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Quick Take: It’s time to flip the switch on hot EMS response

Studies have repeatedly demonstrated that the time saved with lights and siren use has little-to-no impact on patient outcomes


“Much of this is local culture rather than evidence and need.” — Dr. Douglas Kupas, referring to lights and sirens use by EMS agencies across the country

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The American Ambulance Association recently hosted a webinar regarding lights and siren usage and how this affects patient care, “Flipping OFF the switch on HOT emergency medical vehicle responses!”. Speakers included:

  • Dr. Douglas Kupas, medical director of NAEMT and Geisinger EMS
  • Dr. Jon Krohmer, director of the Office of EMS for the National Highway Traffic Safety Administration
  • Dr. Mike McEvoy, EMS coordinator of Saratoga County, New York, and Chair of the EMS Section Board for the International Association of Fire Chiefs
  • Kevin Smith, chief of Niagara EMS
  • Rick Ferron, deputy chief of system performance of Niagara EMS
  • Robert McClintock, director of Fire and EMS Operations for the International Association of Fire Fighters.

Matt Zavadsky, chief strategic integration officer of MedStar Mobile Integrated Healthcare, moderated the Q&A.

The panel discussed ambulance crashes, how often lights and sirens are used and how they affect patient care.

Top quotes on lights and siren use in EMS

“Much of this is local culture rather than evidence and need.” — Dr. Douglas Kupas, referring to lights and sirens use by EMS agencies across the country

“Crash rate goes up 53% when you use lights and sirens.” — Dr. Douglas Kupas

“Competence is more often shown by quiet deliberateness than by noisy bravado.” — E. Marie Wilson, Connecticut EMS Patient Survey 1980

“Lights and sirens should be applied as a clinical procedure with a risk/benefit analysis” — Rick Ferron

Top takeaways on lights and siren safety

1. Increased risk of crashes with lights and sirens

It’s estimated that there are 12,000 emergency medical vehicle crashes a year, many of which occur when lights and sirens are used. One article showed that the crash rate increases 53% when you are responding with lights and sirens. Additionally, there is an almost three-times increased risk of crashing when transporting a patient with lights and sirens.

2. Lights and siren use impacts EMS resources and patient care

It’s estimated that for every EMS crash, there are four “wake effect” crashes, accidents where other vehicles crash while or after an EMS vehicle passes through a traffic signal and disrupts normal traffic flow. These crashes require other EMS providers to respond, leading to more resources being utilized and strained.

Additionally, these accidents may lead to a delay in response time for the initial patient and for those later calling 911 because other units are now responding to other causalities indirectly caused by the initial EMS response.

3. Lights and sirens don’t have a huge effect on response time

Lights and sirens theoretically allow you to reach the patient quicker, but, in reality, there isn’t a huge change in response time. Seven studies that analyzed response times ranged found that with lights and sirens, there was an average of 1.7-3.6 minute decrease in arrival time. This is not a huge amount of time. Granted, there are some patients where this could mean the difference between life or death. For the majority of patients, however, a few minutes will not make a huge impact in their ultimate outcome.

4. Lights and sirens may not be the best treatment for the patient

When patients were asked why they drove to the emergency room rather than call 911, many stated it was because they didn’t want lights and sirens showing up at their home. When EMS arrives noisily, they can cause a bit scene. There is much more of a disturbance than when they discreetly arrive on scene without blaring sirens the whole way. Many people are too embarrassed to call 911 because they know that it will lead to a big commotion in front of their home or workplace. On the flip side, some patients want the lights and sirens and don’t understand why EMS would show up without them. Determining when lights and sirens are beneficial for the patient is important and explaining why they are used, or not, can help educate the patient and the general public.

5. Ensure proper restraints for providers and patients

Although not the main topic for the webinar, it is important to properly buckle in your patient and yourself. Data collected between 1992-2011 showed that 84% of EMS providers involved in ambulance crashes were not restrained in the patient compartment. Additionally, the vast majority of incidences of fatalities and incapacitating injuries were in providers who were not restrained. Only 33% of patients involved in serious crashes were secured with shoulder and lap restraints. It can be difficult to think about buckling up when you are dealing with a sick patient, but try to think about your own safety (and the patient’s safety) when you’re riding in an ambulance.

Learn more about lights and siren use in EMS

The webinar, featuring information about the Niagara Region EMS squad, which effectively “flipped the switch” by responding cold to calls – without lights or siren (just 10% of the agency’s responses to 911 calls are now “hot.”), answered the following questions:

  • How many people are injured or killed during a hot response by EMS vehicles?
  • How many EMS providers have been injured or killed during a hot response?
  • Is there any difference in patient outcomes from a hot or cold response?
  • What really is the public’s expectation when it comes to hot responses?
  • What are the things that are preventing people from calling 911 for EMS (hint - it’s the “spectacle” it creates)

It is available to watch below. To view the presentation’s slides, visit AIMHI.

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Marianne Meyers, BS, is a third-year medical student at the University of Washington School of Medicine interested in pursuing emergency medicine. Previously, she was a member of the Santa Clara University collegiate EMS squad where she received her B.S. in Public Health Science. Additionally, she has worked with the King County Public Health Department in Seattle, Washington studying EMT naloxone administration.