emergency that requires a light and siren response.


The NYS VTL is also in need of an amendment because it requires all auth emerg vehs except police vehicles to run both light and siren simultaniously to be in 'emergency operation'. While police vehicles can run completely no light and siren, the other emer vehicles should be required to run lights but siren use should be as needed.


And the FDNY needs to adopt a real medical dispatch priority system that recognizes certain requests are not emergencies and the responding ambulance does not have to use light and siren at all.

 

[FollowingNFront]

We dont have to and are not supposed to repond lights or sirens to priority 7 and up...


I dont think they are going to change their ways any time soon.

 

[Blaine B.]

Using lights & sirens to the stubbed toe call will get them there quicker so they can be back on duty quicker when something more serious happens later.


If they had to wait around all day you might have a bunch of units tied up and unable to take new calls.

 

[CHIEFOPS]

Using lights & sirens to the stubbed toe call will get them there quicker so they can be back on duty quicker when something more serious happens later.

If they had to wait around all day you might have a bunch of units tied up and unable to take new calls.

That's not a justification to using lights and siren to a non-emergency. If they wreck going to the stubbed toe and kill/maim you or your relative are you gonna accept that explanation?

 

[Travelin Man]

Using lights & sirens to the stubbed toe call will get them there quicker so they can be back on duty quicker when something more serious happens later.

If they had to wait around all day you might have a bunch of units tied up and unable to take new calls.

If that's your planned explanation to the attorneys and judges when you kill or injure someone while responding to a non-emergency call, good luck with that. Foolish logic.


As for the on-going debate between ChiefOps and FollowingNFront, there are two things that stand out to me as being ludicrous:


1. The amount of "what-if" that happens.


2. The fact that you're "required" to go lights and sirens no matter how non-emergent the call is, based on the dispatcher's information.


Elaborating on each point:


1. "What if we get dispatched to a stubbed toe and we get there and it's foot amputation?"


Really? Is this routinely occurring across the US? We need to be basing our response priorities on probability, not possibility.


We're not routinely sending an engine, medic, truck, heavy rescue, ambulance and battalion on every vehicle crash because there "could" be entrapment, so why are we skewing our EMS responses? Use common sense that most of the time, the foot amputation would be associated with additional calls received, caller requesting ETA, the incident wouldn't be inside a residential address, etc. YES, I acknowledge that there was this one time in 1991 that a single call was received from inside a home in Bushwick were a person dropped a machete and accidentally cut off their foot and the caller never told the 911 call-taker exactly what happened. But, to always response L&S for the chance of that being the case is silly.


2. Why are you "required" to go lights and sirens if the dispatcher tells you so? As a professional paramedic, EMT, firefighter, or police officer, you have the knowledge, skills, and abilities to decide if you need to response L&S or not. You know the area, roads, current weather conditions, current traffic conditions, past history at the address, and possibly even the patient or occupants.


Sounds like some litigation-fearing attorney policy to me.


Those are my thoughts, I'm happy to hear yours...

 

[Blaine B.]

There is absolutely no justification for reckless and unsafe driving when using lights and sirens. I don't see your point. Lights and sirens get traffic moving for a vehicle to get through quicker than if it was waiting in backed up traffic, especially in an inner-city.

 

[Travelin Man]

There is absolutely no justification for reckless and unsafe driving when using lights and sirens. I don't see your point. Lights and sirens get traffic moving for a vehicle to get through quicker than if it was waiting in backed up traffic, especially in an inner-city.

Yes, having driven these things for two decades, I'm aware of the perceived advantages of lights and sirens responses.


I'm also keenly aware that very, very few of the calls that EMS responds to require a lights and siren response to the scene or to the hospital. Aggressive EMS systems are limiting their L&S responses and better filtering the calls at the call-taker level.


How easy would it be for the prosecutor to show negligence in the event of a crash (which can occur even when the vehicle is being driven as cautiously as possible by a trained and experienced driver) when the only defense is that you wanted to get there, snatch the patient up, throw 'em in the back of the ambulance, and whisk them away quickly because you MIGHT be in service quicker for another incident that may or may not come in, and you may or may not be in position for? All the time, he'll have copies of case studies to prove that L&S responses generally don't have a positive or negative impact on most patients.


I really liked this quote from a study on L&S responses:


CONCLUSION:


In this urban EMS system, L&S reduce ambulance response times by an average of 1 minute, 46 seconds. Although statistically significant, this time saving is likely to be clinically relevant in only a very few cases. A large-scale multicenter L&S trial may help address this issue on a national level. [emphasis added]

 

[vc859]

N = 32????


That seems like a REALLY small sample size. Not to mention that the methodology of the study has some problems. Namely that even though the observer and paramedic repeated the same route of travel a week later, at the same time of day; that is NO guarantee that traffic conditions were exactly the same. Although I will give them the methodology because I can't think of a better way to do it.


It also says that it is LIKELY there is no clinical significance. That's like saying its likely the suspect has already left the scene of a stabbing so we don't need to stage away.

 

[Travelin Man]

I also agree that the sample is low, as do the authors of the article, who indicate that a more nationwide sampling would be appropriate. However, I believe that the greater point is that the amount of time saved by responding lights & sirens on EMS calls is negligible, and has little overall impact on the patients morbidity or mortality.

 

[vc859]

Are the researchers trying to say that L&S responses actually have negligible effect on patients morbidity and mortality, or that their likely to have a negligible effect (i.e. the researchers are guessing).


Personally, I think that lights and sirens should be used rarely when going to the hospital. The only time they should be used is when you have an absolutely critical patient.


Going to the scene, because of the unknown factor, scene safety issues, and in trauma patients especially the potential for them to go downhill very quickly, EMS should use lights and sirens as dispatched by EMD/MDPS.

 

[FollowingNFront]

Are the researchers trying to say that L&S responses actually have negligible effect on patients morbidity and mortality, or that their likely to have a negligible effect (i.e. the researchers are guessing).



Personally, I think that lights and sirens should be used rarely when going to the hospital. The only time they should be used is when you have an absolutely critical patient.


Going to the scene, because of the unknown factor, scene safety issues, and in trauma patients especially the potential for them to go downhill very quickly, EMS should use lights and sirens as dispatched by EMD/MDPS.

I agree with you 100%. There is a HUGE unknown factor and as I was saying before you never know if it will really be a "stubbed toe"because when you get there. Limiting your response based on what you think may be there when you get on scene is downright irresponsible. And especially in NYC, during rush hour traffic, lights and sirens can mean the difference of taking 15 mins to get on scene, or 45+!

 

[CHIEFOPS]

An emergency light and siren response should be dictated by the information provided by the caller(s), not what ifs. It's not reasonable to assume or anticipate a reported stubbed toe is anything more critical than a stubbed toe.

 

[Quickstep80]

Many ambulance dispatch centers use AMPDS or similar protocols to determine whether a situation requires immediate response or it's not time-critical. If there's any doubt, then lights and sirens should be used by all means. But somebody calling for an ambulance after a minor injury that occured days ago without their condition deteriorating right now should not prompt a L/S siren response. Many ambulance service keep non-emergency ambulance vehicles ready for qualified medical support where ALS staff is not needed.


Researches show that L/S-responses inhire a siginificantly higher risk for the crew and of course also all other road traffic users to be involved in a serious (maybe even fatal) crash. While it's completely understandable that a quick response is vital in potentially life-threatening and critical situations, there's no point why emergency personnel and third parties should be endangered more than necessary, especially when it's a response to a job where patients might as well make their way to a hospital or a doctor's surgery by taxi or public transport.


And even when ambulance care is required and essential, that doesn't mean it's urgent.


L/S should be chosen wisely. When used inflationary, a side effect may also be that other road traffic users probably may disdain such signals somewhere along the line.


We're using highly qualified dispatch centers to bring patients the best way and appropriate sort of care. If yet every single call activates an ambulance responding with L/S, then I do not see the need of having extensively trained control room staff.


But again I want to underline: if a critical situation can't be ruled out, response has to be fast. But there's surely no uncertainty with every single job that's coming in...