A Public Health Practitioner’s Focus on Emergency Response Vehicle Operations Policy and Planning

By: William (Bill) Raynovich, EdD, MPH

On August 25, 2015, I was interviewed by Radio KFM 90.5, located in Busan, South Korea, a metropolis of more than four million people and the World’s 5th largest shipping port. They interviewed me about the use and abuses of ambulance sirens. In listening to the nearly hour long lead up to my interview and several calls from listeners, I was struck by how universal this issue is among different cultures across the globe. As a public health practitioner and EMS educator, I am motivated to share my views for the general public health and EMS communities as this is a point of interdisciplinary intersection.

Introduction

The field of emergency medical services (EMS) is esoteric and, in some respects also peculiar, in that it bridges the fields of public health, medicine, and transportation. Given this shared regulatory structure and the general public heath interest, public health practitioners and agencies must have a solid and well-rounded understanding of the complexities involved in EMS financing, planning, training, policy development and post-event analysis.

This article examines several of the confounding elements involved with common views surrounding the abuse of lights and sirens by crews, as well as examining some of the legal issues and technological solutions that are currently in place and are also rapidly becoming increasingly prevalent.

The Evidence

Although there is a noticeable lack of scholarly evidence on the topic of siren abuse, a search engine query reveals a few themes that are common among the general public globally(1-6):

(1)  Many EMS Crews utilize sirens to transport patients for which there is no medical urgency.

(2)  Many people in the general public abuse the emergency response system to call for emergency services for minor and chronic illnesses and injuries, thus causing additional stress to the system and preventable vehicular accidents and injuries.

Siren Abuse Exists

Some emergency crews over past decades have regrettably abused the use of warning lights and sirens to be able to speed through traffic for personal non-emergency reasons, and sometimes, just for convenience. How do I know this? I’ve been active in the field of emergency services for nearly 50 years. I also have never personally used lights and sirens for my own convenience and it is my preference to suppress their use whenever using them serves no purpose – that is, results in no added safety or unnecessary speed. Aside from my first-hand knowledge, however, there are several articles published by experts in the field that speak to the overuse of sirens and those experts also recommend using the devices more judiciously, as a reduction in accidents has been shown to occur when siren use has been experimentally suspended in a trial period.(5,6,7)

Understanding the Risks

However, even if there were no abuse of sirens, or any warning devices, among emergency vehicle operators, would there be a rationale for allowing the use of the devices for critical emergencies when life and death are at dire risk? In other words, do the benefits of time-saved, if any, outweigh the risks of increased accident rates, and accidents occurring at higher rates of speed?

In considering the time saved by ambulance warning devices and the difference in outcomes, the scholarly literature on this topic provides a number of valuable insights for the public health practitioner to consider. First, the use of ambulance sirens has been shown to decrease the response time for ambulances to arrive at the destination by approximately 30.9% (p < 0.1) in a prospective observational study.(7) However, another study has shown that slower response times (i.e, increased times for emergency vehicles to arrive at the patient and then the additional time to get the patients to hospitals) have not resulted in worse outcomes, even for serious trauma patients.8 Still other studies suggest that while there are significant time differences and some outcomes may be affected, the relative benefit to risk ratio may be insignificant and the ultimate benefit likely does not outweigh the risk.(9)

As a public health practitioner serving on a policy board or advisory committee, both sides of this argument should be considered, and the tradeoffs acknowledged. Life and death are at stake. Would you want to have a small fire having just started in your house and have the fire crew travel to your home obeying all of the traffic laws on the way? Would you want to call for the police if you heard a burglar starting to jostle your back window and have them obey all of the traffic laws on the way to your house? You are in an automobile accident and you feel yourself losing consciousness with a severe open wound bleeding and you are beginning to have difficulty breathing. Do you prefer the ambulance crew take their time on the way to help you, or might you prefer that they warn the oncoming traffic and pass through the traffic signals safely and, when safe, pass vehicles in an oncoming lane, such that their driving would otherwise be illegal? It is incumbent to answer these questions honestly to be able to place yourself reflectively in that policy advocacy and decision-making position.

Conclusion

A narrowly focused issue, such as the use of sirens on ambulances, may only be at the periphery of public health practice; however, the influence and responsibilities that a public health practitioner may at the policy- level can be profound when the public health professional is well-informed and has substantiating sources in hand.

It may be useful for all public health practitioners to view this particular issue as an exemplar for policy analysis and advocacy issues that occur when developing public health policies in general.

William Raynovich, EdD, MPH is an Adjunct Associate Professor in Creighton University’s Master of Public Health program. He has served on the board of the National Association of EMS Educators.

References:

  1. Editorial complaining about ambulance siren abuse in Guyana. http://www.kaieteurnewsonline.com/2014/11/12/abuse-of-an-emergency-privi... Downloaded from the internet March 27, 2016 (originally posted 11/12/2014).
  2. Emergency Vehicle Response. FireCompanies.com  Downloaded from the internet March 27, 2016. (Originically posted 1/1/1995) http://www.michaelwilbur.com/news/fullstory/newsid/122992
  3. Abuse of Ambulance Sirens (blog) http://forums.digitalspy.co.uk/showthread.php?t=1979953 downloaded from the internet March 27, 2016 (original posting 2/7/14)
  4. Two sides of the story (blog) http://forums.anandtech.com/showthread.php?t=1444727&page=2 Downloaded from the internet March 27, 2016 (original posting 2/7/14)
  5. Emergency Vehicle Response. FireCompanies.com  Downloaded from the internet March 27, 2016. (Originically posted 1/1/1995) http://www.michaelwilbur.com/news/fullstory/newsid/122992
  6. Lindstrom, AM. Less use of lights and sirens. JEMS Online, May 31, 2011. Downloaded from the internet March 27, 2016 http://www.jems.com/articles/print/volume-36/issue-6/administration-and-leadership/fdny-limits-use-lights-sirens.html
  7. Ho J, Lindquist M. Time saved with the use of emergency warning lights and siren while responding to requests for emergency medical aid in a rural environment. Prehospital Emergency Care: Official Journal Of The National Association Of EMS Physicians And The National Association Of State EMS Directors [serial online]. April 2001;5(2):159-162. Available from: MEDLINE Complete, Ipswich, MA. Accessed April 1, 2016.
  8. Weiss S, Fullerton L, Oglesbee S, Duerden B, Froman P. Does ambulance response time influence patient condition among patients with specific medical and trauma emergencies?. Southern Medical Journal [serial online]. March 2013;106(3):230-235. Available from: MEDLINE Complete, Ipswich, MA. Accessed April 1, 2016.
  9. Brown L, Whitney C, Hunt R, Addario M, Hogue T. Do warning lights and sirens reduce ambulance response times?. Prehospital Emergency Care: Official Journal Of The National Association Of EMS Physicians And The National Association Of State EMS Directors [serial online]. January 2000;4(1):70-74. Available from: MEDLINE Complete, Ipswich, MA. Accessed April 1, 2016.