Pre-Hospital

[Sigvik]

Are there any guidelines concerning ambulance speed when transporting a pt who is haemodynamically unstable. Of particular interest is the consideration of G-forces on haemodynamic shifts and the implications this may have on the manner an ambulance is driven.

I would appreciate comments

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[pseudoknot]

No. I'd be inclined to have my driver go a little faster if the patient is really unstable, but ambulances don't accelerate fast enough to completely drain a patient's blood out of his brain or whatever it is you're suggesting. I guess this would be an important consideration if you are going to transport your patients via F-16.

 

[Dwindlin]

No. I'd be inclined to have my driver go a little faster if the patient is really unstable, but ambulances don't accelerate fast enough to completely drain a patient's blood out of his brain or whatever it is you're suggesting. I guess this would be an important consideration if you are going to transport your patients via F-16.

I want to work for that service. . .

 

[pseudoknot]

I want to work for that service. . .

Hey, the safety record couldn't be much worse than helicopter EMS, right?

 

[dchristismi]

Now THAT would be a sight.
Except a harrier jet might be more appropriate, and technically easier to get in and out of a busy urban area...

Hm...


(Back to the OP's question, I agree in that the forces involved aren't great enough to come into consideration. Safety for patient and crew is most important - even going full-bore lights and sirens, they still have to slow/stop at intersections.)

 

[gutonc]

Seriously. Is McLaren making ambulances now? And are you cornering @ 80+mph? The speeds required to generate worrisome G forces would more or less guarantee that the truck would either roll over or just slide right off the road.

 

[coldweatherblue]

The fastest sports cars with the stickiest tires corner at about 1.0 G. Braking and acceleration in similar cars (F430, Z06, 911 GT2, etc) can approach 1.0 G but are usually much less. Ambulances are not driven at speeds anywhere near those that create these forces. So the total forces in a not-actively-crashing ambulance is far less than the benign forces of the Earth's gravity, to which life is completely adapted. The same mechanisms which prevent LOC in healthy humans upon standing will prevent significant hemodynamic instability during a flighty ambulance ride.

 

[FDNewbie]

Also, ambulances are typically limited to going 15 miles over the speedlimit. Sure, the can break that from time to time, but:

1) Few ambulances will try and run Class I at 90mph, without knowing they could get in a LOT of trouble for that.

2) The ambulance is a freakin BUMPY RIDE in the back, making it hard nuff to get patient care done while driving at normal speeds. At higher speeds, it's even worse. That's why when it hits the ceiling, many medics have the EMT pull over for a sec so they can actually get a critical task done.

 

[FDGB]

First: I agree with the above points regarding the amount of g-force generated while cornering/accelerating in an ambulance.

Second: With respect to rules governing the nature in which an ambulance is operated varies from state to state. Most commonly the standard is that an ambulance is operated with due regard for the safety of all (crew, patient, other drivers and pedestrians). Lights and sirens are warning devices to alert others to the ambulance and direct them to slow down and pull over to the right and allow the ambulance to pass.

Inexperienced EMS providers typically drive faster with more severely injured / sick patients. There have been studies that look at transport time differences with lights and sirens vs. cold in urban environments and the actual difference is rather small though they did not study outcome differences. Aside from the safety issues with crews that speed excessively and take corners at high rates of speed is the fact that it makes working in the back next to impossible. Trying to obtain IV access while bouncing along in the back of a truck is difficult enough, but also dealing with swaying back and forth while your partner weaves through traffic, slamming on the brakes and then gunning limits your ability to practice and is also exhausting. In a busy truck it would really take a toll on the person teching.

Further studies into ambulance safety and the appropriateness of transporting "hot" need to be done. Crew safety is an important issue that needs to be reviewed more closely.

Sorry for the rant, but I think more important than the subtle momentary change in physiology caused by a cornering ambulance is the actual safety of tranport in general.

 

[leviathan]

I guess this would be an important consideration if you are going to transport your patients via F-16.