Case study: How to use EMS Trend Report data

There is a groundswell of support to change how lights and sirens are used in EMS to reduce risk to ambulance crews, patients and others


The EMS Trend Report survey asks respondents several questions about red lights and siren response to better understand the frequency red lights and sirens are used during response to 911 calls and patient transport to the hospital.  

Here's how 2021 EMS Trend Report respondents answered questions about the use of red lights and sirens for 911 calls: almost one-fifth (18%) of respondents are using red lights and sirens for every call and 38% are using lights and sirens for most call responses.

During the transport phase, red lights and siren use is much lower. Only 5% of respondents are using red lights and sirens for every patient transport. Well over half (60%) of respondents rarely use lights and sirens during the transport phase and reserve the emergency transport mode for time-critical emergencies, like stroke or major trauma. 

The EMS Trend Report examines the current state of the profession, as well as the opinions and perceptions of the field providers, supervisors, managers, administrators and medical directors who participate each year. 2021 EMS Trend Report participants were asked, “My service should use lights and sirens when responding to 911 calls less often, more often or the same as now.”  

More than half (58%) of respondents replied the “same as now” and more than one-third (38%) said “less often.” It is both a relief and troubling that only 4% of respondents would like to see lights and sirens used more often during 911 call response than now.  

The high-number of selections for “less often” speak to the increasing awareness of the risk-benefit imbalance of red lights and siren response. There is plentiful evidence that shaving a few seconds off the response phase has no impact on the patient’s outcome, especially for the majority of patients who don’t have a time-critical complaint.  

EMS field providers want less lights and sirens 

EMS providers and their leaders want policies or standard operating procedures to reduce red lights and sirens use and – in turn – reduce the risk to ambulance occupants, other vehicle occupants and pedestrians. Here are a few free text responses from field providers to the question that asked, “If you could recommend to your chief one thing to improve provider safety at your agency, what would that be?” 

  • “Reduce the number of lights and sirens responses to all calls regardless of nature as the data shows that we are placing ourselves and others in harm's way by continuing the practice.” 

  • “Not to respond to all ALS calls lights and siren.  Lights and sirens should be reserved for time-critical calls but our current county policy dictates all dispatched as ALS calls get lights and siren response unless directed by first person in scene to continue with traffic.” 

  • “To limit the distance traveled for 911 emergencies with lights and sirens engaged. 30 minutes through busy roads to a non-critical patient has no benefit and high risk for other drivers in addition to the EMS vehicle's occupants.” 

  • “We as a whole need to reduce running lights and sirens, the increased risk is not worth gaining a few minutes in difference of going without.”  

  • “Better call screening to prevent over dispatch of units as well as a policy that does not require lights and sirens to every call.” 

  • “Let us use discretion when responding to an emergency. Unnecessary speeding and lights and sirens severely increase the possibility of an accident or worse.”  

  • “Institute a policy to reduce the use of lights and sirens while transporting non-critical patients.”  

  • “I think that we need to think about when we turn the lights and sirens on and make sure they are necessary. It puts the crew at risk.” 

  • “I would all but eliminate the use of lights and sirens. There is a culture of using them indiscriminately.”  

  • “Lights and sirens are a danger more often than help.” 

  • “End lights and sirens responses to non-critical calls.”  

  • “No more lights/sirens ‘stat’ hospital responses for inter-facility transports.”  

  • “Not running lights and sirens to calls that we are staging for.” 

Read the last two direct quotes again. At least two organizations are putting their crews and public at significant risk by responding red lights and sirens to patients receiving hospital care or for patients who don’t yet exist. As Gordon Graham says, those are problems lying in wait and in plain sight.  

Take action to reduce red lights and siren use 

EMS leaders – equipped with the results of the EMS Trend Report, research presentations about red lights and sirens efficacy, and a just-issued Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses from 13 national and international associations – need to take action to reduce the use of red lights and sirens in their service area. If you’re not sure where to start, categorize your action steps into three phases:  

  • Phase 1: Next week. What actions can you implement this week or next week to immediately reduce red lights and siren responses and transports?  

  • Phase 2: Next month. With a few weeks to plan and prepare, what are the actions you can research and implement next month?  

  • Phase 3: Next budget cycle. Some changes, like implementing a community paramedicine program or changing the emergency medical dispatch system used by your community’s 911 system, will take months to plan and additional or reallocated funding. What are the actions you’ll implement in the next budget cycle to reduce the risk associated with red lights and sirens response? 

Phase 1: action item suggestions 

Here are potential action items the field providers, supervisors and administrators in your agency can take this week.  

  • Distribute a “Chief’s Memo” with safe ambulance driving principles, department policy on red lights and siren use, and a reminder to always drive with “due regard”  

  • Watch Flipping OFF the Switch on HOT Emergency Responses to learn the specific and replicable methods other EMS leaders have used to substantially reduce the use of red lights and sirens in their jurisdiction 

Phase 2: action item suggestions 

Based on your next week successes and information gathering, begin planning now to implement improvements next month to continue to reduce risk and increase ambulance operation safety. Here are some ideas:  

  • Deliver behind the wheel driver training, with and without red lights and sirens, for all personnel. 

  • Review and discuss incident and near-miss data with supervisors 

  • Initiate a weekly report for 911 responses and transports with red lights and sirens. Compare those results to a goal or benchmark 

  • Begin a regular meeting with representatives from medical direction, dispatch, receiving facilities, legal, quality assurance, public information and other stakeholders to plan the changes that will significantly reduce red lights and siren responses and transport 

Phase 3: action item suggestions 

Phase 1 and phase 2 efforts should culminate in major changes during the next budget cycle for your organization. Some of those changes might include:  

  • Final adoption of new red lights and siren response and transport policies 

  • Installation of ambulance telematics hardware and software to give your organization comprehensive data about responses and transports 

  • Implementation of standardized, evidence-based dispatch protocols that prioritize the response to call types 

  • Delivery of public education campaigns about your state’s move over laws, when to call 911 and 988 and how quickly to expect an ambulance response 

The specific actions you implement will depend on your current policies, frequency of lights and siren use, and needs of your community. What will you do next week, next month and the next budget cycle to make your community safer by reducing the use of lights and sirens? 

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