Hey Doc! Why don’t ambulances use their lights and siren anymore?

submitted by Ken Lavelle, MD, FACEP, NRP, BC-EMS, EMS Medical Director, Central Bucks EMS

Recently an ambulance was called to a local high school for a knee injury during a softball game. As it pulled into the parking lot, several parents saw that it was not using its “red lights and sirens” (RLS) and commented that they would never call this service for an ambulance because of this.

For decades, the prototypical view of an ambulance or a firetruck is it racing down the road with sirens screaming to get to some sort of emergency.

But the reality is, many of these calls are not true emergencies – where a few minutes will make a life or death difference in the outcome.

This might be an activated fire alarm at the local supermarket during the day, or the sprained knee in a softball player.

As we started doing research into the effects of the use of RLS, the findings were dramatic.

Per the National Highway Traffic Safety Administration, every year there are 4500 ambulance crashes and 33 deaths!

Seventy-five percent of these deaths were pedestrians or people in other vehicles that were struck, and a Denver study found that RLS accounted for 91% of all ambulance crashes.

What we must do is weigh this risk and benefit.

There is a risk in driving fast with RLS, but sometimes that risk is indicated based on the benefit to the patient.

Someone who is unconscious or not breathing, having chest pain or in cardiac arrest needs a rapid response.

But in patients with more basic complaints such as back pain, a fever, a headache or injuries from a minor car crash are unlikely to see any benefit at all from the use of RLS, but the risk to the public is present. Multiple research studies have found that the use of RLS only saves between one and four minutes in response time to the scene.

The dispatchers in the 911 center use an algorithm to evaluate the complaint and send the right resources in the right way.

If more information comes in while we are on the way, we will upgrade the response and use RLS.

Once on scene, the EMT or paramedic will evaluate the patient and decide again if RLS are needed to go to the hospital.

The vast majority do not – we can stabilize the patient, treat their pain or condition and transport safely without putting the public, ourselves or you at risk.

Not all EMS agencies and not all states are the same – some still use RLS for all responses despite the evidence of the risk.

But the next time you see an ambulance take a little longer to arrive at a less critical emergency call, instead of thinking, “What took them so long?” Instead perhaps say, “Thank you for arriving safety and being here to help us.”