EMS: Lights and Sirens: “We Always Did It this Way”

First responders and firefighters are taught that to save lives they must get to the patient first, put water on the fire quickly, and transport to the hospital within the “golden hour” with sirens blaring and lights flashing.

What if I told you that driving lights and sirens to or from an emergency scene might improve the outcome of the call only slightly?

A rule plus flexibility

In 1994, the National Association of EMS Physicians and the National Association of State EMS Directors authored a position statement that identified an increased rate of traffic-related fatalities among law enforcement officers, firefighters and EMS practitioners who responded to emergencies using lights and sirens. Their paper stated that only 42 seconds–3.8 minutes might be saved by responding lights and sirens to or from a scene.

In 2018, Brooke Watanabe and her co-authors wrote “Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes?” The authors reported that lights-and-sirens response increases the chance of an EMS vehicle crash by 50 percent and almost triples the chance of crash during patient transport.

In July 2022, a Lawnside, NJ, firefighter was charged in a fatal crash that claimed the life of two people. The fire apparatus that he was driving struck a vehicle in oncoming traffic. The firefighter was driving with lights and sirens responding to a cardiac arrest.

Evan Darger, who is a 10-year career firefighter/paramedic, suggests a tiered response: Fire and EMS districts continue to respond lights and sirens to an emergency but empower their first responders with discretion when they transport to the hospital.

“It will be easier for providers to get on board with reducing the use of lights and sirens during transport as long as we’re shown that in the substantial majority of cases, we have all of the training and tools needed to mitigate the emergency we encounter,” Darger says. “If there is an intervention needed that we can’t offer, say in the case of stroke or STEMI, then that’s the time to utilize lights and sirens.”

The report from Watanabe and her co-authors contends that emergency vehicle crashes, in fact, cause delays to care and injuries to patients, EMS practitioners and the public. Crashes also increase stress and anxiety among emergency services personnel.

Less dangerous than currently

Despite the overwhelming evidence that shows that responding lights and sirens is inherently dangerous to first responders, 74 percent of EMS responses and more than 20 percent of EMS transports continue to run “hot,” according to the National Highway Traffic Safety Administration’s (NHTSA) 2017 report “Lights and Siren Use by Emergency Medical Services: Above All, Do No Harm.”

So, what’s the answer? Seemingly, the safest thing to do is to eliminate all emergency response that uses lights and sirens, right?

As Darger believes, empowering first responders to call an audible might improve some patient outcomes.

Stroke, STEMI, a motor vehicle collision with patient entrapment and a structure fire with trapped occupants all necessitate a rapid response. Furthermore, first responders are familiar with the phrase “time is muscle.” We also know that a modern fire doubles in size every two minutes. With that in mind, NHTSA’s study contends that, with appropriate training and adequate oversight, the use of lights and sirens could be less dangerous than it currently is. That said, “oversight” and “training” are great buzzwords regarding policy change, but buy-in at the street level is the other piece of the puzzle.

“This will be one of those cases of ‘We’ve always done it this way,” and habits like that can be very hard to break when you are talking to a group of people who are passionate about prehospital emergency care, even in the light of convincing data,” Darger offers.