By Ian Ferman
The average citizen can face some hefty fines for driving recklessly. Oftentimes, ambulances will drive in a similar manner while responding to calls for help. Why is it that when emergency vehicles behave this way with lights and sirens on, it is seen as normal and necessary, yet when the average Joe does it, it is suddenly a moving violation? Yes, they are rushing to help someone who called 911, but does that justify jeopardizing the safety of others?
Before we criticize this practice, it is important to look at the history of emergency responses, which started with fire services. With calls involving house fires, every second counts—and the difference between a rapid and normal response can change lives. When ambulances came into practice, their drivers were not trained medical professionals. In fact, providers joke that one of the earliest slogans for EMS was “You call, we haul” because most of the time, the only way these civilian volunteers could help was by transporting patients to doctors in a hospital.
For EMS calls, using lights and sirens, or “running hot,” is rarely as necessary as civilians perceive it to be. Around 75% of EMS calls are responded to with warning devices. In reality, only 5% of patients clinically benefit from quicker transport to the hospital (Renault, 2023, para. 3). Moreover, ambulances were involved in 4,500 traffic accidents from 1992-2011 (NHTSA, 2014). The vehicles that are supposed to be saving lives are also harming innocent civilians.
So, if the dangers of hot responses negatively impact this many people, then – surely – there must be clinical data validating the use of lights and sirens, right? Well, no. A 2017 study by Cambridge University found that the use of lights and sirens posed a risk to other drivers and had no significant impact on patient outcomes (Murray and Kue, p.215). This is no surprise when we consider the numerous horror stories of crashes involving emergency vehicles.
One of these tragedies took place in New Jersey. Seventeen-year-old Sharron Frieburg started her day looking forward to her basketball game; On the way to her game, Frieburg had been driving through an intersection on a green light when her truck was tragically rammed by an ambulance that had run a red light while “running hot.” When she was finally discharged from the hospital, Frieburg was a paraplegic.
Reading this, it’s easy to be angry at the ambulance driver for driving dangerously, but extenuating circumstances could have warranted the risky driving…right? Somebody could have been having a heart attack in the back or maybe a pregnant mother was in serious distress. In reality, the patient the ambulance was transporting had a broken ankle. A broken ankle. Frieburg’s entire life was turned upside down because an ambulance was taking someone to a hospital for an X-ray. This was not a critical patient, nor would they have benefitted from a quicker transport.
New Jersey State law, as well as the National Registry of Emergency Medical Technicians (which standardizes regulations for 48 of the United States), both require that ambulance drivers operate with “due regard for the safety of all persons” and they specifically prohibit all reckless driving – regardless of patient condition. So, why do EMS providers drive dangerously? Many studies examine the effect emergencies and the use of lights and sirens have on the mindsets of ambulance drivers, and even these professionals get excited in the heat of the moment. Essentially, a lot of weight falls on the shoulders of providers when they have to decide whether or not to run a call hot.
There are two main ways to minimize human error and alleviate the stress that is added to work in the field by emergent transports:
1. Every EMS call starts with dispatch. Dispatch systems across the country are consistently unreliable and inaccurate for providers, but more effective and efficient dispatching operations may provide ambulance services with the information needed to determine whether or not a call requires a critical response ahead of time.
2. Also, there must be clear-cut guidelines for what warrants a “hot” transport and what does not. Protocols only establish the patient priority system that providers use to communicate with hospitals. They do not specifically mention or recommend how agencies should approach transport for each call. The decision ultimately lies in the hands of providers who are also responsible for all other procedures on scene.
Although we see lights and sirens as a way to prioritize traffic so that those who need help can get it quickly, they are often not necessary. Providers overuse emergent transports while ambulances continue to cause crashes and jeopardize public health. Sharron Frieburg was not the first person to be harmed by unnecessarily hot runs, and she won’t be the last. Though accidents will always be a risk for ambulances, their prevalence can be significantly diminished with laws protecting all people.
Works Cited
Archive, V. A., & feed, G. author R. (2022, November 25). I dove into a pool at a party and woke up quadriplegic. https://nypost.com/2022/11/25/i-dove-into-a-pool-at-a-party-and-woke-up-quadriplegic/
International academies of emergency dispatch. (n.d.). Retrieved April 11, 2024, from https://www.emergencydispatch.org/the-science/legal-liability-risk/93070827-4466-4c3f-8dbb-104cd3528cd9
Lights-and-siren hazards. (n.d.). IAED Journal. Retrieved April 11, 2024, from https://www.iaedjournal.org
Murray, B., & Kue, R. (2019). The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: A comprehensive review of the literature – addendum. Prehospital and Disaster Medicine, 34(3), 345–345. https://doi.org/10.1017/S1049023X19000062
New guidance to improve response and reduce injuries and fatalities. (n.d.). U.S. Fire Administration. Retrieved April 11, 2024, from https://www.usfa.fema.gov//blog/new-guidance-on-emergency-medical-services-use-of -lights-and-siren/
Renault, M. (2023, July 7). Emergency lights and sirens on ambulances may do more harm than good. STAT. https://www.statnews.com/2023/07/07/emt-ambulance-emergency-lights-sirens/
Rosenthal, E. (2013, December 4). Think the E.R. is expensive? Look at how much it costs to get there. The New York Times. https://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the ambulance-bill.html
Staff, Azf. D. N., & Prelutsky, Z. (2024, February 18). 1 dead, 1 critical in I-10 crash involving ambulance in Pinal County; Lanes reopen. Https://Www.Azfamily.Com. https://www.azfamily.com/2024/02/18/least-one-person-dead-after-crash-i-10-near-pinal-county/
“The NHTSA and Ambulance Crashes.” 2014; April. National Highway Traffic Safety Administration (NHTSA). https://www.ems.gov/pdf/GroundAmbulanceCrashesPresentation.pdf