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Investigation: Less ambulance siren use won't impact patient outcomes

Recommendations to reduce lights and ambulance siren use to less than 50 percent of responses and 5 percent of transports presented during EMS Focus webinar


The evidence for ambulance use of lights and sirens, and recommendations for response and transport benchmarks were presented by Douglas Kupas, MD, in a NHTSA Office of EMS webinar for EMS leaders.

During the webinar, Kupas described the scope and effort of "Lights and Siren Use by Emergency Medical Services: Above All Do No Harm," a comprehensive investigation into the use of lights and ambulance sirens for scene response and patient transport. Kupas, MD, a physician, paramedic and Pennsylvania medical director, led the study which looked beyond the culture and tradition of lights and siren use. Instead, the investigation reviewed operational and clinical research to provide recommendations and protocols for states, regional authorities and local EMS agencies.

The investigation's report concludes with many recommendations for EMS leaders, medical directors and vehicle operators. Kupas described two of the recommendations, which are not likely to have any negative impact on patient outcomes, during the webinar.

The investigation's report concludes with many recommendations for EMS leaders, medical directors and vehicle operators. (Photo/Greg Friese)
The investigation's report concludes with many recommendations for EMS leaders, medical directors and vehicle operators. (Photo/Greg Friese)

1. EMS agencies should use EMD programs to reduce lights and siren response as much as safely possible. A possible benchmark is reducing lights and siren response to 911 calls to less than 50 percent of all 911 responses.

2. EMS agencies should consider a target lights and siren transport rate of less than 5 percent. The small amount of time saved is likely to be of clinical value in only a small percentage of medical conditions.

Kupas, a passionate advocate for EMS patient and provider safety, has been speaking and writing on lights and sirens for 25 years. The investigation, written at the request of NHTSA, started with review of all literature available. Kupas included peer-reviewed research published in academic journals and non-peer reviewed material available in trade websites and publications. An annotated bibliography included in the investigation's final report categorizes the articles into these topics:

  • EMS vehicle crash statistics
  • Driving (including driver training)
  • Liability and ethics
  • Effectiveness of warning lights and sirens (and vehicle conspicuity)
  • Time saved with lights and siren response and transport
  • Traffic signal pre-emption systems
  • Public perception and expectations related to lights and siren use
  • Provider safety issues when using lights and siren
  • Emergency medical dispatch and lights and siren response
  • Clinical outcomes with lights and siren (including physiologic effects)
  • EMS operations, policies and guidelines related to lights and siren use

Memorable quotes on ambulance siren use

Kupas' presentation was a quick overview of the investigation methodology and recommendations. Here are three memorable quotes from Kupas:

"Look at lights and siren use like we would any other treatment we give the patient."

"Traditionally, there are many reasons for using lights and sirens."

"Are lights and sirens going to make the patient outcome better and is there any potential harm their use is causing?"

Top takeaways on ambulance lights and siren use

1. Lights and siren research

Kupas pointed to a surprising amount of research done on the use of lights and sirens including studies from the 1950s that questioned the necessity of emergent patient transport to south Florida hospitals. He shared several research findings that were counter-intuitive to typical reasons cited for lights and sirens. For example, there is a commonly held belief in the industry that the public expects ambulances to respond with lights and sirens.

Kupas described research that shows some patients decide to self-transport because of concern or embarrassment associated with an ambulance running hot down their street. Ambulance siren noise is attention getting and may cause uneasiness to some patients.

2. Response and transport variability

Like many things in EMS, there is tremendous variation in use of lights and sirens during response and transport. Two-thirds of agencies transport less than 50 percent of patients without lights and sirens, but 10 percent of agencies transport 90 percent or more of their patients with lights and sirens.

3. Lights for different purposes

Ambulance lights are used to request the right of way and block the right of way. Kupas displayed several images of different ambulance light configurations. An amber colored, constantly illuminated light might be better suited for blocking than a rotating or flashing light pattern. More research, as well as EMT and paramedic training, is likely needed on which light colors and patterns to use when an ambulance is used for blocking the right of the way.

4. Lights and siren use is not without risk

Kupas reminded webinar attendees of the risks associated with ambulance siren and red light use. EMS personnel are at risk of hearing impairment and loss from high decibel noise and can also experience soft tissue trauma when working in the patient care compartment without a seatbelt. Both risks can be mitigated by limiting red light and siren response, use of hearing protection and always wearing a seatbelt.

During the question and answer session, Kupas was asked about the potential liability of not responding with lights and sirens. Kupas explained that in general, reducing use of red lights and ambulance sirens reduces the risks of a crash and collision-related liability.

Learn more about ambulance sirens, red lights and safety

The EMS Focus webinar will be available for viewing on EMS.gov. Read the full report, embedded below, and learn more about ambulance safety, patient safety and emergency vehicle operation from these EMS1 articles.

Lights and Sirens Report

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