Lights and sirens - not so fast
It is common knowledge that 70% of fatal ambulance crashes occur with lights and siren activation. NHTSA recently published “Lights and Sirens Use by Emergency Medical Services: Above All Do No Harm.” You might recognize the “do no harm” from “Primum Non Nocere”, which is loosely translated as at first, do no harm. It really means at first, not to kill. It’s important to stress the kill part. Remember, in fatal crashes the emergency vehicle operator (EVO) is killed only 4%, ambulance passengers 21%, occupants of other vehicles 63%, and non-occupants 12%. If involved in one of these deadly crashes, as a driver you are most likely to survive and quite likely to have your driving behaviors evaluated. It’s probably a good idea to be in compliance with any laws.
Laws for emergency medical services
Laws vary from state to state. It’s your job to know what they are. Any statements about laws are not intended to indicate an exhaustive review by a lawyer. They are merely examples to activate your interest. Although the uniform vehicle code does not require vehicles with activated lights and sirens to stop at traffic signals, Alaska, Massachusetts, New Jersey, and Pennsylvania require a full stop at the sites. Compliance with the posted speed limit varies. Some states permit excesses of 10 to 15 mph above the posted speed limit while others have the posted speed limit as a maximum. The concurrent use of lights and sirens may be required, lights or sirens used singly may be permissible. Whatever you do, you should use due regard. Due regard means that you are actually thinking about driving while driving. This allows you to prove that you used a level of competence that may reasonably be anticipated from any similarly trained individual. If you’re starting to think that this sounds like a standard of care, you’re right.
Determining the risk-benefit ratio
Where is a starting point to obtain the medical information necessary to determine if the risk benefit ratio is appropriate? Dispatchers need to be formally trained and clinically competent. The dispatch process must involve structured call-taking with key questions, pre-arrival instructions, and appropriate prioritization. Is the clinical condition time sensitive? Will EWS activation response impact outcome? STEMI, stroke, and trauma programs have time sensitive components related to accessing distributed resources. Time priority events, cardiac or respiratory arrest, airway problems, unconsciousness, severe trauma/hypovolemic shock, and true obstetrical emergencies are examples of conditions for which EWS response is planned and executed. Contractual relationships delineating response time obligations should be based on the priority of care required. Note that requirements, such as arrival within 8 minutes 90% of the time, have no association with improved clinical outcomes. It increases the likelihood of crashes and elevates stress for both EMS providers and the public. Response time requirements based on arbitrary geographic boundaries that are unrelated to call volume density, access to hospital, or specialized medical resources are wasteful creating operational inefficiencies and enhance the aforementioned dangers.
Naturally, public education is necessary to alter the distortions presented in the entertainment media. The depiction of unrealistic driving behavior, coupled with uniformly miraculous clinical outcomes, create expectations that can never be met. Properly trained dispatchers should provide pre-arrival instructions, obtain relevant clinical information, and discover any information that may impact scene safety. This creates some level of scene control. It also enhances operational efficiencies by providing care prior to the arrival of the ambulance and making the ambulance crew better able to provide care when they do arrive by making them better informed. Dispatchers are an important part of ambulance safety. They should be utilized systematically as part of the “Culture of Safety”.
- Kupas, DF, “Lights and Sirens Use by Emergency Medical Services: Above All Do No Harm”, submitted by Maryn Consulting, Inc., for NHTSA Contract DTNH22-14-F-00578, May, 2017
- Szczygiel, M. (ED.) EMS Safety, Burlington, MA:, Jones & Bartlett Learning, 2017