Question for the EMT/Paras
Discussion
I'm not a paramedic. But I thought I might throw in a few spanners...
What sort of medical condition would cause a patient to have a fit/seizure when exposed to loud noises (ie. siren)?
If their medical condition is not immediately life threatening (ie. the patient has been stablised), would you actually need to drive using your exemption? My guess is "no", but you know your job best.
Does the risk of a patient having a fit/seizure outweigh the risk of a collision that might be caused by not using your siren?
Is it possible to activate the siren for only brief moments when there is dense traffic movement or pedestrian traffic?
I've been in ambulances before, and didn't really take notice of how loud the siren was. It was loud, but I could still talk comfortably with the medics without raising my voice above normal level. I wonder if there have been documented cases of patients suffering a fit/seizure because of sirens? I also wonder how rescue helicopter crews deal with the issue of noise-triggered fits/seizures, because helicopters a LOT louder than ambulance vans.
What sort of medical condition would cause a patient to have a fit/seizure when exposed to loud noises (ie. siren)?
If their medical condition is not immediately life threatening (ie. the patient has been stablised), would you actually need to drive using your exemption? My guess is "no", but you know your job best.
Does the risk of a patient having a fit/seizure outweigh the risk of a collision that might be caused by not using your siren?
Is it possible to activate the siren for only brief moments when there is dense traffic movement or pedestrian traffic?
I've been in ambulances before, and didn't really take notice of how loud the siren was. It was loud, but I could still talk comfortably with the medics without raising my voice above normal level. I wonder if there have been documented cases of patients suffering a fit/seizure because of sirens? I also wonder how rescue helicopter crews deal with the issue of noise-triggered fits/seizures, because helicopters a LOT louder than ambulance vans.
Edited by Jungles on Tuesday 22 January 05:09
This is a clinical pre-hospital care question not a driving question, at root, surely?
I'm now a couple of years away from being current pre-hospital, but I know of no evidence (and a quick Medline search didn't find any) of a link between sirens and seizures. I can imagine sirens triggering pseudo-seizures in a psychiatric patient, perhaps (although I've never seen it). But I can't imagine transporting a pseudo-seizure patient on blues and twos. Presumably you were running him in quickly because he was still seizing despite Diazepam and/or because you were worried about the airway?
I've never seen a seizure in a patient linked to loud noise. Lights, yes, and sometimes strobes. But you can't see those from the trolley in the back of most front line ambulances now.
Did you ask your colleague why he was concerned after the job? I wonder whether he's not practicing anecdote-based-medicine; having had a patient seize by coincidence when he turned the sirens on.
My hunch would be that the risk of a collision because you weren't using warning equipment to wake up the dozy traffic is much, much higher than any risk to the patient from using it.
James
(Former BASICS instructor and examiner for the Royal College of Surgeons of Edinburgh diploma in Immediate Care)
I'm now a couple of years away from being current pre-hospital, but I know of no evidence (and a quick Medline search didn't find any) of a link between sirens and seizures. I can imagine sirens triggering pseudo-seizures in a psychiatric patient, perhaps (although I've never seen it). But I can't imagine transporting a pseudo-seizure patient on blues and twos. Presumably you were running him in quickly because he was still seizing despite Diazepam and/or because you were worried about the airway?
I've never seen a seizure in a patient linked to loud noise. Lights, yes, and sometimes strobes. But you can't see those from the trolley in the back of most front line ambulances now.
Did you ask your colleague why he was concerned after the job? I wonder whether he's not practicing anecdote-based-medicine; having had a patient seize by coincidence when he turned the sirens on.
My hunch would be that the risk of a collision because you weren't using warning equipment to wake up the dozy traffic is much, much higher than any risk to the patient from using it.
James
(Former BASICS instructor and examiner for the Royal College of Surgeons of Edinburgh diploma in Immediate Care)
Some very interesting replies, thank you. Patient was a young child who had fitted and needed to be hospital as had not fully come round and risk of another fit was still there. I tried to respect my colleagues request as they were clinically responsible.
Jaf understood fully what i was getting at as he as he says just dealt with a similar situation.
Jaf understood fully what i was getting at as he as he says just dealt with a similar situation.
agent006 said:
Ruskie said:
In all honesty the original question was aimed at people in the profession rather than people with half cocked ideas about the situations we encounter on a daily basis. Not sure why your taking the high and mighty 'I pay my taxes' route but that is your perogative I suppose.
Not quite sure why you're asking questions then as you seem to already know more than us.Ruskie,
As you say, your colleague was clinically responsible, and I know that paediatric airway management is scary if you don't do a lot of it. But from your short description, this doesn't sound like the sort of thing I would have been running in as a blue call.
Maybe the training need here is for a Pre-Hospital Paediatric LIfe Support course, not for more driver training!?
James
As you say, your colleague was clinically responsible, and I know that paediatric airway management is scary if you don't do a lot of it. But from your short description, this doesn't sound like the sort of thing I would have been running in as a blue call.
Maybe the training need here is for a Pre-Hospital Paediatric LIfe Support course, not for more driver training!?
James
jamesallport said:
Ruskie,
As you say, your colleague was clinically responsible, and I know that paediatric airway management is scary if you don't do a lot of it. But from your short description, this doesn't sound like the sort of thing I would have been running in as a blue call.
Maybe the training need here is for a Pre-Hospital Paediatric LIfe Support course, not for more driver training!?
James
I hear what you are saying but was not an airway issue as airway was clear and 100% o2 was on. Looking back maybe was not right for a blue light run but respected her wishes and experience. What is your full background as you sound like you have a very wide knowledge base in pre hospital care? I am aware of BASICS docs but not come across them as yet.As you say, your colleague was clinically responsible, and I know that paediatric airway management is scary if you don't do a lot of it. But from your short description, this doesn't sound like the sort of thing I would have been running in as a blue call.
Maybe the training need here is for a Pre-Hospital Paediatric LIfe Support course, not for more driver training!?
James
Ruskie - the Paramedic has no right to tell you how you will drive on your exemptions (with the exception of perhaps , say,requesting you to slow down or stop). As Von states, it will be YOU who is culpable should you have an RTC while claiming exemptions - regardless of the Paramedic's clinical accountability, the driving accountability is yours. If you want to use your sirens, you use them.
I would add that- as I have stated in previous threads- I do occasionally make use of 'silent red' but that is at my discretion only when I am driving and I certainly would not attempt to dictate that my colleague do so if they are at the wheel as it is not a decision I have any right to make.
As regards the noise potentially triggering a further seizure - (indeed it does on the face of it sound as though you were dealing with febrile convulsions in this case- not an EP seizure?) - there is anyway little credible anecdotal evidence around for such potential 'reflex' epilepsy - let alone research based clinical evidence to support your colleague's argument - While there is some experimental association with noise induced seizures where lab mice and rats have been found to experience audiogenic seizures-sometimes fatal- when exposed to, say, a continuous 6kHz wave at a high sound pressure level(112dB)- that could hardly be used to justify the argument in this case as siren noise within the back-cab is insignificant in this respect.
I would add that- as I have stated in previous threads- I do occasionally make use of 'silent red' but that is at my discretion only when I am driving and I certainly would not attempt to dictate that my colleague do so if they are at the wheel as it is not a decision I have any right to make.
As regards the noise potentially triggering a further seizure - (indeed it does on the face of it sound as though you were dealing with febrile convulsions in this case- not an EP seizure?) - there is anyway little credible anecdotal evidence around for such potential 'reflex' epilepsy - let alone research based clinical evidence to support your colleague's argument - While there is some experimental association with noise induced seizures where lab mice and rats have been found to experience audiogenic seizures-sometimes fatal- when exposed to, say, a continuous 6kHz wave at a high sound pressure level(112dB)- that could hardly be used to justify the argument in this case as siren noise within the back-cab is insignificant in this respect.
Edited by maddog993 on Wednesday 23 January 22:01
maddog993 said:
Ruskie - the Paramedic has no right to tell you how you will drive on your exemptions (with the exception of perhaps , say,requesting you to slow down or stop). As Von states, it will be YOU who is culpable should you have an RTC while claiming exemptions - regardless of the Paramedic's clinical accountability, the driving accountability is yours. If you want to use your sirens, you use them.
I would add that- as I have stated in previous threads- I do occasionally make use of 'silent red' but that is at my discretion only when I am driving and I certainly would not attempt to dictate that my colleague do so if they are at the wheel as it is not a decision I have any right to make.
As regards the noise potentially triggering a further seizure - (indeed it does on the face of it sound as though you were dealing with febrile convulsions in this case- not an EP seizure?) - there is anyway little credible anecdotal evidence around for such potential 'reflex' epilepsy - let alone research based clinical evidence to support your colleague's argument - While there is some experimental association with noise induced seizures where lab mice and rats have been found to experience audiogenic seizures-sometimes fatal- when exposed to, say, a continuous 6kHz wave at a high sound pressure level(112dB)- that could hardly be used to justify the argument in this case as siren noise within the back-cab is insignificant in this respect.
Yep fully understand that and should of dealt with it differently. Anyway I know for next time!
Not sure if was EP, previously had, had 2 fits so probs undiagnosed EP rather than febrile.
Interestingly worked with 2 different FBA's one told me to turn sirens off on nights the other told me to keep them on at all times!!
I would add that- as I have stated in previous threads- I do occasionally make use of 'silent red' but that is at my discretion only when I am driving and I certainly would not attempt to dictate that my colleague do so if they are at the wheel as it is not a decision I have any right to make.
As regards the noise potentially triggering a further seizure - (indeed it does on the face of it sound as though you were dealing with febrile convulsions in this case- not an EP seizure?) - there is anyway little credible anecdotal evidence around for such potential 'reflex' epilepsy - let alone research based clinical evidence to support your colleague's argument - While there is some experimental association with noise induced seizures where lab mice and rats have been found to experience audiogenic seizures-sometimes fatal- when exposed to, say, a continuous 6kHz wave at a high sound pressure level(112dB)- that could hardly be used to justify the argument in this case as siren noise within the back-cab is insignificant in this respect.
Yep fully understand that and should of dealt with it differently. Anyway I know for next time!
Not sure if was EP, previously had, had 2 fits so probs undiagnosed EP rather than febrile.
Interestingly worked with 2 different FBA's one told me to turn sirens off on nights the other told me to keep them on at all times!!
Edited by maddog993 on Wednesday 23 January 22:01
Ruskie said:
Only problem I have is the liability issue if crash at my stage of my career without sirens on. Tried to be best of both turning them off when road is clear but still pedestrians etc about. Was just looking for peoples opinions on this?
For that reason i wouldn't tell the person driving what to do. Eventhough the para is clinically responsible for you due to your trainee status, you're still the one driving, so if something goes wrong they will turn to you.Do your vehicles have an airhorn ? If you don't want to use your siren and see peds who might be crossing just tap it, no need to press and hold but a "pap pap" will usally do the trick as well as the siren.
LaSarthe+Back said:
Do you have to take an advanced driving course as part of your training? Either in a work's car or the Ambulance?
2 weeks advanced driving, 1 week emergency driving. Otherwise you're not allowed to drive any trust vehicle on blues and toos.hardcorehobbit said:
Just a quick question off topic actually, but how would I go about getting your job? I mean one like it obviously.
There´s quiet a lot changes going on at the moment in ambulance land.You used to do a 9 week the technician (EMT) course with 3 weeks of driving, then after passing all written and practical exams go on the road as a trainee technician and work with someone who could closely mentor you.
You would then work as a trainee tech for a year, have assessments every 3 months and create a extended portfolio proving skills and underpinning knowlege. If you pass all assessments and your portfolio is signed off you become a qualified technician and then, when you´re ready and your boss thinks your ready for it you could apply for the paramedic course which was around 11 weeks followed by a several hospital placements.
However that´s all changed now, to get in to most services these days you have to apply to univercity and go through a 2 of 3 year student paramedic course in uni combined with shifts on the road and training by your trust.
If you have a look on NHSjobs you should be able to find some more info.
Ruskie said:
We are taught to ALWAYS drive with lights and sirens on, night or day but it is up to us to use discretion.
What most services will say is you don´t have to use your sirens all times, but you are only legaly claiming exemptions when both lights and sirens are in use.So there is nothing wrong with doing 50 in a 30 zone with blue lights on as long as it´s safe, but officialy you can´t claim the examption of speeding (or any other examption) if you don´t use the sirens.
jaf01uk said:
Personally I have never heard of a patient having a fit in relation to sirens so perhaps your colleague was trying to justify her request/demand? or dare I say it was more a reflection of the condition of the attendant rather than the patient?
Same here, never heard of that either.And if the patient fits, then he/she fits. We got drugs to give and protocols to follow but if they don't work they don't work. It's (in most cases) not an direct threat to the ABCD so i don't believe this para should tell you how to drive as if it different they the way you are thought by your instructors and the para in the back won't get the blame if you cause an excident.
jamesallport said:
But from your short description, this doesn't sound like the sort of thing I would have been running in as a blue call.
To be honest if the child was still fiting (or going in and/out of it) even after the administering of diazemul (which i take it your collegue did) then i would sound like a job which we would alert in (on blue lights) but the one driving would be using both lights and sirens then to get safely through traffic.maddog993 said:
Ruskie - the Paramedic has no right to tell you how you will drive on your exemptions.
it will be YOU who is culpable should you have an RTC while claiming exemptions - regardless of the Paramedic's clinical accountability, the driving accountability is yours. If you want to use your sirens, you use them.
I would add that- as I have stated in previous threads- I do occasionally make use of 'silent red' but that is at my discretion only when I am driving and I certainly would not attempt to dictate that my colleague do so if they are at the wheel as it is not a decision I have any right to make.
As regards the noise potentially triggering a further seizure - (indeed it does on the face of it sound as though you were dealing with febrile convulsions in this case- not an EP seizure?) - there is anyway little credible anecdotal evidence around for such potential 'reflex' epilepsy - let alone research based clinical evidence to support your colleague's argument
Hmmm, maybe i should have read your reply earlier Madddog, cause you've just said exactally what i've been typing out for the last 10 minutes...it will be YOU who is culpable should you have an RTC while claiming exemptions - regardless of the Paramedic's clinical accountability, the driving accountability is yours. If you want to use your sirens, you use them.
I would add that- as I have stated in previous threads- I do occasionally make use of 'silent red' but that is at my discretion only when I am driving and I certainly would not attempt to dictate that my colleague do so if they are at the wheel as it is not a decision I have any right to make.
As regards the noise potentially triggering a further seizure - (indeed it does on the face of it sound as though you were dealing with febrile convulsions in this case- not an EP seizure?) - there is anyway little credible anecdotal evidence around for such potential 'reflex' epilepsy - let alone research based clinical evidence to support your colleague's argument
K, No worries mate - it's reassuring to know someone agrees with me!Ruskie - I can see the point both FBAs are trying to get across to you - on the one hand you'll find it is generally the norm to reduce siren noise at night as there are generally less cars, pedestrians etc and it's fairly anti-social when people are trying to sleep, however the other FBA is simply (and wisely) covering your arse with the blanket 'good practice' of having sirens on all the time which isn't a bad thing particularly when you're still finding your feet on the road (if you see what I mean). Hope you're enjoying it still
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
Think it's all been covered but thought I'd chuck in my 2p anyway...
If you were driving, your colleague was out of order to ask you to drive in with lights but no sirens. If (s)he wants a standby, then it's all or nothing, as you know.
I've never heard of any condition where loud noise would trigger or exacerbate any seizure. I've asked around at work and nobody else has either. So either your colleague was misled or misleading you...
And a point which I don't think has been raised yet - has anyone actually looked at how little difference a blue light run makes the majority of the time? Obviously in heavy rush hour traffic it will have an effect, but from experience I'd bet that in normal conditions, it never makes more than a minute or two difference.
Sorry to resurrect a week old thread....
If you were driving, your colleague was out of order to ask you to drive in with lights but no sirens. If (s)he wants a standby, then it's all or nothing, as you know.
I've never heard of any condition where loud noise would trigger or exacerbate any seizure. I've asked around at work and nobody else has either. So either your colleague was misled or misleading you...
And a point which I don't think has been raised yet - has anyone actually looked at how little difference a blue light run makes the majority of the time? Obviously in heavy rush hour traffic it will have an effect, but from experience I'd bet that in normal conditions, it never makes more than a minute or two difference.
Sorry to resurrect a week old thread....
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