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Stealth Mode: Use of the Silent Approach

The call comes in about midnight. The spring air is crisp as the bay door grumbles, then lifts itself obediently out of your way. You haven't turned a wheel since supper. The Big Diesel coughs, clears its throat, growls for a moment, then roars as your ambulance glides onto the apron and makes a right turn. You're on your way to a mobile home park on„11th Ave. You recognize the space number as the residence of an elderly woman who calls about twice a month with a complaint of chest pain.

It's always chest pain with Shirley, but her real problem is that her husband of 56 years died last January and she's all twisted up. She's told you that the nights are awful for her. You acknowledge the call, suggest canceling the engine and head for the familiar address. Your partner, Ken, is a new paramedic who flinches when you recommend against using the emergency warning equipment. The law in your state -- and most others -- says that if you're responding with lights and sirens, you're supposed to use them together and continuously. Your agency's policy states that if you're dispatched Code 3, you respond Code 3.

Sure enough, you arrive to find Shirley in her nightgown and bathrobe, seated in her living room chair and quietly not watching the late-night programming on her TV. And sure enough, her chest pain has the same vague properties she always describes -- well, maybe it's here and maybe it's there. Maybe it gets worse when she takes a deep breath. And maybe, maybe, maybe she just needed somebody to talk to. So you sit down with her, and for the moment, nothing matters but the cruel, jagged wound in the old woman's soul.

There's a trusty rule in EMS that we learn and re-learn in life: Never do anything that you know is stupid. Again and again, that rule justifies its value as a sound, bottom-line basis for the decisions we make. Some of our lights-and-sirens procedures are guided by fading rules, written for an earlier time.

It's possible the folks who wrote those rules were a little too anxious about the expectations of a public that watched too much TV. Certainly, they weren't reading about fatal ambulance wrecks once a week like we are today. Those incidents may have been occurring, but prior to the Internet, we just didn't know about them.

If an emergency vehicle operator accepts responsibility for the consequences of using warning equipment, they need and deserve the authority to make those decisions. There are some really good reasons why.

Shirley's call just begs for discretion, Life-Saver. When she calls, of course you respond. But what's the benefit of awakening everyone in her mobile-home park (and risking other people's lives) every time you respond? In the middle of the night, with negligible traffic and good visibility at intersections, you can get just about anywhere without making a lot of noise. If you feel the need to break an intersection or two, you can do that quietly. Your lights have a much greater impact at night than during the day.

This whole issue is bigger than disturbing a few dreams. It's about safety. The night hides plenty of people who don't think like you do. Anytime you want to avoid their attention, especially in certain neighborhoods (you know the ones), you need the discretion to shut 'er down early and sneak in -- or stand back. Or, not use your warning equipment at all.

What about dispatch? Dispatchers are interviewers, communicators and resource coordinators, but they're not bosses. Which warning equipment should be used by the crew during an urgent call, and when, isn't up to a dispatcher. It's up to the crew -- who's then accountable for their decisions. (In the emergency biz, sometimes it's your responsibility to break a rule that doesn't fit your situation.)

Think that'll cause collisions? Do yourself a favor. Go online to www.emsnetwork.org. It's an EMS news resource that tracks ambulance crashes. You'll learn something there. Over and over, you'll see ambulance crashes don't just happen by magic. They're understandable, they're predictable and they're inevitable when we drive way too fast and use our warning equipment to take prerogatives we don't need. And they're a guaranteed outcome of entrusting emergency vehicles to idiots.

They certainly don't happen because intelligent, professional people use their discretion to protect themselves and take good care of the public.

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