Caller Is Requesting A Silent Approach...

[x635 4,066]

During my time as a dispatcher, and frequently I hear on the air is that the caller is requesting a "silent approach".

I completly understand the rationale for this, I wouldn't want the commotion if I was having chest pain (knock on wood) especially with the massive response of apparatus in some communities to simple EMS calls.

However, I'm curious as to what burden this places on the responding agencies. If a vehicle is to be involved in an MVA after shutting off their siren when approaching the neighborhood due to the callers request, is this really a valid excuse, especially if you have a lights on, sirens on policy?

How do your dispatchers handle this, and how does your agency react to this request?

I completly understand that you don't know what it is 'til you get there, so it's gotta be a full-throttle response, and "you called 911 you get lights and sirens" is the common response to the question. But, can EMD or common sense be balanced with this to honor the callers request? Often times, it's hard for a modest patient to call for an ambulance, or even to be convinced to seek help.

Also, I'm curious if your agency, when not in danger of traffic (like on a appropriate side street or in a driveway) shuts off the lights of the bus when going into the house. Or, do you leave them flashing outside regardless?

[WAS967 97]

It's one of those cases where you have to balance common sense with good customer service. It also is a good case for well utilized EMD. A lot of times the people request a silent approach either because they don't want to bother thier neighbors or because thier neighbors are just plain nosey. I generally honor the request because most of the times the request seems to eminate from people in a small neighborhood. I can usually get to nearby (around the block) and shut down the lights and siren to go into the scene. It doesn't delay my response in the least. And as Seth said, in cases where stress to the patient should be minimized, following thier wishes just makes sense.

It falls in the same line as taking a person to the hospital of thier choice, or getting some things together before you take them to the ER, or whaever. People who use the excuse "I came here to help the patient, not be thier butler" should step back a second and think about things.

Edited May 17, 2006 by WAS967

[Guest]

If your having chest pain, i dont think you have much of a choice in the matter. Once your paged/requested you have to respond with lights and sirens b/c your now in emergency mode, unless otherwise directed by police or a supervisor. Im pretty sure NYS says that once in emergency mode you HAVE to use both lights and sirens, not one or the other. I tend to think the siren is annoying and ususally only use lights and tap the siren as necessary (through lights or to get one/two cars to pull over) unless ive got my hands full with the radio or traffic conditions (bad weather or high volume) dictate. After all, there is a reason a patient called 911, unless we are talking a non-emergency assist or wellness check, lights/sirens have/should be utilized desipte what the patient says.....unless it is determined that the situation is non-life threatening from an advance unit (medic in flycar).

Edited May 17, 2006 by 66Alpha1

[Guest]

I always find it funny when responses to questions like this start off like" the way i do it...... Aren't we supposed to be following SOPs or SOGs?

Anyway, sorry for the slight rant. I would like to say it would be nice to honor those requests but it will only take one incident of not getting there in time or with enough urgency to put an end to it.

If I were calling 911 and knew it wasn't a code 3 situation I too would like a "silent approach" but hey you can't always have your cake and eat it too - drive yourself if it isn't that important.

My district, like many, try to do a code 3, 2, 1 approach on Fire/Rescue calls if they know the situation - but that usually means waiting until an officer is on the scene.

[WAS967 97]

I always find it funny when responses to questions like this start off like" the way i do it...... Aren't we supposed to be following SOPs or SOGs?

Show me an SOP anywhere the deals specifically with "silent approaches". SOPs and SOGs cant POSSIBLY cover EVERY situation we encounter. Our higher ups draw up Procedures and Guidelines to be used as just what the name implies - a guide. It's up to us to use our noodles and decide on the best course of action for each situation.

Anyway, sorry for the slight rant. I would like to say it would be nice to honor those requests but it will only take one incident of not getting there in time or with enough urgency to put an end to it.

I'm not saying (nor - hopefully - anyone else) that the entire response should be silent. Thats just silly. But turning off the lights and sirens when you are around the corner so as not to attract attention and stress the patient will absolutely have NO impact on response time and/or patient care. If it does, you're not doing it right.

If I were calling 911 and knew it wasn't a code 3 situation I too would like a "silent approach" but hey you can't always have your cake and eat it too - drive yourself if it isn't that important.

If I told people to drive themselves to the hospital because thier "problem" isn't that important - I wouldn't be employed very long.

My district, like many, try to do a code 3, 2, 1 approach on Fire/Rescue calls if they know the situation - but that usually means waiting until an officer is on the scene.

Thats where EMD plays a good role. I got a call last week for a kid with a dog bite that was described as minor and the parent "just wanted it to be checked". As a secondary responder I responded sans L&S and let the primary responders do thier work. I wish we had EMD on more calls. Nothing is worse than rushing to a call to find out the condition is minor and didn't warrant an expeditious reponse.

Edited May 17, 2006 by WAS967

[roeems87 0]

I think NYS DOT says that you can operate your vehicle with lights and NO sirens only if you are NOT ASSUMING/REQUESTING THE RIGHT OF WAY. i.e. the purpose is to alert people to the fact that you may be driving slowly (i.e. with a pt.) than the rest of the traffic, or alerting them to your presence without requesting they stop or move out of your way. Emergency mode requires both, though as everyone knows, sirens may not always be on anyway...

As for the silent approach thing. If someone requests it, it's for one of two reasons: (1) it makes them nervous and they've done this before, or (2) they don't want everyone in the neighborhood to know what's going on. In either event, they requested that you do that. Remember it's their emergency, not yours. If they want you to slow down, take it easy, and not utilize "lights and sirens" then that's their risk, not yours. Turn the lights and sirens off when you get in the neighborhood. If it makes it more dangerous for you (e.g. a busy or narrow/one way street) then don't. Do what will keep you safe and honor their wishes. They may have called for chest pain, but they also asked you didn't respond RLS. It's not anyone's god-given right to use break-neck speed to get to someone who may be in need. Do what you can and honor their wishes.

On a side note... if you have rules against not responding with the whole noise/light show, then they may want to be reconsidered. And if they do, whoever is dispatching you should (a) know that, ( b ) give that information to the caller asking for it, and © there should be no reason for them to dispatch it with the "silent approach" suffix. It seems to me a contradiction in logic to think the two situations co-exist.

Edited May 17, 2006 by roeems87

[mstrang1 213]

There are many good points being made about silent approach here, but, on another front, I remember an address that, at least 5 years ago anyway, had someone who was very prone to seizures, especially from strobe/blinking lights. We were supposed to turn off our lights as we neared the building. As the building is located on a dead end street with no other properties (ie no other traffic flow), no lights on while driving up the narrow dead end street was never a problem. I do not know if the resident is still even there. I don't know of any other addresses or "frequent flyers" that have this condition, but just be aware of some of the other reasons people may request response to be quiet/strobeless.

[Guest]

First of all there are SOPs that deal with how to respond to incidents.... as for "silent approach" - suppose you get a call from an elderly patient requesting a silent approach, feeling dizzy - you get there and they're DOA - the family may have a lawsuit. Now, i'm not saying a silent approach necessarily means it will take longer but questions may arise to bystanders and family as to why YOU chose to do that - it doesn't matter what was requested by the patient. From a legal standpoint the EMS providers can be held responsible..... while it is nice o respect the wishes of our customers, safety must come first. This isn't the restaurant business.....we're talking about life and death.

If you're talking about shutting sirens when you're around the corner.....fine I can understand that better - but at no time should the lights be shut off while enroute.....it's hard enough getting the public to respect emergency vehicles with the lights/sirens on. As for the seizure incident - yes I've heard the same before - lights off at the scene is acceptable.

[WAS967 97]

First of all there are SOPs that deal with how to respond to incidents.... as for "silent approach" - suppose you get a call from an elderly patient requesting a silent approach, feeling dizzy - you get there and they're DOA - the family may have a lawsuit.

Uhm. If you get a call from a patient complaining of being dizzy and you get there and they're legitimately DOA then you have response time issues that go WAY beyond caring about silent approaches.

Edited May 17, 2006 by WAS967

[JBE 328]

My attitude on this subject is pretty simple. You need help, we send the help. It's not what the caller wants. We are in the business of emergency service. Not in the food service where we give the customer a ham on rye with mayo and hold the tomatoes. If the officer of the responding apparatus wants to turn off the lights and siren a block or two out, that's up to them.

In most of my dealings with the public, the request for a silent response is usually coupled with the request only to send one piece of apparatus. Mind you, it's an odor of smoke in a 7 story OMD. It is then followed with the concern of being embarassed or the neighbors being nosy.

Personally, I don't give a rat's @$$ if you are embarassed, or if your neighbors look at you a little strange. You asked for help, you get help. I think you would be more embarassed if you didn't call and your building or neighbor was burned out. I understand the concerns of the public, but I don't agree with it. Simply as stated before, the one time you go silent and it goes sour on you, what are you going to do then. Respond safely, folks.

Edited May 17, 2006 by JBE

[res6cue 67]

Turning off the lights and sirens a block or two away is not going to affect your response time adversely. Matter of fact, the argument could be made in most communities that lights and sirens will save you only a few seconds at most off the entire response. For most "routine" calls, it's not an issue. If you can do the right thing by the patient, you're already helping treat them. Rolling up quietly will reduce the patient's stress level, which is the beginning of treatment as far as I'm concerned. The attitude of "this is how we do it, tough sh!t if you don't like it, you called us and you get what you get" is absolutely absurd and would make me question how anyone with it can claim they have the public's best interest at heart. Remember, it's only a few SECONDS saved (if any at all), not minutes.

Edited May 17, 2006 by res6cue

[JBE 328]

It appears that I am not looking at this from an EMD standpoint. However, I stand by my previous statements. Unfortunately, with the public and press complaining about higher response times, my job is to get the information out to the units in the quickest, most efficient manner possible. So they can get to a scene in a quick and efficient manner, following set protocols.

No call is ever routine. Doing the right thing by the patient/person in need is correct, no doubt. But, it's a double edged sword. If a unit is directed to respond silently, and something bad happens, who is going to be responsible?? Those who ask for help will be the first ones to try and burn you if something goes sour.

And as for not having the best interests of the public in mind, I can only speak for myself. Not only do I have their best interests in mind, I also have my best interests and the interests of the department I work for. In this lovely age of sue everybody for everything, It's not a chance I as a dispatcher am willing to take.

[210 91]

It's one of those cases where you have to balance common sense with good customer service. It also is a good case for well utilized EMD. A lot of times the people request a silent approach either because they don't want to bother thier neighbors or because thier neighbors are just plain nosey. I generally honor the request because most of the times the request seems to eminate from people in a small neighborhood. I can usually get to nearby (around the block) and shut down the lights and siren to go into the scene. It doesn't delay my response in the least. And as Seth said, in cases where stress to the patient should be minimized, following thier wishes just makes sense.

←

I agree. It comes down to the common sense and experience of the responders. Having the siren on at 3 a.m. in a small quiet neighborhood really doesnt accomplish much.

In reference to shutting the lights off once on location where traffic IS NOT a concern; In my area it's up to the responder and they are often shut off. Also if an engine company responds along with EMS, emergency lights are shut off once on location, only four way flashers are used. Fire and EMS are separate career departments here.

Edited May 17, 2006 by 210

[ltjay157 10]

How you respond all comes down from the info the dispatcher takes. In Monroe Ct, the FD's & EMS are dispatched by CMED. CMED stays on the line with the caller to get as much info they can of the injury. They won's send EMS in emergency response if the caller is complaining of a stubbed toe or for a lift assist. Not every call that comes in warrants an emergency response. I know some of you aren't going to agree with this. It's like a double edged sword. You don't respond lights/siren and the caller b&%#@es that it took you forever to get there, or you respond lights/siren and get into an accident and have to explain to someones family why their relative was hit by an ambulance driving lights & siren to the stubbed toe. Man, I miss the old days when it was soo much simpler

[20y2 43]

I really don't understand why this is causing so much trouble. Here is the VERY simple way to both get to the call and please the caller at the same time, 'TURN OFF THE LIGHTS AND SIRENS 2 BLOCKS AWAY'. Your response time will not suffer and neither will the patient's pride. What the heck are you all refering to SOPs for? This is common sense.

[JohnnyOV 2]

I really don't understand why this is causing so much trouble. Here is the VERY simple way to both get to the call and please the caller at the same time, 'TURN OFF THE LIGHTS AND SIRENS 2 BLOCKS AWAY'. Your response time will not suffer and neither will the patient's pride. What the heck are you all refering to SOPs for? This is common sense.

←

This right here is the way it should be done...Its no different then if a chief on scene is requesting a 10-20 responce when your in the middle of town with your lights and sirens going. Go 99% of the way there standard code 3 response, but once you turn on the side streets, there is really no need for sirens anyway, expecially if you are in a residential area where traffic is very light. Sure the occational siren wail at the top of a hill or shap turn is good, but there is no need to be Mr. OMGLIGHTSANDSIRENSALLTHEWAYTOKINGDOMCOME!!!!!! its just unnessicary.

Getting through town and around traffic fine and any intersection you come upon is fine, but once you get on the side roads, leave the lights on and siren off (again, use at an intersection is fine)...unless of course they can hear the strobes from their house.

[Guest]

This right here is the way it should be done...Its no different then if a chief on scene is requesting a 10-20 responce when your in the middle of town with your lights and sirens going. Go 99% of the way there standard code 3 response, but once you turn on the side streets, there is really no need for sirens anyway, expecially if you are in a residential area where traffic is very light. Sure the occational siren wail at the top of a hill or shap turn is good, but there is no need to be Mr. OMGLIGHTSANDSIRENSALLTHEWAYTOKINGDOMCOME!!!!!! its just unnessicary.

Getting through town and around traffic fine and any intersection you come upon is fine, but once you get on the side roads, leave the lights on and siren off (again, use at an intersection is fine)...unless of course they can hear the strobes from their house.

←

Agreed.

[roeems87 0]

Unfortunately, with the public and press complaining about higher response times,

I think this is hilarious. I don't disagree, you're right, people b*tch continuously, but they just don't know how good they have it. What is a long response time by someone's definition living in Westchester/NYC? 15 minutes? 20 minutes? 25 pushing it? Where I go to school in upstate NY, the PAID AMBULANCE SERVICE which covers most of the county (minus a few voly corps, and we won't talk about those here) could take 25-30 minutes (full lights and sirens) to get to where you may be.

People don't understand how good they have it. Next time they have trouble breathing, and call 911, let them think about how that would feel for 25 minutes before someone got there, not 8 minutes.

[Guest]

I’m not an EMD myself, but correct me if I’m wrong here. Don’t EMDs have a series of cards read off of...and answers the caller gives to the questions on the cards will in turn directly correlate with what is dispatched to the EMS/FD? IE: in Putnam County we have Alpha, Bravo, Charlie, Delta and Echo level responses. If a caller were to dial 911 and say "i had a standing fall and I think I broke my arm or I have leg pain" the call goes Alpha - BLS unit only with a cautionary response. What I’m getting at is the dispatch information is only as good as how accurately the caller answers the EMDs questions....i mean after all, I’ve been dispatched on calls that were sent out as an Echo level cardiac arrest only to find the patient completely ambulatory, alert and oriented, having only suffered an anxiety attack. No way could an EMD have done anything else if the information given to them was poor.

Edited May 17, 2006 by 66Alpha1

[Guest]

I guess it all depends on the type of call, and type of ems, and type of person incharge.

[210 91]

I guess it all depends on the type of call, and type of ems, and type of person incharge.

←

Thats the bottom line man.

[Guest alsfirefighter]

Let's face the facts, for both fire and EMS the majority of calls we respond to are not true emergencies. In the EMS world they are probably less then 2% of our total call volume. If you read NYS V & T law regarding emergency response, the exemptions are granted when you are responding to a true emergency and when you have at least one lighted lamp (yada, yada) and when you use one siren, bell or whistle AS REASONABLY NECESSARY, and/or when you utilize the exemptions granted of such such as disregarding a direction of travel, going through a red light (which my opinion needs to be changed to reflect the same as NFPA 1500 that you will come to a complete stop).

I have to go back to use my trusted phrase....its not about you. Its about our patients, our customers (yes firecapt there is that word I like again, me and my boy Brunacini) and what they want. If they request a silent approach so be it. I only use my siren as necessary anyway and I can't remember one time looking for an address with it on. Not to mention that probably 95% of the calls I respond to both fire and EMS would be better fitted for overall public safety as well as my own and crew members if we went cold anyway.

Here is a flip side....and maybe I should start another post on this. What if a unit on scene requests a cold response? Do you still do it? I have requested this several times only to hear sirens blaring on the bus to the scene that is under control, with myself and BLSFR on scene with a stable patient just needing transport per their request. Or even better, I turn over the call to the BLS crew, I'm sitting at a traffic light and they go by me lights and siren to the hospital. What's the deal with that? I've heard them all....well traffic is heavy, etc. The last time I checked, heavy traffic isn't mentioned in V & T law as a valid reason to utilize the exemptions granted as a emergency vehicle, nor is it in NFPA 1500. I certainly can't also stand when I ask for no lights and siren, but they are used to pull out into traffic then shut down or to pull into the ER. Huge liability over what a few seconds or minutes that mean nothing?

[Remember585 815]

Someone mentioned SOGs that discuss responding "silently"....we have it.

Our FD has two response modes which applies to both fire and EMS incidents.

Code 1 - Emergency mode (Lights & Sirens)

Code 2 - Non-Emergency mode (Nothing)

For fire calls that aren't true emergencies, we go Code 2. For EMS, our policy is that our responses are at the discretion of the Crew Chief. I've personally responded to calls with nothing on. It's just a personal opinion, but I really don't think going to an intox where the PD is already on scene warrants me lighting it up.

Here's something else to think about. Why do we hurry up and wait?! So many of us (I am guilty too) will go to an incident "Code 1" and we get there, do the vitals, etc., then transport to the ER with NOTHING ON! If it isn't desperate enough to drive several towns away to a hospital, then why do we feel it is important to hurry to the scene? Like ALS said, how many calls do we do that aren't true emergencies? A lot more then we realize.

We, as much as people fail to embrace it, are a customer service profession. We live in a society that expects anything it asks for, even though it may not be something we want to do for them. But if someone asks for a silent approach, how hard is it to shut it all off as you get closer?

Remember, our public makes choices for us, especially when it is a matter of money and our budgets. If we keep them happy, then perhaps when we need something they will appreciate what we've done for them.

[Guest]

Going back to my original point it should NOT be up to the individual responder to "honor" these requests - they should follow SOGs which do exist in most districts. Call it Code 1,2 or 3 if you prefer. Not that i'm a big fan of taking the patient's word but if it's going to be done it should be by the book not another way to freelance. One more thing, I do not think that fire apparatus should ever respond without at least lights....automatic alarms, burnt toast or whatever - you never know when it might be a true emergency....sirens...well those are for busy intersections and verified jobs. Good Talk.

[res6cue 67]

I'm actually pretty surprised by some of the responses and attitudes here. I'd swear some of you either don't actually operate in the real world, don't actually drive the rigs at all/haven't been a driver for very long, are young and immature, or just really don't give a crap about anyone but yourselves and your craving for an adrenaline rush from the lights and sirens. I'm not going to preach, we all do things differently, but when some of the responses border on sheer ignorance or apathy, that's kind of sad.

There are so many variables, there really are. As I said previously, I've been around plenty long enough to know that lights and sirens generally don't make much difference, especially if we're only talking about shutting them down in the last few blocks or so. Thankfully I've been in a position to have taught enough driver training classes that I'm confident the drivers I've passed have real world knowledge, and most importantly, COMMON SENSE.

[Remember585 815]

I'm actually pretty surprised by some of the responses and attitudes here. I'd swear some of you either don't actually operate in the real world, don't actually drive the rigs at all/haven't been a driver for very long, are young and immature, or just really don't give a crap about anyone but yourselves and your craving for an adrenaline rush from the lights and sirens. I'm not going to preach, we all do things differently, but when some of the responses border on sheer ignorance or apathy, that's kind of sad.

There are so many variables, there really are. As I said previously, I've been around plenty long enough to know that lights and sirens generally don't make much difference, especially if we're only talking about shutting them down in the last few blocks or so. Thankfully I've been in a position to have taught enough driver training classes that I'm confident the drivers I've passed have real world knowledge, and most importantly, COMMON SENSE.

←

Well said!

[20y2 43]

I'm actually speechless that someone stated that they didn't care if the person calling (usually the PATIENT) is embarassed. If that's your feeling, then its time for you to stay away from the ambulance, I think you forgot why we are doing what we are doing...

[Guest]

I guess you hear what you want to on these forums - The argument here should not be about care, compassion, adrenaline or anything else. It should be about operating on a system that makes sense, keeps people safe and gets the job done. Whatever that means to your department is up to your department - it should not be up to the individual - if your department does not have SOGs concerning response to calls then maybe you should see to it that it does. I'm tired of hearing about people freelancing and getting hurt or hurting others.

[firemoose827 324]

First of all there are SOPs that deal with how to respond to incidents.... as for "silent approach" - suppose you get a call from an elderly patient requesting a silent approach, feeling dizzy - you get there and they're DOA - the family may have a lawsuit. Now, i'm not saying a silent approach necessarily means it will take longer but questions may arise to bystanders and family as to why YOU chose to do that - it doesn't matter what was requested by the patient. From a legal standpoint the EMS providers can be held responsible..... while it is nice o respect the wishes of our customers, safety must come first. This isn't the restaurant business.....we're talking about life and death.

If you're talking about shutting sirens when you're around the corner.....fine I can understand that better - but at no time should the lights be shut off while enroute.....it's hard enough getting the public to respect emergency vehicles with the lights/sirens on. As for the seizure incident - yes I've heard the same before - lights off at the scene is acceptable.

←

To help you out with this one...just about all of the 911 dispatch centers have recording capability on both radios and phone lines. If the family requests no lights or sirens, its on tape. If they try to sue us, we play the tape and the dispatcher is a witness.

Also, using lights and sirens has not been proven to save us MUCH time at all. I have seen studies with two ambulances going to the same location, one hot the other cold. The bus with the code 3 response arrived 30 seconds before the cold bus. Lights and sirens send too many drivers into tunnel vision mode and cause many accidents.

I believe that responding to the "Area" code 3 than going cold is acceptable, it gets you there in the scope of your "SOP's" and offers that special consideration to the patients request. Like mentioned earlier, how do we know WHY they requested it that way? Are they epileptic? Would they have a massive MI when they hear the sirens and see the lights? Service to the people we serve, good patient care, proffessionalism......OH, and common sense!

Jonesy

[Guest]

Jonesy,

I like your point about responding code 3 until you are near the scene - my only argument is that we need to start looking at our SOPs/SOGs - they are disregarded too many times or even worse unknown to many - Also, I too believed that recordings of calls would be sufficient - however, i was recently told that there are stipulations to that with regard to an agency having to be "professional" enough to make a sound decison.