William Torres Jr.
EMS Department Head
Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
The Ambulance Did Not Use Lights & Sirens! Does This Mean That They
Emergency Medical Service (EMS) providers have been driving to and from
emergencies or potential emergencies, with engaged lights and sirens,
for many years. There has been a conscious effort and due diligence completed
recently to evaluate the effectiveness and necessity of using lights &
sirens to respond to and from emergency calls. The latest study conducted
was by the U.S. Department of Transportation National Highway Traffic
Safety Administration Office of Emergency Medical Services.
All medical treatment modalities are continuously assessed to ensure the
benefits outweigh any associated risks. This study has equated the use
of lights and sirens to a medical treatment which should be monitored
and benchmarked. It also recommends that stringent criteria be established
by each EMS agency and every transport with lights and sirens be evaluated
through the agencies current quality assurance process.
Many EMS agencies have developed policies for responding to and from emergency
scenes. With the development and implementation of emergency medical dispatch
systems becoming more prevalent, EMS agencies are able to use an approved
and vetted algorithmic system to assess the need for responding to emergencies.
Our 911 Center, part of the Ravalli County Sheriff’s Office, adopted
the use and is a champion of emergency medical dispatch. This implementation
provides EMS agencies with the information necessary to dispatch the right
resource, to the right patient, using the right response.
There are many misconceptions that are mostly anecdotal and have never
been proven factual by any study or poll. One exception is that the use
of lights and sirens saves time. While statistically correct, the associated
risk far outweighs the benefit except for a very few medical conditions.
EMS providers can assess patients and provide lifesaving intervention
and transport to the closest most appropriate facility. Most studies show
savings of 3.8 minutes or less utilizing lights and sirens. There is far
better benefit when the patient, family, and EMS provider have a discussion
regarding the closest, most appropriate facility. This discussion can
benefit the patient because the service required may not be available
from the closest hospital. Choosing the closest hospital is not always
beneficial to a patient depending on the patient’s medical condition.
Another great way to save time when time is critical is by EMS providing
the receiving hospital with a notification prior to arrival. This provides
the facility time to have the appropriate staff at the bedside. Using
lights and sirens to transport to a hospital that is not able to provide
the necessary service or have not been notified will negate any benefit.
There are other misconceptions of the use of lights and sirens for either
responding to, or transporting a patient from, an emergency. Many agencies
use lights and sirens because the public perception and risk of receiving
complaints that the EMS providers did not care because they “took
their time” and did not use lights and sirens. This is not a common
complaint received by EMS agency leaders. Some EMS agencies use lights
and sirens because there is always a potential that the condition of a
patient may deteriorate. EMS providers are trained to assess and monitor
the current status and identify any change. Some EMS agencies use lights
and sirens because member retention may decrease if they are not able
to use lights and sirens. This is also that is anecdotal and certainly
not a good reason to increase risk to a crew or the public at large.
There are many risks associated to the patient, EMS provider, and the public
when using lights and sirens. 70% of ambulance accidents have lights and
sirens associated as a contribution factor. This is a major risk for all.
The patient condition may worsen due to increased stress or anxiety with
the loud noise. There is also some information that patients may choose
not to engage EMS because of the use of lights and sirens due to the increased
attention and noise. One increased risk specific to an EMS provider is
the possibility of suffering from hearing loss from the volume of the
siren. Newer ambulances have the siren located in the grill; however they
used to be mounted on the roof of the vehicle cab.
EMS agencies are continuing to evaluate the use of lights and sirens during
a response. Many have Emergency Medical Dispatch available which greatly
enhance the ability to gather information from a caller and provide the
right response for the patient presentation. Having lights and sirens
considered a lifesaving treatment that should be used judiciously and
appropriately is a huge change for EMS. Measuring the effectiveness will
be an ongoing process.
Please thank our EMS providers for all they do and for embracing the stringent
use of lights and sirens based on good clinical judgment and recommendations
from emergency medical dispatch guidelines. Their professionalism is exhibited
The health column is a brought to you by Marcus Daly Memorial Hospital.
For questions and or comments about this week’s health column, please
contact Willie Torres, Jr., EMS Department Head at Marcus Daly Memorial
Hospital, 1200 Westwood Drive, Hamilton MT 59840. Working together to
build a healthier community!