Lights, Sirens, & Speed

I have
probably caused more initial friction with my new EMT’s over my driving
preferences than anything else. I really hate lights & sirens,
perhaps weird for a longtime Medic. Early in our getting acquainted, I
request that we never leave the scene lights & sirens unless I
specifically request them. This makes some folks nuts. In my last EMS
System, the County had the most insane policy of ordering all scene
responses lights & sirens. The dismal rationale is that if the
patient called 911, it must be an emergency. That meant everybody got a
little too used to running around hot.

I
always deeply resented that the County was willing to risk my life, my
partner’s life, and even the public – because they had been neck deep
in sand so long they never heard of Prioritized Dispatch. This is real
dangerous, and even those that attempt to support the practice, do so
with dubious evidence. One recently published study concluded that the
difference in time was worth the risk because they recorded a 4 to 6
minute shorter run to the hospital.  Some other
evaluations have concluded running hot saves an average of only two
minutes. Either way, I feel confident enough in my Medic skills to say
– “I can handle the extra few minutes of care without a problem”. After
all, how many times have you run hot to the hospital only to be told
"Stick him in room 3, the Doctor will be around after awhile.." – and
by the time you pack up and go the patient has still has not been
examined yet.

Frankly,
the only time this nominal transport time difference will ever matter
is on a multi-systems trauma patient, which all get flown anyway. The
benefit of saving just a few seconds on non-critical trauma and
emergency medical patients to me is not worth the cost. What is the
potential cost? 

The
cost could easily be your life, or even worse, the life of an innocent.
The cost is an unstable, and noisy work environment that makes it
harder to render high quality patient care. The cost is simply too high
for the little proven benefit in outcomes. A good, competent Paramedic
would rather be able to see & hear what is going on early enough to
do something about it. A good Paramedic will be just fine alone in the
back for a few more minutes. A good Paramedic relies on experience,
skill, and confidence – not just Speed & Prayer.

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About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I write about EMS Technology on the Paramedic Blog, the Insights on Innovation column for EMS1.com, on AmbulanceWorld.com and Multibriefs.com. I work for Intersurgical, Inc. managing EMS sales and distribution. I can be reached directly at 573-240-0002. Follow me @Paradan on Twitter
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11 Responses to Lights, Sirens, & Speed

  1. Strawberry says:

    So do you have a speed limit you have to follow when driving? Just surfin\’ and came upon your blog. Great writing. Never met an ambulance driver before or EMT. I\’m sure you\’ve been followed by LOTS of lawyers. Hope you have a great day and be blessed!

  2. Dan says:

    A good question – Actually some areas do have an emergency vehicle speed limit. I got a ticket many years ago for "going more than 10 MPH beyond posted limit" on an emergency run, which was a local ordinance. Some areas have different laws that apply. You always have an obligation to operate the vehicle in a safe manner. Ambulances cannot blow through an intersection, just because they are an emergency vehicle running lights and sirens. You must always slow to stopping speed at a red light, & make sure it is safe in all directions before proceeding. Thanks for asking, and the blessing.

  3. Nae says:

    I wanted to thank you for your supportive comments. Moriah and I took the tests this weekend … and we passed the praticals (and I\’m pretty sure we passed the written also). We will take your advice to heart if we need to speak to anyone about their behavior.God bless you and keep you,Nae :o)

  4. Unknown says:

    Hey, I stumbe upon your blog, as I was doing a browse….I realised you had link me at http://paramedicjournal.blogspot.com/.Well, I\’ve currently moved to a new site.http://onacrack.blogspot.com/By the way, I really enjoy reading your entries!I don\’t enjoy using the siren and lights in my ambulance as well…It gives me a terrible headache!!!!

  5. Unknown says:

    my names justin im an 18 y/o medic in michigan, im still in high school, and am looking for local jobs and also possibly a fire academy besides the one at the local community college do you have any suggestions on where i can look online for academies?

  6. Dan says:

    Call Tony Sorensen, Education Coordinator517-335-1825mailto:tsoren@michigan.govAt theMichigan Department of Community Health EMS & Trauma Systems SectionP.O. Box 30717Lansing, Michigan 48913for list of training programs in your area.Best of Luck, Dan

  7. Unknown says:

    Speed will depend on state law. Where I live, an Emergency Vehicle (as defined by state law…and including ambulances) can disregard traffic and parking laws as long as it is operating the red flashing lights and its siren.However, the driver must always drive with Due Regard for the safety of others. Meaning, it would not be with Due Regard to drive at 120 mph through a city, no matter the emergency. Typically, most services in the state have local protocols that state you cannot drive more than 10 or 20 mph over the posted speed limit while on a high priority call. When appropriate and when patient care demands it, the sirens and lights are not to be used (think baby with partial airway obstruction or seizure patient. that noise will not help them).

  8. Unknown says:

    Here\’s another study for you that supports your view:—Methodology: Ambulance transport times from the scene to the ED were compared using an experimental group that transported without lights and siren, and a control group using lights and siren. Routes and time length were recorded by an observer during actual patient transport. A simulated transport was then performed during the same day and time without the use of lights and siren, and obeying all traffic regulations. The driver re-corded the length of the transport.Results: The ambulances using lights and siren averaged 43.5 seconds faster than those that did not use lights and siren. The range of transport times with ambulances using lights and siren was 104 to 927 seconds with a mean of 362 seconds. The range of transport times of ambulances not using lights and siren was 129 to 881 seconds, with a mean of 406 seconds.All ambulances in the lights and siren group used flashing red warning lights and most used sirens intermittently. Forty-one of the lights and siren transports, and the 41 corresponding simulated transports, took place on a weekday. All were conducted on dry roads with full visibility.Conclusions: Except in extreme clinical circumstances, a mean savings of 43.5 seconds does not warrant the use of lights and siren during ambulance transport.Citation: Hunt RC, Brown LH, Cabinum ES et al (Pitt County Memorial Hosp, Greenville, NC, USA) Is ambulance transport time with lights and siren faster than that without? Annals of Emergency Medicine 1995; 25:507-511 (11 ref). from Emergindex® Clinical Abstracts—One of the things I noticed on a recent shift is the number of unnecessary code 3 (lights and siren) responses we were dispatched for that could have been served by a code 1. FD in our system has a significantly expanded footprint and quicker response. FD does BLS, and also can call dispatch to request a change in code priority. It seems more common to upgrade call priority rather than downgrade it. We responded to numerous calls that were dispatched as Code 3, only to arrive and find a stable, ambulatory pt that was refusing transport. FD did not request a downgrade.This endangers the ALS crew, the general public, and can cause unncessary psychological stress on the pt. who may report feeling fine, but see an ambulance pull up code 3, and start to wonder "maybe I am really sick." It\’s not only the responsibility of FD, but also good dispatchers, and informed PD to evaluate whether a code 3 response is truly warranted. I suspect that further education of first responders would reduce the number of code 3 calls. Mostly, if nothing else, it would save the ALS crews the stresses involved in a high priority dispatch.

  9. Robert says:

    And here is yet another study that supports your views. In mid-1997 at about 3am on an interstate highway, during a rainstorm, I was attending an imminent birth and the EMT was driving, lights and sirens, at 10mph above the posted speed limit. Technichally, she was right according to company policy.The lights caused a glare on the road and windshield, causing her not to see a vehicle that had wrecked moments before we arrived at the same piece of road. Our ambulance hit the car broadside and killed an otherwise shaken but uninjured lady. The lights actually hindered us in that situation and only helped in the sense that the bystanders had more time to dive for safety as we crested the small hill.

  10. Robert says:

    I forgot to put the whole reason I placed that last comment. I am getting a bit senile in my old age. Since that incident, I have CAREFULLY weighed my options and have found that in almost all cases, excepting gridlocked rush hour traffic, lights and sirens do nothing but frighten patients and other drivers as well as give me a headache. I also spend an inordinate amount of time worrying about what is happening up front as opposed to what is happening in the patient compartment!

  11. Unknown says:

    Hi Dan Totally agree about the use of Lights and sirens. Running hot to hospital is only ,I think, applicable to a tiny group of patients. This subset are more than likely critically ill and might benefit from those precious few minutes. My system doesn\’t even run to that many jobs on lights. That way you are only using these devices for people that actually need them and are ensuring staff and public safety. The other benefit is that for those calls where people aren\’t sick or have called inappropriately. You arrive in good time but are not in a bad frame of mind. You deal with these calls but without the shouting match that they can descend into. I\’ve been thrown around in the back enough times to hate it. I know its doing no good for the patient or me. I find it amazing that there are organisations that have such little regard for their staff or the public. I still think driving on lights and sirens is a skill. One that should be done smoothly, safely and progressively but only used when necessary. Take care,PeteH.

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