STAY ON TOP OF YOUR GAME
At what point do we
decide to follow the
logic of the science
& the evidence being
collected on this issue?
No more emergency warning devices?
By Vincent D. Robbins, FACHE, FACPE
When an ambulance or medic unit is dispatched, we routinely turn on our lights and siren to warn the
public on the roadways of our approach, to take
priority in traffic and to reduce our response
time in getting to the patient. Most systems
continue to use lights and siren when moving the patient to the hospital, at least when
our practitioners believe the patient
is seriously ill or injured.
For years now, a growing number of our colleagues have begun to
doubt the efficacy of using emergency warning devices (EWD).
Some believe they should only be
used to respond to the scene, and
turned off when transporting the
patient to the hospital. Others think
using them during transport to the
hospital is still warranted in certain
time-sensitive cases. Still others feel
we should abandon them altogether.
There’s increasing evidence suggesting that
using EWDs contributes to traffic congestion, slowing provider response, causing more
motor vehicle crashes and playing no appreciable part in helping the outcome of patients.
There have been several studies looking at
the consequences and effectiveness of using
lights and siren specific to risk of injury (to
the provider, patient and the public) as well
as patient outcomes.
In 1994, a study regarding the use of a medically based protocol to limit the use of lights
and siren resulted in 92% of patients being
safely triaged to non-EWD transport without adverse effect on their medical conditions
or outcomes. 1
At least one study revealed that using
EWD did reduce response times by a statistically significant amount, but failed to improve
patient outcomes. 2
Another study also found a statistically
significant savings in response time with
the use of EWD, however it did not assess
patient outcomes. 3
According to the National Highway Traffic Safety Administration (NHTSA), between
1992 and 2011, there were an estimated mean
of 4,500 motor vehicle crashes involving an
ambulance every year. Of these crashes, 65%
resulted solely in property damage, 34%
resulted in an injury and less than 1% ended
with a fatality. Still, that less than 1% represented an annual mean of 33 people.
There’s an aspect of public expectation that
overlays this issue, which must be considered.
Most in the field would agree that there’s a
belief held by the public that the use of EWDs
saves time and saves lives. Failing to respond
to a person’s emergency, whatever they perceive that to be, could be perceived as a cavalier, uncaring attitude by the EMS providers.
This could result in poor public opinion of the
EMS agency and the quality of its services—
not exactly the kind of relationship we want
to build with the public.
In fact, some civil lawsuits against EMS
agencies filed over the years include allegations that slow response times by ambulances
caused or contributed to the death of patients.
Headlines like “NY city settles wrongful
death suit over late ambulance arrival” from
the Lockport Union-Sun & Journal in May
2014, underscore the perception by many that
an ambulance should respond fast.
Still today, many contracts for EMS
require specified “fractile response times,”
which require that a certain high percentage of responses must be in less than eight
or nine minutes.
Even more progressive EMS systems still
respond with EWD on most of their
dispatches. First responders, such
as fire and police departments also
engage emergency lights and siren
when answering EMS calls.
At what point do we decide to follow the logic of the science and the
evidence being collected on this
issue? When do we decide to alter
our response to almost all EMS dispatches and transports to medical
facilities to a “no lights and siren”
protocol nationwide? Is there a role for NHTSA’s Office of EMS on this issue beyond the
release of information to the paramedicine
1. Kupas D, Dula D, Pino B. Patient outcome using medical protocol to limit “lights and siren” transport. Prehosp Disaster Med.
1994; 9( 4):226–229.
2. Brown L, Whitney C, Hunt R et al. Do warning lights and
sirens reduce ambulance response times? Prehosp Emerg Care.
2000; 4( 1):70–74.
3. Ho J, Lindquist M. Time saved with the use of emergency warning lights and siren while responding to requests for emergency medical aid in a rural environment. Prehosp Emerg Care.
2001; 5( 2):159–162.
Vincent D. Robbins, FACHE, FACPE, is the
president and CEO of MONOC, New Jersey’s
single largest ALS and mobile integrated
healthcare service. He’s
also president of the
National EMS Management Association.
In partnership with