Forthwith??? Rush??? Expedite???

[STAT213 332]

This is something that has bugged me about the downstate thing for quite a while. There is this habit of requesting addtional resources or units not on scene yet to respond "forthwith" or "on a rush".

WTF??? Does no one else see the inherent danger in this practice? How else would units respond? Would you, as a police officer or a fire officer or first arriving EMS crew like me to turn the extra lights or the special siren on reserved for the BIG ONES? Do you want me to speed? Cause that is what you're asking for. And, if you don't have a crusty medic like me who doesn't really care if its a code or a finger lac, you might be getting an impressionable medic who will push it, and try and drive faster than conditions allow and maybe get into a wreck. I have seen it happen. I have reached over and turned OFF the lights and the sirens to force the calm on a partner. It is not our emergency. Why are we doing something to encourage any other behavior?

Granted its not limited to the downstate area, but you folks really seem to love calling for things with these zippy phrases like forthwith and on a rush.

When we respond, we respond. If its with lights and sirens, it should be to do so to get there a little bit faster and avoid traffic. It should never be in a manner that could cause danger to ourselves or the public. Remember that whole do no harm thing? Adding that we want the bus on a rush only excites the situation and can endanger our fellow providers. So, why do we do it?

[JBE 328]

It gets abused, simple as that.

[x648eng119 2]

Remember, we as emergency vehicle operators have to proceed with due regard for saftey. If we wreck, we obviously didn't have due regard. It's as simple as that.

[Guest alsfirefighter]

It gets abused? Expedite is a word that should be removed from the dictionary. Its not abused, it just shouldn't be utilized and its unprofessional. Instead of saying or requesting an expedite or "step it up." How about giving us an update on patient condition. Not to mention how many "expedite" requests I've gotten that I walked in and wondered why other then panic, incompetance or just lack of clinical experience.

If you get no the radio and tell me to expedite, you'll 2 replies from me. First is "I can't go any faster then what I'm going" and the second...."so that means in your in the ambulance transporting right, so where should I intercept with you?"

It is basically the same reason why I barely ever transport to the hospital code 3. Unless it is a true true emergency (which means I do it about 3 to 5 times a year) we go like a normal transport. Why? And experienced providers know that the drivers actions change. I also point this out to the EMT or attendant with me as well. Have the driver start out normal and then tell him to light it up, and notice the difference. No more smooth ride. Hard on the brakes. The majority will have a normal alarm reaction and operation goes out the window, its hitting the siren and looking to get through intersections.

Excellent post STAT.

[LCFD968 10]

Its just a word to tell you its a more serious than usaul. I have used the word/s instead of trying give a patient update. Its just telling ALS and the Ambulance that don't dilly dally just get here and be prepared. I also give a patient update if I can get a sec. I am sure when the word/s is said we don't expect for you to hit that red button in your truck that makes a turbo boast come out or the nitrous to activate. We expect you to act professional and just get there cause the sh%t hit the fan.

Don't get me wrong I am sure the word does get abused but for the most part its a short way of telling you we need help.

[Guest NYTruckie]

I don't understand why the medic's get expedited? They are responding. What do you think they are doing? I would rather get a patient update, then "expedite the medic"

[CAM502 6]

STAT,

If you here someone say "expedite EMS" or "step it up" or whatever they are letting you know that the personnel on scene are busy and they don't think the situation is under control. In other words it should give the EMS crew a heads up that it dosen't look good. We know you are coming as quick as you can, but you should know if you only have 2 guys on scene you might be too busy to get on the radio and give a full rundown.

[Medic137 6]

"Crusty Medic"..... I resemble that remark!

The key to faster response times is to have more medics. Not to have the few medics available drive faster.

[wcr20 17]

One of my favorites along these lines was just the opposite message... "Respond with Caution" - One of the towns i used to ride used that all the time to tell the ambulance or medic that the call was either no big deal, or at least under control, but it used to really irk me - Like what do you think I'm doing? Bouncing the rig off the other cars like a pinball on my way across town??!! Like otherwise i'm flying along at low altitude, "responding with reckless abandon"! Gee, I guees that STILL irks me...

[COMMANDCHIEF 4]

I say use it.

[Guest alsfirefighter]

How can you be too busy to give an update but not that busy to call a unit or dispatch to say expedite? I can say cpr in progress, traumatic arrest, obstructed airway, or whatever in the same amount of time as expedite. If you have 2 people, 1 can definately get it accomplished. If you have time to say expedite the medic, or that "you have 2 people only on scene, you have time instead to say what you have and what intervention is happening or that what difficulties your having that you feel "things aren't under control." What do you think most staffed buses run around with? 2 people. Either 1 and 1 or 1 plus 1.

"Don't dilly dally" just get here....what exactly do you think goes on? Once again, can't go faster then what I do and I don't think I'm gonna take the long way. I've never walked into any scene report or no report amazed, stunned or unprepared. Patient updates are nice, and often most seasoned medics will use it as a tool to get BLS focused and thinking lets get the patient to the ambulance.

WCR...I'm with you on the respond with caution ordeal also. Even though the county is weak and won't tell everyone what a 10-20 should exactly mean and most agencies won't actually write a policy on it. Either you need me there, or cancel me. If I get a 10-20 from bls, I take that as they either don't know what they have or dealing with, or they aren't sure of themselvs. No disprespect to anyone. But often its I'm not sure I should cancel them so let me 10-20 them and they can figure it out. Only problem, you 10-20 me and your on the edge of the district, it takes me a while to get there in non-emergent mode.

[x635 4,066]

When trained and equpped first responders are on the scene, then the situation is or should be under control, period. This isn't a fire here.

There is absolutely NO justification for an BLS ambulance to expedite the medic...use your BLS skills, training, and common sense!! Proper, rapid, and efficient BLS will save lives.

Patient not breathing? BVM Trauma? GO! Bleeding? Direct Pressure! MI? O2, Stretcher, move! It's SIMPLE!

Remember, BLS is a neccesity, ALS is just a luxury (a much needed important one though)......that's just a way a good EMS provider should think within reason.......the medic is part of your team.

It is such a ridiculous phrase, as is asking for an ETA.

The two main reasons why I think it is said.....worried, untrained mostly urban cops who aren't trained or equipped as to what to do (When was the last time you heard an ESU cop request a rush on the bus? Never!) and the second reason is because it sounds cool and buffy to say.

[WAS967 97]

If you here someone say "expedite EMS" or "step it up" or whatever they are letting you know that the personnel on scene are busy and they don't think the situation is under control. In other words it should give the EMS crew a heads up that it dosen't look good. We know you are coming as quick as you can, but you should know if you only have 2 guys on scene you might be too busy to get on the radio and give a full rundown.

I'm with alsfirefighter on this one. It takes seconds to spew a quick "CPR in progress" over the radio as it does to say "expeditie". We did a call recently together where he got there in seconds. Bad GSW to the head. It only took him 3-4 seconds to get on the radio and say "gunshot to the head, step it up". I HATE hearing the word expedite. I was working 45medic3 during a snowstorm when we had a bad diff breather that coded on the FD. They called an expedited. Well the VAC captain did the interesting thing of getting on the radio and saying "request denied due to weather". It sucks to have the be there with a patient crapping the bed, but it's a way of things sometimes. Just do your best, we'll get there when we get there.

[emt301 4]

I totally agree with ALS...if a medic is responding code 3 to the scene already, how much faster are they actually supposed to go?

As a dispatcher, I hate having to relay "expedite" or "step it up" requests to responding units. Unfortunately, as a dispatcher you often end up being the "middle-man" in these situations, and have to relay these requests from PD or BLS already on the scene...

[LCFD968 10]

I would quote myself in the earlier thread because it seems everybody missed it.

Its just a word, a phrase that give some sort of comfort that the Medic and any other arriving units know that We need help. Again, not that we think you are stopping to get gas and a donut or that you can sprout wings and fly, its Just a word to let some know and thats all.

What is the difference "gunshot to the head, step it up" and just plain "forthwith", same message just longer.

We had a patient found passed out on the floor by his wife. I was the first one there only because i live around the corner(not an EMT). Unresponsive, and barely breathing unknown how long like this. HIS lips were purple, face greyish color. Another member with a medical bag is on location, we were trying desperatly to gain airway to no avail. Mean while tones keep going off for an EMT so our ambulance could respond. I get on the radio and Ask dispatch for everybody to forthwith to the location patient unresponsive.

Now what is the big deal. I needed help and I gave an urgent word.

I AM SORRY FOR USEING THE WORD DILLY DALLY, ITS NOT WHAT I MENT BY THAT.

[mikelouf2 0]

I HATE WHEN THEY SAY EXPEDITE YOU ARE ALREADY GOING THE FAST YOU CAN WITH THE LIGHTS AND SIREN ON KNOW THEY WANT YOU TO GO FASTER WHATS HAPPEN IF YOU HIT SOMETHING OR SOMEONE HITS YOU THEN YOU WONT GET THERE AT ALL AND THEN YOU NEED HELP PLAY IT SAVE OUT THERE GUYS

[lss207 0]

I agree with LC968. I think that sometimes asking for an expedite helps volunteer organizations form crews with a little bit more of a sense of urgency. Instead of going 5 sets of tones for an EMT, one may come out on the first or second. Of course, I believe that the term should be reserved for extremely problematic cases and that everyone should assume due caution as usual. :wink:

[TR54 239]

I also agree with ALSfirefighter.The times I was told to expidite I just wanted to know what I was going to do when I arrived.Give me a quick idea of the most critical action the crew will need to take when getting out of the rig.

[calhobs 110]

I htink insteed of taking the time of saying step it up or expidite, start getting the pt into the rig, if its that bad you shold not be waiting for the medic anyway.

[Guest]

I guess I never looked at it from a medic veiw. Asking for an ambulance or medic to step it up was something I have heard being used for years. I think It time to address this at a department level trough training. I never gave it a second thought to say it before and propable have even "cried wolf" myself when a simple patient update would of been better. Thanks for the heads up!

[Remember585 815]

Bottom line, once we, the PD, FD or EMS, arrive on scene, the "emergency" is over. Sure it may be an urgent situation, but once someone calls for help and help has arrived, by definition the "emergency" is no more.

Hey Stat, can you expedite the Helicopter?! Always been my personal favorite.

[WAS967 97]

One easy way to get the message across is to ask for an ETA. Like "What's the ETA on the bird?". If you have the time you can give a sit-rep and if the responder is listening, they get the point.

[STAT213 332]

"Hey Stat, can you expedite the Helicopter?! Always been my personal favorite."

And, that has been said over the radio, for those of you that think JM is joking. Truly a funny moment.

RAT

[Oswegowind 17]

another fav...

NYPD terminology...."central put a rush on the bus" ha ha ha...

Oh yeah and talking about quick transmissions...if you are dispatching and you ask for an update and an EMT says "working" don't bother to ask them what they are working on just assume the worst...especially if the vic was just run over by a car...

[Guest NYTruckie]

I'm going to the call at the safest/ fastest speed that I can, the police and volunteers should know that. The only thing I expect to hear from units on the scene prior to my arrival is Cancel the Medic. Other then that I'll figure it out when I get there. I have asked for an ETA on Stat Flight. If I ask I'm deciding if I want to wait or transport by ground to a trauma center. 10-20 the medic if useless Cancel me or nothing. I was told to 10-20 after responding for 5 minutes it took me another 30 minutes to get to the scene in non emergency mode during rush hour. The BLS crew was waiting for me to sign there RMA as a witness. I have also not been canceled because a BLS crew (in a snow storm) didn't have a pcr to RMA the patient.

[Guest WCDES636]

Stat,

They have the internet up in the woods? Anyway...... Expedite is a word used by untrained people. They (Mostly PD) do not want to deal with the problem so they yell expedite into the mic and hope that the Ambulance will show up and make it all better. I also would hope that anyone in a position to drive an emergency vehicle would know better than to actually drive fasted ( If thats possible... OK maybe Empire State!) if they were informed that somebody on the scene wanted them to come quicker. As if you were not already going as fast as safety allows.

And yes I have heard with my own 2 ears people ask me to tell the helicopter to expedite.

[STAT213 332]

ok, thanks to everyone who agreed that this is the dumbest thing since the edsel. how bout the rest of you? there are people out there who use this term. can you defend it? or, will you just keep using it. it is one thing to be ignorant, but informed ignorance is something else entirely....

c'mon, somebody out there tell me that asking someone to expedite is a good idea...please...

[Remember585 815]

If you tell your pizza delivery guy to EXPEDITE - that may be a reason to use it.....

[Guest CFDFASTleader]

I want to respond so badly, and there just is nothing to say...

[PC414 0]

As a long-time responder, sometimes responsible for IC until higher rank arrives (in an unnamed County just to the north), I have sometimes used the terms "expedite," "forthwith," etc., apparently without thinking and just 'cause it was done:(

As a squeaky-new 911 dispatcher, I've learned a lot from this thread and trust that both my future dispatches in Putnam (along with my northern responses) will consistently model something more useful (i.e., an intelligent update rather than an empty catch phrase).

Thanks to all who've participated here. I learned something important and useful. =D>

PC414