EMS agencies and their medical directors should be aware that a significant number of EMS personnel are injured during motor vehicle collisions while on duty and that emergency response “lights and sirens” is a significant risk factor for motor vehicle collisions. EMS agencies should continually review which types of calls really require an emergency response. In the July 2019 edition of the Annals of Emergency Medicine there was a very good study by Watanabe1 looking at the safety of “lights and sirens.” I recently reviewed part of this article at the March Medical Director update in Wilmington, North Carolina. I want to summarize a few key parts of the article to reinforce the need to be judicious when utilizing “lights and sirens.” The key point I want to drive home with my column this month is that “lights and sirens” is dangerous and only use when it’s really necessary.
The study looked at 20,465,856 dispatches using 2016 NEMSIS data. The paper showed that overall there were 12.4 crashes for every 100,000 ambulance runs. In the response phase for no lights and sirens the rate of crashes was 4.6 crashes for every 100,000 runs and the rate was 5.5 with lights and sirens. For the transport phase the no lights and sirens rate were seven and with lights and sirens the rate was 16.5 per 100,000 runs. The transports phase (no lights and siren to lights and siren) increasing from a rate of seven to 16.5 is a huge difference and implies a great deal of increased risk from using lights and sirens. In fact, the use of lights and sirens during the response phase more than doubles the risk of an accident.
Medical Directors and system administrators should review how calls are dispatched. This can be done by reviewing the different EMD cards used by emergency medical dispatchers. Every medical director should have the ability to make changes to how each individual call is dispatched. The paper makes the point that lights and sirens should only be used for time-critical calls such as airway compromise, respiratory failure, trauma requiring emergency surgery and patients with seizures that are not controlled. The process of reviewing how each type of call is dispatched, and response modes during transport, should be part of normal performance improvement processes. Failure to at least periodically review the mode of transport for the response and transport phases of each call could potentially result in some legal liability in the event that a patient, provider or other motorist/pedestrian is injured in a motor vehicle collision during EMS operations.
(1Watanabe BL, Patterson GS, Kempema JM, Magallanes O, Brown LH. Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes? A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. Ann Emerg Med 2019;74:101-9)