When I was working in EMS and Fire, one of the things that was thrilling was being in a vehicle with the lights and sirens on.  Just knowing you were on your way to an “emergency” was an adrenaline rush.  Although I was never truly comfortable personally driving at high speeds; back in the day, before the data, before the realization hit, it was exciting to be in a vehicle rushing to a call with the wailing of the siren and flashing of the red lights.

Because I was an EMT and not a Paramedic, I was required to drive for the higher emergency calls.  The term, “ambulance driver” was one I disliked but in those times I was in fact just that and I had no formal training to drive an emergency vehicle.  I was fortunate to have never been involved in an accident.  The agencies I worked for had never had an accident either, yet history shows that accidents occurred on a regular basis.

In the 1950s, ambulances were used mainly as a transport vehicle with little more than oxygen and a place for the patient to lay down.  The ambulances had high-performance engines, flashing lights everywhere and loud mechanical sirens. Modern ambulances are equipped with much more than oxygen. They have (non-inclusive list) Automated External Defibrillator, bandages, suction units, as well as medication, heart monitors, and ventilators. What they don’t have is a bubble around them to protect the vehicle and passengers from an accident.

Modern day traffic is different than it was in the 50s, 60s, and 70s.  It’s built so the external sounds stay outside, allowing drivers to have their music up, hands-free phone conversations, and movies playing in the back for children.  What this means is the loud sirens with a multitude of varying pitches and tones, are much harder to hear for the motoring public.  I have been in an ambulance when the driver was using lights and sirens to move motorists out of the way when “that driver” appeared.  The ambulance pulled up closely to the vehicle in front of us, blasting different siren tones to get them to move only to have them mosey along their path, oblivious to their surroundings and the ambulance driving lights and sirens on the way to a call for service.

After thousands of deaths and injuries to EMS personnel and the motoring public due to the indiscriminate use of lights and sirens, many in the EMS field started looking into the benefits of an emergency response. One paper estimated over 12,000 motor vehicle collisions involving a responding or transporting EMS vehicle with 4 times that many in wake effect crashes.  A wake effect crash is an accident that occurred in response to an EMS vehicle.  As in my example of the slow moving vehicles in front of the fast moving EMS unit, the driver of the slow vehicle finally sees the ambulance and panics, causing an accident.  Or an EMS unit passes lines of traffic and while watching it pass (and still moving), one car collides with another.

In 2003, EMS World1 published an article about the scientific evidence available for the use of lights and sirens.  During a study in North Carolina when transport was eight miles or less, they found that responding with lights and siren averaged just 43.5 seconds faster than non-usage.  In New York a similar study showed a reduction in response times with lights and siren was 1 minute 46 seconds, still less than 2 minutes.  Fast forward to 2022, where more scientific data has been compiled and the averages show the use of lights and sirens reduces EMS response times between 1.7 and 3.6 minutes and transport reduction time between 0.7 and 3.8 minutes.  More recent studies2 estimate that the fatality rate for EMS personnel is 12.7 fatalities per 100,000 EMS workers annually. For law that rate was 14.2, fire was 16.5.

Most of these fatalities were due to traffic accidents.  With these statistics in front of us, how much of a shortened response time makes a difference? Opponents of change in this area site the golden hour as a reason for the increased response and transport times.  The golden hour is the period of time immediately after a traumatic injury and is often cited for stroke patients. I personally asked about the golden hour after my dad was hospitalized for a stroke.

The doctor carefully explained that new studies show patients can benefit up to 24 hours after a stroke for aggressive treatment (depending on symptoms), the golden hour, she explained, doesn’t really apply anymore.  The golden hour, according to an article by Urbanization3 was a term first coined in the 1970s and popularized in the 1980s.  The terms origins come from a photograph referencing the first hour of light after the sun rises and the last hour as it sets. The concept of a critical window of perfect sunlight was adopted by the emergency medical providers to refer to the crucial period of time after an injury.

There is little scientific basis to this one-hour rule and in fact one study showed that in some cases this concept when applied can end up doing more harm. A study was conducted showing the results that time did not coincide with mortality.  EMT&Fire Training Incorporated4 reported these results stating that in each case, mortality rates did not change significantly with the time spent in the field.

  • “In ten-minute increments of EMS time, the study revealed no evidence of increased death rates with an increase in time in the field.
  • In fifteen-minute increments, the study revealed no correlation between increased death rates with increased time in the field.
  • The study looked at patients that received care in less than 60 minutes and those that received it in more than 60 minutes. There was no association with the mortality rate.”

While there are critical patients who need to get to the hospital more quickly, studies clearly show that most do not.  While this currently remains a local decision a repaid response may only benefit a very small number of patients. This leads to recalling the statement made by Spock in the Wrath of Khan.  Spock stated, “Logic clearly dictates that the needs of the many outweigh the needs of the few.”

A more scientific statement is related to the origins of EMS.   EMS is a prehospital provided care and can be considered an extension of the emergency department (ED).  As an extension of this service, EMS must be subject to the same scrutiny as applied to the ED staff when it concerns their methods, interventions, and protocols.  Emergency lights and sirens ubiquitous throughout society but that does not mean the use of them cannot change.  With “Do No Harm” as a guiding EMS concept, the time for change appears to have been upon us for several years now.

Bledsoe, B. (2003, December). Myth #4 Lights and Sirens. EMSWorld. Retrieved October 20, 2022, from https://www.hmpgloballearningnetwork.com/site/emsworld/article/10325079/ems-myth-4-lights-and-sirens-save-significant-amount-travel-time-and-lives

Neulander, M., Siddiqui, D., & Mountfort, S. (2022, September 12). EMS Lights and Sirens. National Library of Medicine.

Hoemeke, L., Rossiter, N., Augustin, S., Cortes-Rodriguez, A., & Joseph, M. (2021, September 7). The Golden Hour: The Critical Time Between Life and Death. Think Global Health Urbanization. 

The “Golden Hour” and Other Common Myths in Trauma Care. (n.d.). EMT&Fire Training Incorporated. Retrieved October 20, 2022, from https://www.emtfiretraining.com/blog/the-golden-hour-and-other-common-myths-in-trauma-care.php