Why are we still running emergent?
The time has come for EMS leaders and clinicians to take a data-informed look at how we operate apparatus and the risks involved
Less than 5%!
A 2017 study by Murray and Kue estimates less than 5% of 911 calls truly warrant an emergent response . That is 1 out of 20 calls where lights and sirens may result in a significant difference for a patient.
Ask yourself, how often are you running emergent? Are you running emergent to a two-vehicle MVC with reports of no injuries, “just in case”? Many of us were raised in a fire and EMS culture which required a lights and sirens response everywhere we went. Maybe we engaged in the practice because we could, maybe we honestly believed that we were getting somewhere a few seconds faster, or maybe we just saw Johnny and Roy do it, so we thought it rounded out the image of what we should be.
Who is injured or killed in ambulances crashes?
At least 13 ambulance crashes happened in the month of November, with paramedic David Eads ultimately losing his life. The time has come to take a serious look at how we operate apparatus and risks involved.
There are an average of 29 fatal crashes per year involving ambulances with an average of 33 fatalities each year . When examining the fatalities, “25% of fatalities are inside the ambulance, with the other 75% most often being the driver or passenger of the vehicle which struck or was struck by an ambulance” . Estimates place the number of non-fatal crashes involving ambulances as high as 1,500 per year, with 46% of injuries in these accidents incurred by occupants of the ambulance . Reports from the National Highway Transportation Administration (NHTSA) indicate that between 2002-2012, 49.3% of fatalities involving emergency vehicles occurred with lights and sirens active . Researchers also report a significant increase in the risk of emergency vehicle collision at speeds over 50 MPH .
While the relationship between speed and collisions seems obvious, if we correlate higher rates of speed with emergent responses, the relationship becomes clearer; speed kills. Bottom line, 60% of fatal ambulance collisions occurred while lights and sirens were in use .
The data present in available literature certainly paints a vivid picture regarding the use of lights and sirens. Emergent responses increase the risks for collisions and fatalities. Secondary to the increased risk of collision, is the financial component of these incidents, which according to Murray & Kue could amount to around $500 million per year in damages, lost time, etc. .
How to avoid, survive an ambulance collision
Ambulance collisions, which happen with frightening regularity, often result in injury and are occasionally fatal, especially for private vehicle drivers
How much time do we save running hot?
A study conducted in Syracuse, New York, found an average of 1 minute 46 seconds was shaved off of the response time to scene when utilizing lights and sirens, and a study conducted in Greenville, North Carolina, demonstrated an average of 43.5 seconds saved on the return to the hospital from scene when utilizing lights and sirens .
As clinicians, we must ask ourselves and honestly answer these questions:
- How many of our patients will truly experience a significant difference in outcome secondary to these changes in response and return time?
- While numerous reasons exist to decrease or even eliminate the use of lights and sirens, could there be some scenarios which warrant these emergent responses?
- Could there be situations where lights and sirens responses are not only warranted, but even recommended?
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
Is the shorter response time worth the risk?
There are certainly situations, like an infant choking or an open chest wound, wherein a minute could legitimately be the difference between life and death. You’ve probably heard that there is a 10% decrease in the likelihood of resuscitation from ventricular fibrillation for every minute that defibrillation is delayed, which is a common argument for expedited response to a patient in cardiac arrest .
Based upon the conclusions drawn by Murray & Kue, that only 5% of 911 calls warrant an emergent response, the calls where a 1 minute, 46 second time difference is of meaningful significance are the exception and not the rule. If these calls are the exception and not the rule, why are there still jurisdictions where emergent response is the rule rather than the exception?
Is an emergent response the exception or the rule in your agency?
I have heard the arguments from all sides. “This is great, but it doesn’t apply to rural areas,” “This may be true in a smaller city, but it’s different in Los Angeles or New York.” The reality is, traffic congestion is traffic congestion in any city, and greater distances are greater distances in any locality.
If we do the simple math for a rural area, a distance of 60 miles traversed at 60 mph will take 60 minutes. If we increase the speed to 70 mph, we will make the sixty-mile trip in roughly 51.4 minutes.
If we are taking nearly an hour to get to a call, will 8.5 minutes make a significant difference? I don’t believe the increased risk of an injury accident to the ambulance crew or other drivers justifies the 8.5-minute improvement in response time. Furthermore, if a patient has been in cardiac arrest for 51 minutes, the likelihood of resuscitation is so miniscule as to not be a determining factor in the speed of response.
Every system has unique needs and response challenges; as a profession, we must remain cognizant of the most valuable resource our agency has, our providers. Agencies must look at the available data and develop response guidelines based upon real data. Any loss of a provider is unacceptable, perhaps even more so when that loss occurs secondary to an unwarranted emergent response.
1. Murray B, Kue R. (2017). The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: A comprehensive review of the literature. Prehospital and Disaster Medicine, 32(2), 209–216. https://doi.org/10.1017/s1049023x16001503
2. Smith N. (2015, September). A National Perspective on Ambulance Crashes and Safety. EMS World.
3. NHTSA FARS and GES Reports, (2002-2012). Retrieved from http://www.nhtsa.gov/FARS and https://www.nhtsa.gov/national-automotive-sampling-system/nass-general-estimates-system.
4. Missikpode C, Peek-Asa C, Young T, & Hamann C. (2018). Does crash risk increase when emergency vehicles are driving with lights and sirens? Accident Analysis & Prevention, 113, 257–262. https://doi.org/10.1016/j.aap.2018.02.002