EMS Lights And Sirens

At face value, prehospital emergency medical personnel's use of lights and sirens does not seem to be an area of high-value research or controversy. Drivers are all quite used to seeing emergency vehicles at work on the streets, lights flashing and sirens wailing. Both lights and sirens are, and for a long time, standard components of EMS vehicles. They are used both to decrease the time it takes emergency medical personnel to respond to the location of an accident, illness, or injury and the time it takes to transport the patient to a definitive care center. They are also used to keep medical providers safe while on the scene of an incident. The judicious and safe use of lights and sirens is a topic that has been well-researched recently, and how emergency medical service (EMS) providers use them has changed significantly over time. Their use presents quantifiable risks and benefits to EMS personnel and the public. Like any medical intervention, those risks and benefits must be thoughtfully considered and measured. This is to allow for the greatest safety for EMS providers and non-medical traffic and pedestrians, and the maximal benefit for the patients being transported for care. During the early years of EMS response, lights and sirens mirrored their use in the older and more established fire service. The typical thinking was that a fire could spread very quickly; the earlier firefighters arrived, the more likely lives and property could be spared. That logic was appropriate for EMS providers as well. The quicker a patient can be transported to a hospital, the higher the likelihood of a better outcome. Very early "ambulance drivers" were just that. They had little to no formal medical training and, in most instances, did not even travel with the patient in the vehicle's rear. Lights and sirens were used to get the patient to trained medical personnel as quickly as possible. Over the ensuing years, there began scrutiny of EMS protocols regarding the routine, unquestioned use of lights and sirens, looking at both the response phase of the call and the transport phase. As the training of EMS providers began and improved, EMS agencies rightfully started to see themselves as the prehospital adjunct to hospital-based emergency medicine. As such, they were subject to the same questioning of methods and research to evaluate those methods that emergency medicine physicians have come to expect and embrace. That research, performed mainly over the last 30 years, looked at emergency lights and sirens with specific questions: did they make EMS vehicles more conspicuous? Did they save time in EMS response and transport?  Did the time make a difference in the medical outcome of the patient?  These questions were asked and studied, all within the relative context of the risks that lights and sirens present to EMS workers and the public. Without evidence-based research, EMS providers' continued routine and unquestioned use of lights and sirens would be subject to time-honored and emotionally driven opinions by those who use them. The most deeply held belief is that using lights and sirens saves time and that time is paramount in medical emergencies. Indeed, medical professionals still teach the public and medical personnel at all training levels that "time is muscle/brain." There are expectations of the public that play a role as well, in that if their lights and sirens were not employed, then the EMS agency involved was not providing the urgency that a patient or family believes is warranted in their situation. Some would believe that the lights and sirens were a part of attracting new members to the job, and any decrease in their usage would damage recruiting. The companies that insure EMS agencies also played a role, believing that the routine use of lights and sirens made EMS vehicles and personnel safer, and their use was required for insurance purposes. If these views were to be questioned, protocols and attitudes toward using lights and sirens changed, then quality research was needed.