Ambulances play a key role in emergency responses, with the expectation that they will arrive on scene, and later arrive at the hospital in a quick fashion. To help with the fast arrival times, ambulances travel in “emergency modes” turning on both their lights and their sirens allowing them to bypass certain roadway rules. Even though it is effective in cutting down transport time, it may increase the risk of being involved in a collision and may pose risks of injury not only to onboard personnel but pedestrians and other vehicle occupants (Missikpode, Peek-Asa, Young, & Hamann, 2018).
The purpose of this review is to look at current literature on emergency vehicles driving with lights and sirens in order to gain a more comprehensive understanding of the risks that they may pose on the EMS personnel, patients and the general public.
The benefits of emergency lights and sirens use as warning devices for others around has continued to be a highly debated topic in Emergency Medical Services.
A study done by the National Highway Traffic Safety Administration (NHTSA) from 2001-2010, revealed that 368,946 emergency vehicles (ambulances, police and fire) were involved in collisions during that time period, as opposed to the previous 10 years where 302,969 collisions were reported (Ray and Kupas, 2005). In 2002, the NHTSA also reported that of the fatalities involving emergency vehicles in the last 10 years, 49.3% had occurred when the vehicle was operating in emergency mode (NHTSA FARS and GES Reports, 2002). Moreover, there were 131 fatalities reported to be due to emergency vehicles, with 46% occurring while the vehicle was driving in emergency mode (NHTSA FARS and GES Reports, 2012).
This was also supported by another study that looked at 1980s United States data, which stated that there were more than 12,000 motor vehicle collisions involving EMS vehicles, and four times that many non-EMS vehicle accidents that responded to EMS vehicles driving in emergency mode.
Another study pointed out the need of lights and sirens when driving to the scene as opposed to driving the patient to the hospital (Murray and Kue, 2017). It stated that it is important to distinguish between the ambulance response time and the ambulance transport time, since in most scenarios the response time should be prioritized and therefore should be shorter than the transport time. This is due to the fact that there will usually be no health care professional that will respond and care for the patient while the ambulance is on route (Murray and Kue, 2017). Once the ambulance arrives on scene, the patient can be stabilized (if need be) and the need for a quick transport to the hospital will be decreased, thus omitting the need to travel with lights and sirens. A fourth study weighed the positives and negatives of driving emergency vehicles with lights by looking at time spent responding and transporting a patient. Using data from studies over the last 25 years, it found that the use of lights and sirens decreased ambulance response time between 1.7-3.6 minutes and reduced transport time by 0.7-3.8 minutes (Neulander and Mountfort, 2018). While the response/travel times were shortened, the study also found that only about 5% of the cases observed had experienced a clinical difference from the reduction in prehospital EMS time.
With previous research strongly hinting at the connection between EMS vehicles driving with lights and sirens and the number of motor vehicle collisions associated with those EMS vehicles, it is difficult to say where the line should be drawn when it comes to ambulances driving with lights and sirens. Without lights and sirens the ambulance might not make it to the patient or hospital in time, whereas with lights and sirens the ambulance might not make it to the patient at all and put the general public in danger as well. The studies that have been looked at in this literature review have all agreed on the increased number of motor vehicle collisions that occur when an EMS vehicle drives with lights and sirens. With this in mind researchers should now look into what could possibly help in decreasing response and transport time without increasing the danger to the patient, personnel and the public. Potentially, a design change in the ambulance lights and sirens could help reduce the number of motor vehicle accidents (Murray and Kue, 2017).
Reducing the volume of the siren and the glare of the lights can decrease the surprise reaction that the EMS vehicle produces in the general public that is around, thus helping the people respond to the emergency in a safer/more thought out manner. Additionally, stricter rules could be placed on EMS personnel operating the emergency vehicle, such as a speed limit when driving with lights and sirens turned on especially when driving through intersections. A study done on ambulance collisions in the U.S. found that over 50% of the collisions occurred while the ambulance was going through an intersection (Murray and Kue, 2017). Furthermore, all EMS drivers should be screened prior to being allowed to operate ambulances, which is not an unreasonable expectation since EMS providers are involved with promoting public safety. A study done over eight years on emergency vehicle collisions in Denver, Colorado found that in 71% of the collisions, the driver had a history of multiple prior emergency vehicle collisions (Custalow and Gravitz, 2004).
This could have a significant impact on the number of emergency vehicle related collisions if a stricter screening process was implemented for the drivers. Moreover, EMS personnel and patient safety should also be emphasized by ensuring that everyone on board the vehicle is strapped in (in case of an accident), even if the EMS personnel are busy assisting the patient on route. Research should also be conducted on how the ambulance could have a safer interior design, with research pointing to the chances of death or sustaining a serious injury in the rear compartment 2.7 times higher than when sitting in the front compartment (Kahn, Pirrallo & Kuhn, 2001). This should not come as a surprise since the rear compartment sees a limited use of safety restraints by the EMS personnel, as well as poorly restrained medical equipment and design risks such as sharp edges and multiple cabinets (Slattery and Silver, 2013). Redesigning the ambulance could have a positive impact on the safety of the EMS personnel and patients, resulting in less fatalities and injuries if the vehicle were to be involved in a collision.
In recent years there has been numerous research conducted on the relationship between EMS vehicles driving with lights and sirens vs. the number of motor vehicle collisions. What was found is that driving with lights and sirens did correlate with an increase in accidents of not only other cars, but the EMS vehicle itself. Although the research points to a negative side effect of the lights and sirens, the lights and sirens should not be completely removed from the emergency vehicle, since this allows the vehicle to alert other drivers and bypass some of the main road rules. Prior screenings and stricter rules should be enforced on drivers driving with lights and sirens, to ensure a safer road environment. Additionally, more research needs to be conducted on different ways the EMS vehicle could be manipulated to reduce the number of accidents related to it driving in emergency mode. A solution for decreasing motor vehicle collision accidents associated with EMS vehicles should be found without having to get rid of the lights and sirens system completely.