25 thoughts on “Unless you live where I do”

1. The Golden Hour:
   Short of massive arterial bleeding or a central-nervous shot, outcomes are vastly better if the victim can be in treatment within an hour of being injured.

   If a responsible adult suggests that it would be a good idea to go the the hospital, agree with them and go.

   Sometimes folks will be in an accident and decide they were not hurt THAT badly. They regret not seeking immediate treatment, sometimes bleeding out internally over night. Even when outcomes are not as dire, it gets ugly if insurance companies get in a pissing match about which one has to pay the bills.

   If you go when the EMTs say to go, your employer will not give you crap if you miss some time off work. If you go a day or two later then they might not believe it was due to the accident.

2. Points To Ponder:

   So, if things go to total shit while you’re driving someone to the ER, do you stop, pull over, and hope the ambulance – which you’ll now have to call anyways – can try to find you somewhere between home and the hospital? What have you got in the car that you didn’t have at home for that eventuality? Starting with space, and a well-lit area?

   Or do you step on it, trusting to your cat-like reflexes and total lack of red lights and sirens to get them to the ER yourself, and hope that 14 minutes without a heartbeat or oxygen, or sufficient blood flow, can be overcome by medical arts and luck? And that you won’t crash on the way, and injure or kill more people in a vehicle neither designed nor intended to transport critical patients at high speeds, with a totally untrained and emotionally compromised driver at the wheel?

   What if there’s a Big Accident halfway there that you can’t get around or through, lacking flashing red lights and a siren?

   What if the person you’re bringing crumps in the parking lot of the ER, at night, and now you have to go get the ER staff to play Hide-and-Seek, in the dark, with your unconscious (or dead) relative?

   What if you went to the wrong ER, because they’re not the place equipped to handle the problem? What if they’re closed to certain patients, because their CT scanner is down, or they have no cath lab team for a heart attack, or they’re so overcrowded there’s literally nowhere to treat the patient but the parking lot?
   The ambulance would have known that before they got to your house; you don’t.

   The reason you call an ambulance is that the ambulance brings the ER to you. Paramedics were literally invented 50 years ago to prevent the exact scenario you’re describing.

   I had some jackass once decide to bring his elderly wife, with a history of cardiac problems, to the ER for chest pain, from only five minutes from the hospital. In town. With the FD’s paramedics two minutes away from his house.
   She went into full arrest two minutes out, and arrived DOA, and a lovely shade of gray.
   And received no treatment for another couple of minutes on top of that for the time it took us to get a gurney and a team, pull her dead ass out of the car and onto the gurney as a sack of jello with sticks, start CPR in the driveway outside the waiting room, and get her inside to a treatment area.
   We managed to restore a pulse after several minutes. I don’t know her long-term outcome, or if she had any resultant brain damage.
   I do know if he’d called 911, she would have received vastly better care, from beginning to arrival. And he wouldn’t have been kicking himself for risking killing his wife because of panic.

   All of the care she needed would have happened before she got to us in the back of an ambulance, i.e. instantaneously.
   Every minute you go without CPR decreases your survival chances by about 7%.
   And that’s best-case.
   (i.e., except for cold-water immersion drownings, after 15 minutes with no heartbeat, we’re probably just saving the body for organ donation, and making the family feel better. Hard truth.)
   And you can’t do CPR and drive a car.

   Serious bleeding?
   Traumatic Full Arrest, because the victim bled out, which you can’t monitor, nor do anything about while driving a car, can be managed and headed off en route by paramedics just by starting an IV and administering fluids (which you can’t do either of from behind the wheel), as well as by applying the tourniquet you probably don’t have, and positioning the patient better in a vehicle designed for a stretcher with a critical patient on it.
   OTOH, the survival rate for TFA runs into single digits.
   And that’s if you’re smart enough to go to a trauma hospital (which isn’t every ER).

   Anaphylactic shock, with closure of the airway?
   What, you have no meds for treating that on hand? You can’t intubate en route? Bummer.

   And on and on.

   There are rare exceptions to the rule, and there’s always sheer dumb luck, but as a general rule, the impulse to scoop-and-go on your own with no medical capability en route is a foolish one, with statistics to match, and you’re throwing dice with Death with someone near and dear to you as the chip pile, every time you do it.

   Anybody that survived riding with you could have waited for paramedics at home, where you don’t have your hands full of steering wheel, and can do things that can actually help if they get worse.

   You fly planes, B.
   In your terms, you’re the guy telling the CFI/CATP with 20,000 hours you know better, and hoping you get back to the field before you run out of altitude, airspeed, and ideas.
   Some few times, it might work.
   Mostly, not.
   The quote about bold pilots comes to mind.

   If arrival time of medical aid is an issue, you’re far better off getting medical training yourself and having a basic kit, than you are trying to be Mario Andretti.
   Even if you live in BFEgypt.

   The only transport that should ever be contemplated is to move them to a more advantageous location for either a handoff (say, at the dirt road where a maze of unmarked country roads meets paved highway), or getting them out of a forest or canyon to someplace where emergency vehicles or a helicopter can make a rendezvous/find an LZ.

   Even then, all the drawbacks I noted still apply.
   You should probably have at minimum two people to transport, so somebody is monitoring the patient at all times, with enough kit to intervene, within your training and abilities. If you haven’t got that, the odds of making things worse rather than better just multiply.

   And the time to play what-if, just like with flying, isn’t after all the yellow and red lights on your panel start coming on.
   You grok flight plans to the max, amirite?
   So make a Medical Action Plan.
   Talk with somebody local with serious medical training, and work out now what to do ahead of time for your exact area/situation, instead of trying it on-the-fly after your adrenaline has pegged at 11.
   At 3 AM.
   When it’s raining.
   Fail to plan: plan to fail.

   • So you’d suggest wasting those 14 minutes WAITING FOR THE “Professionals” (Trust me, they aren’t, at least around here) TO SHOW UP, then hope that they have a clue as to what to do when they get here….do more than put the victim on a gurney and drive to the hospital? That waiting 14 minutes for care is a better idea than getting closer to the real skilled care? I can’t intubate someone while waiting for the ambulance either. If they are gonna die in the 14 minutes waiting for the ‘bolance then why wait?
     Rather than get 14 minutes closer to real, skilled care? If a heart attack, a stroke or suchlike? What makes you think I wouldn’t be on the phone with 9-11 while driving towards the hospital? Instead of making the time to the ER be 30 minutes rather than 14?
     Or that I can’t find the hospital *Hint: There is *ONE* in the county….or the emergency room entrance (The one with the BIG RED SIGN that says “EMERGENCY”….. or that I wouldn’t pull directly to that entrance? Or that I could not find alternate routes or get there as fast the ambulance could if there is a road closure?
     You fall into the same trap: That the care is better in the ambulance than in the car (slightly, but not much), and that the ambulance is more than just a transport with flashing lights and oxygen and gauze? That may be true where you are, but it generally isn’t true here. The folks with the gurney are marginally more skilled than the average person with first aid training, but only barely.

     Again, city centric thinking.

     • You do make some good points. OTOH, having lived in a rural county (our hospital was the only one in two counties this away, oy three counties, thataway), I , as a former medic, can authoritatively state that having your partner drive the ambulance, is orders of magnitude better, from a patient care perspective, than you barrelling yonder to your local hospital. There are, of course, exceptions. If you have the expertise to differentiate A from B, or G, then feel free to make that determination.

       As I told my daughter ref her wheezing child, do you know CPR? Can you perform same in a moving automobile? What’s your notification plan, to warn the hospital that you’re coming in hot with a critical child?

       One Weird Trick? Your local medics, at whatever level of licensure, CAN do those things, DO have those capabilities. Yes you likely can phone whoever, WHILE driving essentially “Code 1”, AND wondering how you’re gonna provide care, while simultaneously driving, navigating, communicating, and assessing your patient.

       Reflect on the deleterious effects of task stacking, on each one of those mission critical tasks, while under stress that most of us will never have experienced in our lives.

       Which one of those tasks are you willing to compromise?

       So, yeah, there will be occasions wherein scoop-and-go is reasonable and prudent. In my experience on thousands of EMS rine, and decades as ER RN those are uncommon.

       Like, use-a-tourniquet-as-a-civilian uncommon.

       • So in a heart attack or stroke situation, waiting for 10 or more minutes (Plus the time while the “EMT” follows his/her procedure, adding at least 5 more minutes) , THEN a 16-18 minute drive to the ER (close to 35 minutes) is better than a 16-18 (or even less, yeah, I am that good of a driver with the equipment to match, even under the stress you refer to…I’ve done it once before) minute trip to the ER for a real medical professional to treat is the better option? Why do you think that I can’t call 911 or the ER on the way to let ’em know I am on the way and what the issue is?

         Yes, there are some instances where waiting is better, absolutely. (Choking and I am the only person available, arterial bleeding that need a tourniquet and no one to hold it while I drive, etc) But adding all that time for nothing, when the EMT’s won’t do anything en route, seems foolish. But like the original article (and our resident “expert in all things Medical”, Aesop) would have it: Every Single Time the Ambulance Is Better.

         I feel otherwise. The so-called EMT’s here are generally just taxi divers rather than caregivers, and while they may be better than me, and better trained, their modus operadi is generally “drive to the ER with the flashy lights on kinda fast” after evaluating. Seldom do they do any care en-route. All they do is add time until treatment at the ER. Perhaps your folks are better trained or more capable. Sadly, ours don’t seem to be.

         • You can do the research on how many state motor vehicle codes (including yours) think driving (let alone rushing to the ER at high speed) while yakking on a cell phone is a good idea. I’ll wait.

           Then we can add in you, with zero medical training, playing twenty questions with someone two to five skill levels higher than you, trying to glean critical medical information about your in-distress relative second-hand, while you’re driving, and no one is monitoring them at all, and why you think that’s the better solution to your emergency.

           If all you’re getting in response to bona fide medical emergencies is 110-hour basic EMTs, not paramedics, that’s the failure in the whole plan where you are.

           Big cities figured this out 50 years ago.
           FFS, Emergency! made a frickin’ TV show about it in 1972(!!), by which time it wasn’t even news anymore.

           It’s now 2023 – 51 years later than TV networks figured this question out.
           WTF is the problem with your local authorities, and why are you and they settling for literal Civil War/Zimbabwean bush village levels of emergency medical services in the 21st century in a First World country??

         • Your second question is valid. Very. I don’t have the answer…nor do I know how to fix it. It is pretty sad, really.

           As for the driving while on the phone, that isn’t that big of a deal. Not the best, but considering the options, it isn’t that big of a deal. Best of the bad choices…. High speed driving on mostly empty roads isn’t much of a stretch from normal driving….most are straight and (fairly) ,level. Plus there is that whole speakerphone thing. You may have heard of it. Most cell phones made in the past 10 years or so have one.

           As for the rest, as I said. City Centric. If yer gonna give all encompassing dictates on the media, you’d better see all of the angles. Otherwise you look and sound like a coastal (East or West) liberal telling the guy in rural Kansas why subways are the best form of transportation. In a city or suburb, where the hospitals are not that far apart and traffic is more of an issue, your points are all valid….But not everywhere in the country is like where you live. If yer on a tourniquet or having a stroke, doubling (or more) the time to care can’t be better in any way.

         • “THEN a 16-18 minute drive to the ER (close to 35 minutes) is better than a 16-18 (or even less, yeah, I am that good of a driver with the equipment to match, even under the stress you refer to…I’ve done it once before) minute trip to the ER for a real medical professional to treat is the better option? ”

           Well a coupla things: in my experience, folks who are in arrest, generally have measurably better outcomes (even if any outcome from an arrest trends toward “dismal”), should they receive, say “16-18 minutes…” of, say, cardiopulmonary resuscitation. Hell, taking your numbers, even 45 minutes of CPR is more likely to produce a “good” outcome (for whatever value of “good” you select) than 16 minutes of anoxic cardiac arrest.

           Again, your circus, and you ought to organize your monkees in the manner that you think is best. Aesop and I are presenting alternate viewpoints, that’s all. In my case, since around 1988, I have been in rural areas as EMT, ER RN, and midlevel provider. Again, in my case, I have carried a pager for my local fire department exactly so that SOMEBODY would show up at someone’s house, who was having the worst day of their lives, in order to attempt to mitigate same.

           My opinion derives from 2 generations in the sick people business, in rural areas. No, not Four-Corners-Of Arizona rural, but Upper-Midwest rural.

         • 1) Real-world evidence from the sandbox has shown tourniquet application times of six hours with zero limb deficits afterwards.
           If you live five hours or more from a major hospital, you have much bigger problems than that, for any emergency.

           2) The problem with using the cell phone isn’t your hands, it’s your brain. Multi-tasking is a myth. You can yak and fly, but you’re not weaving a plane around other traffic three plane lengths away while flying through tight canyons at wingtip range, at night, when you’re doing it. In a car on the highway, OTOH…

           3) My answer is not city-centric. Anything but. If you personally can’t call in a flight medic response, you driving is worse than doing nothing. You’re delaying any care until you arrive, and depriving the facility of any prep time whatsoever.
           As it happens, I dealt with a real-world stroke yesterday morning, FTR. All mine. We had 10″ warning.
           By the time it got there, there were three nurses and a doctor ready to go at the door. The paramedics had already started an IV en route, so we had blood tests going on at the bedside, and results in 2-10 minutes, not an hour after we got the line going. (Getting the machines to do that into an ambulance is matter of when, not if, and then just spending the $$. They’re about as complicated as using a glucometer, which millions of people do at home, daily.)
           You screeching up 15″ later means none of that. No warning. No assessment. No History. No IV.
           The CT scanner was ready and waiting for us. We had a Neurologist via tele-medicine on a robot assessing the patient from 50 miles away. (And if I have that now in an ED, it’s coming to the back of the ambulance soon. It’s only slightly harder than a Skype call.) Again, you have none of that in your car.
           Within 10 minutes of them hitting the door, we had a surgical team inbound to treat the problem. They were in surgery 70 minutes after the patient came through the door.

           All of that would have been delayed measurably had someone elected to scoop and go.
           Assuming they didn’t have an accident on the way.
           And there’s nothing on that list not available, even in BFEgypt.

           If time is that critical, unlike you, EMS can request an airlift from an LZ en route, meet the helo, and skip straight to Big City Medical at 2-3 times your best driving speed, on a straight line, little to no traffic, with world-class medical care en route, and full patient monitoring for any complications the entire time.

           Joe Blow and his F-150 bring exactly none of that to the equation, in town or out, anywhere anyone can read this.

           If you have shit-level EMS (and you may, indeed), beat on TPTB thereabouts to step it up until you drive the lesson home.
           They’re literally 50 years behind the times, and there’s no excuse for that.
           That makes this not a city vs. country discussion.
           It’s a 1970 vs. 2023 discussion.

           There’s a word for doctors who learned medicine in 1970: Retired.

     • I’m also 20 minutes from town and nearest hospital– in good weather.
       However… I’d still call 911 and wait for the ambulance. Despite their “only local-yocal EMT-Rs”, they still have to be trained to be allowed to answer the call (I was one). Their jump kit will have more than enough to maintain life, and the skills.

       • If our folks actually treated, I’d agree with you.

         They merely transport. Even heart attack and stoke victims.

         • TBH, field care of an MI or an ischemic/hemorrhagic stroke is, at best, ongoing assessment, supplemental oxygen. Again, every fraction of a second you are watching traffic is another fraction of. A second you are NOT assessing your patient. Conversely, every fraction of a second you glance at your patient, is a fraction of a second for some kid to run into traffic/some granny to bust a red light/other trip stopping additional calamity.

           But, you are correct. Aesop’s years in ER, my 2+ GENERATIONS of EMS and ED experience mean nothing, because “city”. Or something.

           You indeed DO know your AO better than I do. You, indeed, know the risks you are willing to undertake, better than I do. And, finally (in both senses of that word), you know the risks that you are willing for your loved ones to assume, in this hypothetical situation.

           My 2cents worth of advice, is worth exactly what you paid me for it.

           I’ll E-mail you, your change.

           I genuinely hope that you never need to field trial your plans. Just as I pray that I never again have to field trial my own plans.

3. McFee and Aesop:

   Neither of you are wrong, Nor are your words of advice going unheard. I’d never “Scoop and Run” unless I thought it was the best choice, when time is of the essence. But waiting 15 minutes for a ride with O2 or without as the only difference between the box with flashy lights and myself as the transport, then that 15 minutes plus the time in the ambulance can make a difference. IF being on oxygen matters, then waiting for 15 minutes for the ambulance to get there with oxygen doesn’t seem like a good idea when the patient can be in the ER, on oxygen, only 3 or 4 minutes later than the ambulance can respond to the scene. Constant assessment might matter, but only if the assesor in the ambulance can do something about it.

   Having done the high speed run to an ER when someone was having a heart attack, I’d prefer to never do that again.

   Having said that, the ambulance is often just much-delayed transport. If it isn’t time-critical in my judgement, I’ll call 9-11 and wait. Like shooting in self defense, you should only do it when it is the least bad choice.
   ‘Thing is, our EMT’s aren’t that skilled or credentialed. So that matters in the judgement call.

   • “Having said that, the ambulance is often just much-delayed transport. If it isn’t time-critical in my judgement, I’ll call 9-11 and wait. Like shooting in self defense, you should only do it when it is the least bad choice.”

     Well stated, sir.

     I do wonder about Aesop’s thoughts about grassroots your-corner-of-the-world EMS enhancement. Having been in a volunteer first responder setting, it is a difficult thing, on so very many levels. Given your appraisal of your local EMS folks and their capabilities, it still might be worth a bit of contemplation.

   • I don’t think you’re being Wild Bill here.
     I get where you’re coming from, figuratively and literally.

     Scoop-and-run always makes sense, in one case: If you can see the hospital from where you’re standing.

     For anything else, from big city to BFEgypt, there are better choices.

     If your EMS is that bad, fix that. Everyone wins.
     Worst case, get an EMT card and your own O2 tank, at minimum.
     Have a neighbor or friend drive you.

     Half-ass ambulance is waaay better than none, because continuous patient care is the key factor, and you lose that, every single time, with scoop-and-run.

     Study after study confirms that the difference in transport time for RLS (red light and siren) vs. just driving normally, rarely amounts to even 2 minutes’ savings. It’s generally between 0-120 seconds, time after time after time. It’s been studied dozens of times, for thousands of runs.

     The point of EMS is to bring resources Joe Blow doesn’t have in his Rambler or Chevy van.
     In the 1960s, it was defibrillators, cardiac monitoring, and base radio contact.
     Then IVs, drugs, and paramedics trained to use both.
     Including monitoring for worsening condition, and intervening.
     Somebody who arrives DOA is generally staying that way, and the odds of that go up astronomically with solo scoop-and-run transportation.
     Your family, your choice.

     I respect your aeronautical experience, truly.
     Bear in mind what I’m telling you comes from something over 45,000 hours of emergency medical experience, everywhere from Death Valley and Yosemite to within sight of City Hall in L.A.

     Whatever else you take away, you or anyone else should
     a) have everyone’s medical information written, and stored to conveniently grab and go, if not on their person. Thumb drives are nice, but a couple of typewritten sheets are still better.
     b) consider carefully their real-world situation, wherever they live, and factor in all possibilities of time of day and weather in their plans, as well as capabilities of your local EMS, and the various potential hospitals
     c) make plans for every emergency (they aren’t all the same), calmly, rationally, before everything goes to sh*t, so that if The Day ever comes, they’re acting, not reacting.
     The goal is to execute the plan, not your loved one.

     d) If your local EMS sucks, now you know what to hammer on until it doesn’t. Don’t settle for Civil War skill and response levels, FFS.

     Best Wishes

     • “Study after study confirms that the difference in transport time for RLS (red light and siren) vs. just driving normally, rarely amounts to even 2 minutes’ savings.”

       You’d be right, and it WOULD be a better choice were it not for the fact that the WAIT TIME for the ambulance to arrive here is EQUAL (or nearly so) to the actual drive time to the ER. So waiting for the ambulance and the “EMTs” with (possibly) more skill and training nearly doubles the time before the ER (15 vs 30 ish). It doesn’t take any time away from the time to treatment, as not waiting for the ambulance folks is nearly the same as the response time before the ambulance might arrive.

       What does it matter if it is nearly 15 minutes to “Skilled” treatment either way (assuming that the ambulance attendant care and the ER care level is equal, (which it isn’t)? I fail to see why 15 minutes wait time (more or less) BEFORE the ambulance will arrive vs a 15 minute (more or less) drive to the ER is different. Either way it is 15 minutes (assuming I don’t have to do CPR or something like that). Please explain (Not being snarky here, I’m truly trying to understand). I’m not saying you are wrong, I just don’t see the logic of waiting 15 minutes for a gurney and then (possibly, but not likely), better care for the ride to the ER is better than 15 minutes direct to the ER where skilled care is guaranteed to be available, is a better choice. Either way it is 15 minutes wait before skilled care. In other words by the time the ambulance can get there and begin treatment, the patient will be at the ER. (Of course, it depends on the injury/malady/situation).

       All I’m saying is that the blanket statement to “wait for an ambulance” is good advice, *IF* it gets there in a timely manner such that the wait time is less than the trip by car. If you know that that is not going to be the case, then why wait?

       • Because while you’re waiting, you can monitor the patient and intervene. Airway. Breathing. Circulation. Treat for shock. Gather information to help the crew, and the ER, treat the patient better. What happened (if you know)? Pt’s medical history? Patient’s everyday meds? Their allergies? (You’ve got that handy, pre-recorded? Or d’you want to play Twenty Questions when you get to ER with a loved one – spouse, kid, grandchild – on the gurney?)

         The ambulance crew can monitor the patient too, from your door to the hospital. ‘s why they come in pairs, or more.

         All that’s precisely what goes out the window with scoop-and-run.
         You’re abandoning any actual care of the patient to luck and chance that whole time, in a situation that’s already serious-to-critical. (Srsly? Who wants to do that on purpose??)

         That’s why I asked what you’re going to do if the person you’re transporting goes south en route.
         Like happens every single day, even in a state-of-the-art ambulance with a crack paramedic crew.

         And when I say “goes south”, I mean things like “becomes agitated and combative from lack of oxygen, low blood sugar, seizure, overdose, infection, brain trauma, etc.”.
         So, while you’re driving to the ER, you’re (all by yourself) going to hog-wrestle a functionally crazy person to keep them from getting out of a moving car, or trying to take the wheel? BTDTGTTS. It sucks even with a full crew to help. Solo, while driving? Hell no.

         Or maybe it means they “can’t protect their airway, and choke/stop breathing, or go into profound shock from uncontrolled bleeding, and/or then go into cardiac arrest”.
         The industry term for that last is “dead”.

         You’re also robbing the receiving facility of a skilled, accurate, and ongoing clinical assessment long before arrival, plus preventing any possible interventions (including lifesaving ones) by the crew you don’t have with you, and any lead time for the receiving hospital to make room and prepare the response before the patient gets to the back door. IOW, every advantage we gain from every EMS run we ever receive, since before I started in this business.
         Paramedics (or anyone else) not calling us long before they hit our ER driveway? That’s a full-contact hard double dick-punch party foul. Guys get suspended for bonehead moves like that.

         You know this answer:
         Why do pilots declare an emergency in flight – including the exact nature of it – instead of just waiting to let the field know there’s a problem until they hit the apron gloriously aflame, or with the prop(s) feathered, or with an unconscious unresponsive patient in the other seat…?

         And you’re actually not guaranteed skilled care will be available when you arrive. In fact, no one pulling up cold has any wild idea what the ER status is.

         CT scanners go down, and ERs routinely divert ambulances because of that.
         ERs close to saturation (because too damn many patients), and divert ambulance traffic elsewhere, every single day.
         Hospitals have disasters and emergencies too. Power goes out. Back-up generators don’t work. (Ask me how I know). And 50 other wild problems.
         Guy with a gun in the ER, hospital on lockdown.
         Car crashed into the hospital.
         Bomb threat.
         Five car pile-up and twenty critical patients.
         The list is endless.

         Also, not all hospitals are even certified stroke centers. Or cardiac centers. Or trauma centers.
         Even with 40 hospitals in this county, there are only exactly 6 or so stroke centers. A few more are cardiac centers. Far less are trauma centers.
         (Do you know which, if any of those, your local ER is?)
         Show up at the wrong one?
         You’re waiting, again, for an ambulance for the transfer to the right hospital for the patient.

         You pull up to no beds, no available staff, and forty people in the waiting room, and your patient is screwed.

         Because you don’t know who or how many hospital staff called off sick.
         Or if a bus flipped 5 miles the other way, and they’re overloaded.

         If the CT is down, guess who has to call (and wait for) another ambulance anyway, to take the patient to the right hospital?

         The list of things you “know” in an emergency is limited to what you can see with your eyes.
         Everything else, you’re guessing and hoping.

         Hope is not a plan.

         The scenario you keep laying out is assuming you know all the other cards in all the other players’ hands.
         Anybody can win that game, but that’s not how any game is played.
         In this one, you really don’t know any other cards. Just yours.
         (I don’t have any idea how things are going every night at my own ER until I get to work. If *I* don’t know that, how could you, or anyone else who’s not plugged into the EMS system?)

         All the things I mentioned? Those are the enemy.
         Yours, and mine.

         And the enemy always gets a vote.
         Murphy is a bitch like that.

         You want to win in this game, you do everything you possibly can to make the contest as fair as killing baby harp seals.

         You might get someone not-so-serious to the ER faster than an ambulance. No doubt.
         But if they’re not serious, this whole question is moot.

         If they are serious, and it’s your relative, you’re adding huge amounts of risk to an already serious situation, based on any number of unknown variables.
         The fact that once in a while, despite all that, you might roll a 7 doesn’t make that added risk wise. Even more so with someone dear to you.
         Play the hand you’re dealt, and work the problem. Beginning with minimizing the risks beforehand, to the greatest extent within your control.

         You’re the only one who’s going to be there on the day, and you’re the one who has to live with the consequences of your choices.

         • Actually, we Declare an Emergency to receive priority over all other traffic. This is to facilitate the mandate from the FAA:
           “Land as soon as practicable safely”.
           We don’t wait, we get on the ground.

           Again, why do you think that I can’t call the ER en-route and tell them that I have a stroke patient inbound, arriving in 10 minutes, age 80, male, 210 lbs, white, etc?
           Why do you think that leaving a person lay on the ground for 15 minutes, then 10 or more minutes for the emt’s to diagnose and load, THEN a 15 minute ride to the ER (while being “monitored” of course), is better than a straight run to the ER. The first 15 minutes is the same. either way. If they are gonna die in that time does it matter if they are on their living room floor or the backseat of the car?
           If they can be moved **safely, then why not move them to the place of care sooner?
           You haven’t answered that question multiple times.

         • You get priority as a pilot declaring an emergency, because you’re a licensed professional making a critical decision based on your documented experience, and to let them know to limber up and get ready to assist.
           You get exactly none of that professional credibility calling an ER, and throwing a critical patient into your car and roaring to the hospital.
           In the aviation world, this is why they don’t let any random guy in the back of the 727 make that radio call. Capice?

           You’re also, once again, assuming they’re going to die either way.
           That’s the problem.
           You don’t know what’s going to happen.

           You’re also assuming that you can move them “safely”, a fact nowhere in evidence.

           But there’s absolutely nothing you can do about anything if you’re driving.
           That’s not a what-if, it’s baked into your response, guaranteed, every single time.

           So if you could have opened an airway (which takes both hands to do), but couldn’t because you’re driving, now they’re going to die.
           If their heart stops 10 minutes from the ER, and you can’t do CPR, because driving, now they’re going to die.
           Best case, you stop to do either of those things, and somehow manage to notify the 911 agency you should have called of the complication, and now they’re playing hide-and-seek with you, somewhere on the side of the road between A and B. So now you’re doing CPR, calling 911, and giving them directions to the green sedan off to the side on the south…or was it north? side of the highway, near a cow at the third stump west of the old Bumfuck farm past the Texaco station.
           At night.
           In the rain.
           While you’re doing CPR compressions on your own relative. (Stop me when the penny drops.)

           You can call the ER with your report at the outset, sure. And they’re going to tell you “Hang up and call 911!” Every. Single. Time. Because unlike a pilot declaring an emergency, your medical credibility is dick. All they’re going to do is judge that Panicky Guy may – or may not – be coming to their hospital. And wasn’t bright enough to call 911 instead. (This already shot any intelligence score or judgement points awarded to you, right in the ass, from the get-go.) With or without an ambulance involved. You’d be better off calling them with a report of a UFO.

           1) Pro Tip:
           Most “strokes” and “heart attacks”, even ones reported from professional responders, using far better assessment skills and medical equipment than you have, aren’t any such thing. I see it every single day. But licensed paramedics, unlike you, get the benefit of the doubt.

           2) You might get registered a whisker faster. But no vital signs, no updates, no history, no patient monitoring, no lifesaving nor timesaving interventions.
           So they’re going to take about 10 minutes (that you thought you “saved”) to do all those things first anyways after you get there, and to decide it it’s really an emergency they need to run around about with their hair on fire. And 20:1, their first priority is to have you, The Panicky Relative, GTFO of the treatment area, and go help get the patient registered. Because you bring emotion and drama (very possibly needlessly) into a situation that is helped by neither.

           3) You might arrive to any of the bad scenarios I laid out before. No beds. No staff. CT scanner down. Wrong type of ER.
           So now you’re waiting again for another ambulance to take them to another ED, or for a Lifeflight the original ambulance could have summoned to pick up your relative, at an LZ half a mile from your door, and take to the right hospital with state-of-the-art medical intervention, at 100-160MPH both ways, and zero traffic, for a bona fide life-and-death emergency. You gave that option away the minute you didn’t pick up the phone.

           Please, stop assuming, and trying to fill in boxes you can’t, to tip the scales.

           All anyone knows is you have a problem you’re unqualified to assess or deal with.
           Noted.

           Your response is to keep handling it yourself, knowing those limitations, and turning all those drawbacks up to 11 if anything else you didn’t even know you didn’t know how to handle, happens.

           The book response, from tens of thousands of professionals, is to summon someone better qualified than you (starting with not being massively emotionally compromised from the outset), and for you to do the best you can with what you know until they arrive.

           Some people are going to die.
           Even if their emergency happened in the OR, with a full team right there.

           Most aren’t.

           Some are right on the edge either way, based on choices you make.
           Wisdom is to not make it worse.
           Break the chain of disaster.

           If you decide you’re the ambulance, with no capability to do anything for that 15 minutes, please have the decency to tell your loved one that if they die because you’re busy driving, it’s just tough shit. If they’re willing to live with that, and so are you, it’s on you what you do at that point.
           Like always.

           With all those drawbacks, I already said, if you’re alone except for the victim, 200 miles into the Alaskan bush, yeah, fly them to town yourself, ASAP.

           But for any life-threatening emergency, two paramedics always beats one emotionally distraught close relative, both for treatment, and transport.
           Even if it’s 30 minutes each way.

           Now, if you have a relative right there, or can call your neighbor the next lot over to come on over in a couple of minutes, and you ride in the back with the patient while he drives, and you earn at least a basic EMT card, keep a simple medical kit, and a tank of O2 to go along with your cell phone, we can talk.
           One medic now trumps zero for fifteen minutes, or waiting for two for the same amount of time.

           Fair enough?

           But there’s no scenario (outside of the deep wilderness, above) where zero medics and no patient monitoring for a sizable hunk of their Golden Hour is a good plan, and never will be.

4. The best part of this entire thread would be actually SEEING A-Flop actually have to practice what he preaches, and then doubles down on again, and again and again.

   Thirty minutes into a medical emergency… “The AMBULANCE will be here any minute!!! We just have to WAIT MOAR LONGER!!!”

   • No, he’s correct in most urban and sub-urban places.

     That’s just not where I (and many people) live.

   • So, how many patients do you strap on top of your fire engine, and haul ass to the hospital with?
     Like even once, in your celebrated signature 28-year firefighting career?

     Tell you what, I’ll give you $10 for every one of them, and you give me $1 for every one where you waited for the ambulance, and I’ll let you know what color Porsche you can buy me with my winnings on that wager, if you’re willing to put your money where your mouth is.

     Snotty is easy; thinking is hard.

     The ACEP guidelines are to call for an ambulance anytime the reason is potentially life-threatening, including but not limited to trauma, heart attack, stroke, poisoning, overdose, severe burns, and difficulty breathing.
     That’s their recommendation knowing that the average 911 response time is 7 whole minutes longer in rural areas where 60M Americans live, than it is near and inside cities, right at B’s described 15 minute mark.
     But what do 38,000 ER physicians know, compared to the breadth and depth of your experience?

     The bigger issue is that when you choose to live in BFEgypt, you’ve self-selected for worse patient outcomes on average, because fewer hospitals, less trained responders, with a low call volume, and all farther away, not just the extra 7 minutes’ wait for the ride.
     Turns out physics wins again, even for people who never learned it.

     The answer to that is for rural folks to get trained, because they’re the help until help gets there. Most of them get that without a fuss.

     It’s not to make sub-optimal choices, and hope everything goes right despite that.
     But hey, they’re going to be your relatives we’re talking about, 28 year.
     So you do you.

5. I find it interesting that only “medical” folks can make a diagnosis, and that the ER will ignore an inbound emergency and any information given en-route via cell phone because the transporter is not a “qualified” medical professional. . What an arrogant self-serving attitude. I have no doubt that your attitude is prevalent among the ER folks, sadly.

   Funny that. SO far I’ve diagnosed (but not transported) 2 heart attacks and one stroke, one Diabetic Ketoacidosis, and a few other maladies that were somewhat life threatening. And I was right each time. But I’m just a guy with a bit of first aid training. I know others who have similar experiences…none of whom are medical professionals. Sometimes we can see what is obvious.

   Your arrogance that people can’t do basic diagnosis, and that if they stop because their patient needs help they can’t give directions… that they can’t drive and give information over a cell phone, and all the other arrogant crap you spouted are, frankly, insulting. While some may not be able to do that, many of us can.

   • It’d be arrogant, except for millions of actual counter-examples from real life, and direct experience with far more than were ever necessary to underline the lesson.

     And the cavalier dismissal of legitimate drawbacks is why I can tell you with infallible authority that you don’t even know what you don’t even know.

     Do us both a huge favor: go do a ride-along with a local paramedic crew in your area for one entire shift, and post about it.

     While you work on that, tell us how many unqualified unprofessional non-pilot passengers routinely call in for takeoff and landing clearances from the back of the passenger jet, in your experience?

     How many uncertified shade-tree mechanics does the FAA let fix even private airplanes (not experimental homebuilts), let alone passenger aircraft?

     D’ya suppose there’s any reason for those numbers?
     Or is it sheer FAA arrogance?

     First responders, even if they’re doctors, provide a clinical snapshot, based on initial and limited information and assessment. That, often as not, proves not to be the actual case.
     Bystanders and relatives? Even worse prognosti-guessers, since ever. By a factor of ten,cubed.

     And yes, sometimes you can see what is obvious.
     Just like anyone can win the lottery.
     And 1000 times more frequently, you’d be completely wrong.

     Just like 1 guy in a thousand can probably land a 737 with no prior experience. Once.

     In both cases, other people’s lives are at stake, IRL.

     I didn’t say people can’t do basic diagnosis.
     I said they suck at it, universally, and perpetually.
     Paramedics with $20K worth of diagnostic equipment and 10+ years of experience get strokes and heart attacks wrong, routinely.
     That’s why we have cardiologists, neurologists, and CAT scanners.

     What they can do, is administer potentially beneficial treatments and interventions that won’t hurt, and may help, and intervene definitively if things get worse, as they often do. Family members trying to “play doctor”, OTOH, have killed and injured more people than I can count that I’ve seen firsthand, just in my career.

     So any ER is going to weigh your medical opinions against the fact that you chose to ignore best practice, skipped 911, and put a loved one (and potentially anyone else on the road) at risk, while abandoning any ability to monitor and care for them en route, and made a mad dash to the ER.

     Everything you think you know X zero credibility = 0.

     We’re going to treat them exactly as smart as you’d view the passenger who couldn’t wait for the pilot, and decided to fire up the 737 and take off to get to their destination, even if they had am actual medical emergency as an excuse, and they somehow managed to pull it off successfully without killing anyone. (The TSA would haul them off to federal prison.)

     But at the end of the day, you go ahead and discount all the reasons I told you what you think is best is actually a bad idea, despite virtually the entire medical profession from the pinnacle to the lowliest techs saying the opposite, and despite millions of examples of the truth of that, because you and yours will live (or, not) with the consequences, and there’s no one there to change your mind or throw a penalty flag. As usual, the same ER staff you think is arrogant will just try and fix the chain of mistakes that brought people to their door in the first place, like they always do.

     That exact attitude is what’s kept a roof over my head, food in my freezer, and money in my bank account for going on 30 years.

     I sincerely hope your plans work out in real life as well as they do in your imagination. But I think Mr. Dunning and Mr. Kruger ought to have a word with you.

     Best wishes in your endeavors.

     • Your analogies to aviation REALLY suck, but that is from ignorance. I get it and don’t discount your trying.
       Yer comparing apples and pork chops.

       You still have failed to answer:
       Why is 15 minutes laying on the ground for the Professionals to arrive then a diag/transport worse than 15 minutes in the back of a car on the way to the ER? Either way it is 15 minutes to professional care starting. 15 minutes to the ER or 15 minutes to the EMT’s. Still 15 minutes

       Your other statements are noted, and I will consider them. I’m not discounting what you say….but the professional arrogance that “The way we tell you is the only way” doesn’t work. If in a city with a reasonable response time I will always wait. At my home, probably not.

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