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The truth about EMS use of lights and sirens

After a string of fatalities from ambulance-involved collisions in 2012, this video created by a N.J. agency shows how drivers react to sirens, and supports using them only in a true emergency

In November 2012, a 30-year-old EMT and father of three in Newark, N.J., was killed when an SUV being followed by police slammed into his ambulance.

Two months later, a paramedic in Stillwater, N.J., died when he suffered a heart attack while transporting a patient burned in a house fire, and crashed into a utility poll. And in February 2013, six people, including four volunteer responders and two passengers in a second vehicle, were injured when a car collided with a Bernardsville (N.J.) Fire Company ambulance using lights and sirens while responding to an emergency.

Though each of the circumstances was different, the recent string of crashes in the state hit home for MONOC (Monmouth Ocean Hospital Service Corporation) Mobile Health Services. Thankfully, their last fatal collision involving a responder was more than a decade ago, says Peter Dworsky, MONOC’s corporate director of support services. But reports from around the state heightened concerns over the reliance on lights and sirens to warn other motorists about an emergency vehicle’s approach. In the crashes involving his responders, the vehicles were running lights and sirens, but “the other cars just didn’t hear us,” Dworsky says.

To raise awareness about these hazards, the team at MONOC unveiled a groundbreaking video, “Driving Responsibly: The Truth About Sirens.”

Putting statistics to the test

Studies show that EMS personnel die more often than police and fire in traffic collisions; that many crashes are preventable; and that rapid EMS response with lights and sirens makes a difference only in a few circumstances, such as cardiac arrest, explains the voice-over on the seven-minute video.

Yet the video goes beyond simply citing statistics. To vividly depict the risks, MONOC — a nonprofit, 15-hospital cooperative that has 26 ambulance stations covering 1,800 square miles in New Jersey and provides EMS for 2.8 million people in 2013 — conducted a simulation in a suburban neighborhood to show how well-insulated vehicles, drivers listening to car radios and talking on cell phones, and vehicle air-conditioners compromise the ability of drivers to detect sirens.

In the simulation, an ambulance was driven at various speeds with the siren on various settings — wail, yelp or electronic air horn — while a second participant (the “driver”) parked in a passenger vehicle by the side of the road indicated how close the ambulance had to be before he could hear it coming.

With the windows closed, the radio on, the driver talking on a cell phone and the ambulance traveling at 25 mph, the driver could hear the siren from a distance of about 280 feet, or a warning time of seven seconds. If the ambulance drove 45 mph, the warning distance dropped to four seconds, “neither of which allows for a safe reaction by either driver,” according to the video.

“We want to get the EMS community to see that despite the sirens, which are very loud to us, the general motoring public doesn’t hear them, doesn’t care about them and doesn’t recognize them for what they are,” Dworsky says. “Even when people hear them, many don’t know what to do, so they slam on their brakes. We want our people to know that when they use lights and sirens, it’s actually going to put them at increased risk and we want them to weigh that against the criticalness of our patient.”

EMS safety experts are praising the video for educating responders about the limitations of what are supposed to be safety devices. “It’s an awesome video that shows the side of it we don’t often think about — the people sitting in the car with their radio and cell phone,” says Don Lundy, president of the National Association of Emergency Medical Technicians and EMS director in Charleston County, S.C.

Growing awareness of a serious problem

Unpredictable driver behavior is a problem everyone who has spent time in an ambulance has experienced, says Chuck Millican, assistant director of operations for Charleston County EMS.

“The reactions are everything from total disregard for the ambulance, to stopping in the middle of the intersection or the roadway, to pulling to the left vs. the right or the right vs. the left, to slamming on their brakes, to pulling in right behind you and trying to go through the intersection in our draft,” he says.

Whether it’s an ordinary accident or one in which an ambulance rushing to a call contributed to the crash, there’s growing awareness in EMS that simply being out on the road poses a major on-the-job injury risk. The National Highway Traffic Safety Administration estimates there are 10,000 ambulance crashes per year, leading to one fatality per week involving EMS responders, their patients, occupants of other vehicles or bystanders.

Part of the issue is a lack of training among responders, experts say.

“Paramedics receive about 1,300 hours of training over the course of nine to 14 months on the things they are going to do when helping a patient,” Lundy says. “That same EMS employee will receive, if we’re lucky, eight, maybe 16 hours of training on how to drive a vehicle at high rates of speed with lights and sirens. For a number of years, we as professionals have known that it’s one of the weak links in our training.”

Like many other agencies around the nation, since 2000, dispatchers in Charleston County use National Academies of Emergency Dispatch protocols to determine low-acuity calls, and ambulances no longer respond with lights and sirens.

In New Jersey, MONOC still responds to all calls with lights and sirens, although paramedics and EMTs can determine on scene if transports to the hospital are time-sensitive and need to go lights and sirens. The long-term goal is to decrease the use of lights and sirens, but one hurdle in improving triage is that police dispatchers answer all 911 calls, then contact EMS dispatchers if it’s a medical call. EMS dispatchers never actually speak to callers, Dworsky says.

The video supports the use of lights and sirens when dealing with a true emergency, but recommends improving patient triage by dispatchers to determine who truly needs a lights and sirens response.

“Unfortunately, many people get involved with EMS to drive fast. They don’t realize it doesn’t actually save much time, and when you do get to the hospital, you’re waiting in line to see the triage nurse,” Dworsky says. “It’s a cultural change that we’re going through.”

Produced in partnership with NEMSMA, Paramedic Chief: Best Practices for the Progressive EMS Leader provides the latest research and most relevant leadership advice to EMS managers and executives. From emerging trends to analysis and insight, practical case studies to leadership development advice, Paramedic Chief is packed with useful, valuable ideas you simply can’t get anywhere else.