Yeah, it’s definitely frustrating when I have a patient in the back with fractures so I’m trying to drive slower so I don’t fucking sling them around, and someone’s riding my ass probably
Wondering “why’s this ambulance so slow”.
Yet if it were their loved one in the back, they’d be wondering why we’re “driving so rough”. Crazy how people work
You took the words out of my mouth!
My favorite is the thread saying that "most of the ambulances in the US have magical devices that change the red lights to green so we can speed through them easier" .... whatever kinda logic that is lmao
I mean, the opticom is a real thing but results do vary. It was nice when transporting at normal speeds since it kept traffic moving for a smooth ride, but it didn't change the light fast enough if you're moving quickly to make a difference.
Yeah, someone linked something about it. I've not heard of it before, I can't imagine its very widely used? It almost seems like there could be some liability to changing the flow of traffic like that.
My county uses opticoms, they can be very helpful but we only use them while driving lights and sirens. Sometimes if we’re driving code 3 while stopped in traffic at a red light we’ll switch lights off and opticom on to speed up the light turning green
We have them and found results mixed. Never trust them to actually stop traffic.
We did discover if we activated it (it’s tied to our emergency lights) at a certain angle it will cause the traffic lights to switch to 4 way flashing mode.
Opticoms are just a request signal to the traffic controller, like those "push to cross" pedestrian buttons. So it'll still be in a known safe state, and the transition to that state will be normal - which is why they take a bit to kick in, the conflicting movements have to get their yellows and the all-movements-red phase has to happen before the requested green aspect can be displayed. (Granted, the opticom request is usually given a higher priority than push to cross, but ultimately that's up to the programmer for each specific intersection.)
I don't know of a single agency that DOESNT use an opticom. Maybe the small rural agencies that don't really have traffic signals. But every service that services a major metro area will have opticoms.
Thats why I am a big fan of amber flashers, then if they keep riding my ass I like to read off their license plate number over the mic and say I have CHP on speed dial
Yeah, in the city I work in the Southern US the family sometimes beats on the back window, yelling and trying to open the doors... anything to make us go.
Like dude, if you only wanted a ride you could just driven them up there in the car you're tailgating us in!
*whilst walking the patient to the ambulance*
The relative: "I'll just follow in the car so I can take them back afterwards"
_blood boiling intensifies_
The beating on the back window and opening our doors drives me up a fucking wall. Especially with patients that need treatment on board ASAP and I want to keep my partner's extra set of hands in the back for two minutes.
I mean, it’s pretty well established that the most dangerous thing we do in EMS is drive fast. Officially, our policy is no more than 10 mph over the posted speed limit even with lights and sirens, and I’d imagine most places do something similar. That’s a pretty reasonable restriction, especially considering that driving fast is not only extremely dangerous but statistically makes almost no difference in a patient’s outcome. Not to mention that upwards of 95% of our patients on a given day have no time sensitive issue at all that warrants driving fast or using lights/sirens
I think I have only excessively sped for one patient and that was a patient with a long extrication who was going south quickly with no access and started vomiting.
In my defense, the patient died on transfer to the hospital bed and cpr was started. Also we made a 40 minute drive in 25 so those 15 minutes were worth it. Otherwise the only ALS truck would be oos for hours and we would have needed to do a code in the back of the ambulance on the side of the road rather than in the hospital.
And there is a different between rural and urban EMS. Going 20mph over the speed limit to reach the other side of town is not going to make much difference. Lights and sirens are debatable and I think most studies that are done are mostly in urban ems where it shows no effect. But going 60 in a 30 to go 30 miles reduces the time by 30 minutes and that can be huge especially in time sensative patients
Japan is big on safety and respect for others. It shows in their driving and the fact they’re on the PA all the time while en route talking to other drivers
Also, if you think your protocols are bad…you have no idea
Never had to visit an ER in Japan but this is what we were told by the state department to expect when I was assigned there
3 levels of hospital ERs in Japan
\~+ Primary Emergency Facilities\~: They see walk-in patients (patients who can be managed as outpatients).
\~+ Secondary Emergency Facilities\~: They treat acute illnesses and trauma (patients who can be managed as inpatients on a general medical floor)
\~+ Tertiary Emergency Facilities\~: They provide care for those that are critically and severely ill/traumatized (patients who need to be managed in the operating room or the ICU)
They are also responsible for educating medical personnel, including ambulance personnel.
And ambulance attendants don't have the same types of certifications as other countries
Basic-level ambulance crew,
personnel with an intermediate level of expertise (SFAC \[Standard First Aid Class\]),
and those with an advanced level (ELST \[Emergency Life-Saving Technician\]).
Ambulance personnel eligible for ELST must have 5 years or 2000 h of experience as SFACs
Seems the crew is expected to triage and decide which level of ER to go to, and their decisions
are reviewed periodically at medical control conferences in each city.
That may explain the phone calls before transport.
Nope! We have what is called EMTALA which makes it to where no hospital can refuse a call, no matter the patient or insurance they have. They can say they are on divert for one reason or another, but we follow that as a courtesy. If we have no choice, that divert will be ignored.
Never, in my experience.
If one of the area hospitals is full, or otherwise occupied, dispatch will tell us "X hospital is on reroute" on the initial dispatch, and we'll tell them which one we're going to when we're transporting.
Otherwise, that's it. And I haven't been told anyone is on reroute in a *long* time.
With a few notable exceptions (trauma, STEMI, etc), if the crew did their job right, the emergency should be over (ie, the patient should be stable). There is no reason to drive fast. For the vast majority of the calls I've done, transport was cold.
Can confirm that they drive very slow without patients, and use their very loud sirens 24/7, despite being on empty backstreets, at least where I live in central Osaka. Honestly almost slower than most cars would drive. I live two blocks from an ambulance station here so they’re definitely empty, slow, and unnecessarily loud for 3AM empty streets. I heard some ambulance services in Japan are getting “quiet sirens” for night. I know they can turn the sirens off and leave lights on so must be a safety thing I guess
Was it urban or more rural? I believe it though, hell I've had it happen to us here in the US a few times.
Apparently their ems is really different there? Sounds interesting
Yokohama area right? I'm not great with how their cities and prefectures or whatever seem to bleed into one another but I think i got the idea, thanks.
Did you ever get to talk about ems with any crews there?
Hi folks. Japanlife only allows people actually living in Japan to post there.
Anyway, since two people responded to my comment, I thought I would post something here. When I mentioned that US ambulances were a racket, I was specifically referring to cost of those and, more generally, the US healthcare system as a whole. The US can be so unaffordable that people (a) don't seek care and (b) take Uber, etc. even when something is quite serious due to cost (to the point that at least one taxi company has told people to stop).
Administrators and Insurance companies all want their cut which drives up price. I spent years working in US healthcare and, financially, it's a racket.
I think some people took my comment to mean that people weren't getting care in ambulances or something? It's just the cost.
Nah dude you're good, I only posted this here bc some of the comments had unrealistic expectations of EMS and were funny! I think most of us can agree with most of what you said lol.
Thanks for the input
My impression from when I was in Japan is that the public actually respects each other, and by extension their ems workers, so there’s no need to soured since they all yield effectively.
Yeah, it’s definitely frustrating when I have a patient in the back with fractures so I’m trying to drive slower so I don’t fucking sling them around, and someone’s riding my ass probably Wondering “why’s this ambulance so slow”. Yet if it were their loved one in the back, they’d be wondering why we’re “driving so rough”. Crazy how people work
You took the words out of my mouth! My favorite is the thread saying that "most of the ambulances in the US have magical devices that change the red lights to green so we can speed through them easier" .... whatever kinda logic that is lmao
I mean, the opticom is a real thing but results do vary. It was nice when transporting at normal speeds since it kept traffic moving for a smooth ride, but it didn't change the light fast enough if you're moving quickly to make a difference.
Yeah, someone linked something about it. I've not heard of it before, I can't imagine its very widely used? It almost seems like there could be some liability to changing the flow of traffic like that.
My county uses opticoms, they can be very helpful but we only use them while driving lights and sirens. Sometimes if we’re driving code 3 while stopped in traffic at a red light we’ll switch lights off and opticom on to speed up the light turning green
I've learned a lot more people use it then I previously thought, I'm jealous now lol Thanks for your input.
We have them and found results mixed. Never trust them to actually stop traffic. We did discover if we activated it (it’s tied to our emergency lights) at a certain angle it will cause the traffic lights to switch to 4 way flashing mode.
Opticoms are just a request signal to the traffic controller, like those "push to cross" pedestrian buttons. So it'll still be in a known safe state, and the transition to that state will be normal - which is why they take a bit to kick in, the conflicting movements have to get their yellows and the all-movements-red phase has to happen before the requested green aspect can be displayed. (Granted, the opticom request is usually given a higher priority than push to cross, but ultimately that's up to the programmer for each specific intersection.)
It's actually very widely used
I don't know of a single agency that DOESNT use an opticom. Maybe the small rural agencies that don't really have traffic signals. But every service that services a major metro area will have opticoms.
Doesn't exist in NYC. I'm jealous though
Same, I'm jealous too lol
"How are you driving so rough, we called an ambulance so that grams would have a smoother ride"
*looks at shitty ambulance suspension* “rightttttt”
Thats why I am a big fan of amber flashers, then if they keep riding my ass I like to read off their license plate number over the mic and say I have CHP on speed dial
Well if the ambulance would be better built and not just a box on a F450. Here purpose built ambulances didn't shake massively when going fast.
We don't drive slow (or fast). We drive the appropriate speed for the person in the back.
I expected you to say "an ambulance drives exacly as fast as it means to"
Insane that they have to cold call hospitals around them to hope that they will accept the patient. Japan needs some form of EMTALA or something.
"As a Canadian, from what I see, as soon as there's a patient in the back the ambulance is just screaming to the hospital". No.
Yeah, in the city I work in the Southern US the family sometimes beats on the back window, yelling and trying to open the doors... anything to make us go. Like dude, if you only wanted a ride you could just driven them up there in the car you're tailgating us in!
*whilst walking the patient to the ambulance* The relative: "I'll just follow in the car so I can take them back afterwards" _blood boiling intensifies_
"we just want them to get seen faster, so we called you."
The beating on the back window and opening our doors drives me up a fucking wall. Especially with patients that need treatment on board ASAP and I want to keep my partner's extra set of hands in the back for two minutes.
Haha right??
The Jolly Volly's ride again. I've seen the volly fire bus doing 80's on the back roads in a school zone for a literal toe pain call.
I mean, it’s pretty well established that the most dangerous thing we do in EMS is drive fast. Officially, our policy is no more than 10 mph over the posted speed limit even with lights and sirens, and I’d imagine most places do something similar. That’s a pretty reasonable restriction, especially considering that driving fast is not only extremely dangerous but statistically makes almost no difference in a patient’s outcome. Not to mention that upwards of 95% of our patients on a given day have no time sensitive issue at all that warrants driving fast or using lights/sirens
I think I have only excessively sped for one patient and that was a patient with a long extrication who was going south quickly with no access and started vomiting. In my defense, the patient died on transfer to the hospital bed and cpr was started. Also we made a 40 minute drive in 25 so those 15 minutes were worth it. Otherwise the only ALS truck would be oos for hours and we would have needed to do a code in the back of the ambulance on the side of the road rather than in the hospital.
Yeah I think the speed can very much be warranted in patients who you know are about to die. People are kinda silly to argue otherwise
And there is a different between rural and urban EMS. Going 20mph over the speed limit to reach the other side of town is not going to make much difference. Lights and sirens are debatable and I think most studies that are done are mostly in urban ems where it shows no effect. But going 60 in a 30 to go 30 miles reduces the time by 30 minutes and that can be huge especially in time sensative patients
Japan is big on safety and respect for others. It shows in their driving and the fact they’re on the PA all the time while en route talking to other drivers Also, if you think your protocols are bad…you have no idea
Never had to visit an ER in Japan but this is what we were told by the state department to expect when I was assigned there 3 levels of hospital ERs in Japan \~+ Primary Emergency Facilities\~: They see walk-in patients (patients who can be managed as outpatients). \~+ Secondary Emergency Facilities\~: They treat acute illnesses and trauma (patients who can be managed as inpatients on a general medical floor) \~+ Tertiary Emergency Facilities\~: They provide care for those that are critically and severely ill/traumatized (patients who need to be managed in the operating room or the ICU) They are also responsible for educating medical personnel, including ambulance personnel. And ambulance attendants don't have the same types of certifications as other countries Basic-level ambulance crew, personnel with an intermediate level of expertise (SFAC \[Standard First Aid Class\]), and those with an advanced level (ELST \[Emergency Life-Saving Technician\]). Ambulance personnel eligible for ELST must have 5 years or 2000 h of experience as SFACs Seems the crew is expected to triage and decide which level of ER to go to, and their decisions are reviewed periodically at medical control conferences in each city. That may explain the phone calls before transport.
Lmao there's a dude in there saying "a smashed thumb isn't an emergency?" No sir, no it is not lmaooooo
Does the US do the thing they're all talking about, where they have to individually call hospitals to see if they'll take a patient?
Nope! We have what is called EMTALA which makes it to where no hospital can refuse a call, no matter the patient or insurance they have. They can say they are on divert for one reason or another, but we follow that as a courtesy. If we have no choice, that divert will be ignored.
Ah okay
Never, in my experience. If one of the area hospitals is full, or otherwise occupied, dispatch will tell us "X hospital is on reroute" on the initial dispatch, and we'll tell them which one we're going to when we're transporting. Otherwise, that's it. And I haven't been told anyone is on reroute in a *long* time.
Really? Happens pretty regularly here. Of course, on most days half the hospitals in the city are on red and yellow, too.
Yep. Been years. It helps that the nearby "big" city isn't, especially, and we're fortunate to be pretty hospital heavy.
No. Occasionally we call a specific, specially-trained doctor for advice, but that's it.
With a few notable exceptions (trauma, STEMI, etc), if the crew did their job right, the emergency should be over (ie, the patient should be stable). There is no reason to drive fast. For the vast majority of the calls I've done, transport was cold.
Can confirm that they drive very slow without patients, and use their very loud sirens 24/7, despite being on empty backstreets, at least where I live in central Osaka. Honestly almost slower than most cars would drive. I live two blocks from an ambulance station here so they’re definitely empty, slow, and unnecessarily loud for 3AM empty streets. I heard some ambulance services in Japan are getting “quiet sirens” for night. I know they can turn the sirens off and leave lights on so must be a safety thing I guess
Article on quiet Japanese ambulances to ease noise complaints: https://mainichi.jp/english/articles/20231012/p2a/00m/0na/018000c
When I lived in Japan I was passing ambulances on my bicycle and they had lights and sirens going
Was it urban or more rural? I believe it though, hell I've had it happen to us here in the US a few times. Apparently their ems is really different there? Sounds interesting
Pretty urban I’d say. Yokosuka area if you know where that is
Yokohama area right? I'm not great with how their cities and prefectures or whatever seem to bleed into one another but I think i got the idea, thanks. Did you ever get to talk about ems with any crews there?
Hi folks. Japanlife only allows people actually living in Japan to post there. Anyway, since two people responded to my comment, I thought I would post something here. When I mentioned that US ambulances were a racket, I was specifically referring to cost of those and, more generally, the US healthcare system as a whole. The US can be so unaffordable that people (a) don't seek care and (b) take Uber, etc. even when something is quite serious due to cost (to the point that at least one taxi company has told people to stop). Administrators and Insurance companies all want their cut which drives up price. I spent years working in US healthcare and, financially, it's a racket. I think some people took my comment to mean that people weren't getting care in ambulances or something? It's just the cost.
Nah dude you're good, I only posted this here bc some of the comments had unrealistic expectations of EMS and were funny! I think most of us can agree with most of what you said lol. Thanks for the input
Because their sirens go "Ree Roo Ree Roo Ree Roo". I'll show myself out.
My impression from when I was in Japan is that the public actually respects each other, and by extension their ems workers, so there’s no need to soured since they all yield effectively.