Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-23T08:41:01.244Z Has data issue: false hasContentIssue false
  • English
  • Français

The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature

Published online by Cambridge University Press:  30 January 2017

Brett Murray  and
Ricky Kue
Brett Murray
Affiliation:
Boston University School of Medicine, Boston, MassachusettsUSA
Ricky Kue*
Affiliation:
Boston University School of Medicine, Boston, MassachusettsUSA Boston EMS, Police, and Fire Departments, Boston, MassachusettsUSA
*
Correspondence: Ricky Kue, MD, MPH, FACEP, FAEMS Associate Medical Director Boston EMS, Police, and Fire Departments 785 Albany Street Boston, Massachusetts 02118 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The benefits of emergency lights and sirens (L&S) use as warning devices by ambulances continue to be a debated topic in Emergency Medical Services (EMS). While the most widely studied aspect of L&S use has been related to their effect on ambulance response and transport times, the literature suggests minimal time savings with more questionable impact on actual patient outcomes. As L&S use has been shown to increase the risk for vehicle crashes, the secondary concern of ambulance design and safety also becomes an important aspect on potential design recommendations that could mitigate the effects of a crash on patients, EMS providers, and the general public. The least studied aspect of L&S use (and probably the most important) is their effect on patient outcomes and quality of medical care during transport. The current evidence suggests no significant improvement on patient outcomes and potential worsening to certain aspects of patient care during transport. The purpose of this review was to examine the current literature regarding ambulance L&S use and the risks they pose to EMS providers, patients, and the general public. In doing so, it will provide sound background for EMS leaders to better develop policies governing the use of L&S by ambulances and promote better research in the patient outcomes effect associated with their use. This review offers some strategies in mitigating the risks associated with L&S use, such as ways to reduce their overall use and modifying other related factors to emergency medical vehicle collisions (EMVCs).

MurrayB, KueR. The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature. Prehosp Disaster Med. 2017;32(2):209–216.

Keywords

ambulanceEmergency Medical Serviceslights and sirenspatient safety
Type
Comprehensive Reviews
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 2 , April 2017 , pp. 209 - 216
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. Larmon, B, LeGassick, TF, Schriger, DL. Differential front and back seat safety belt use by prehospital care providers. Am J Emerg Med. 1993;11(6):595-599.Google Scholar
2. Custalow, CB, Gravitz, CS. Emergency medical vehicle collisions and potential for preventive intervention. Prehosp Emerg Care. 2004;8(2):175-184.Google ScholarPubMed
3. Becker, L, Zaloshnja, E, Levick, N, Li, G, Miller, TR. Relative risk of injury and death in ambulances and other emergency vehicles. Accid Anal Prev. 2003;35(6):941-948.CrossRefGoogle ScholarPubMed
4. Ho, J, Lindquist, M. Time saved with the use of emergency lights and sirens while responding to requests for emergency medical aid in a rural environment. Prehosp Emerg Care. 2009;5(2):159-162.CrossRefGoogle Scholar
5. Brown, L, Whitney, C, Hunt, R, Addario, M, Hogue, T. Do warning lights and sirens reduce ambulance response times. Prehosp Emerg Care. 2000;4(1):70-74.Google Scholar
6. Chung, TN, Kim, SW, Cho, YS. Effect of vehicle speed on the quality of closed-chest compression during ambulance transport. Resuscitation. 2010;81(7):841-847.Google Scholar
7. Berg, RA, Hemphill, R, Abella, BS, et al. Part 5: Adult Basic Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 suppl 3):S685-S705.Google Scholar
8. Sanddal, TL, Sanddal, ND, Ward, N, Stanley, L. Ambulance crash characteristics in the US defined by the popular press: a retrospective analysis. Emerg Med Int. 2010;2010:525979.Google Scholar
9. Berger, E. Nothing gold can stay: EMS crashes, lack of evidence brings the golden hour concept under new scrutiny. Ann Emerg Med. 2010;56(5):A17-A19.Google Scholar
10. Isenberg, D, Cone, DC, Stiell, IG. A simple three-step dispatch rule may reduce lights and sirens responses to motor vehicle crashes. Emerg Med J. 2012;29(7):592-595.Google Scholar
11. Ho, J, Casey, B. Time saved with the use of emergency lights and sirens while responding to requests for emergency medical aid in an urban environment. Ann Emerg Med. 1998;32(5):585-588.Google Scholar
12. Kupas, DF, Dula, DJ, Pino, BJ. Patient outcome using medical protocol to limit “lights and siren” transport. Prehosp Disaster Med. 1994;9(4):226-229.Google Scholar
13. Ross, D, Caputo, L, Salottolo, K, et al. Lights and siren transport and the need for hospital intervention in trauma patients. Prehosp Emerg Care. 2016;20(2):260-265.Google Scholar
14. Hunt, R, Brown, L, Cabinum, E, et al. Is ambulance transport time with lights and sirens faster than without? Ann Emerg Med. 1995;25(4):507-511.Google Scholar
15. Marques-Baptista, A, Ohman-Strickland, P, Baldino, K, Prasto, M, Merlin, M. Utilization of warning lights and siren based on hospital time-critical interventions. Prehosp Disaster Med. 2010;25(4):335-339.Google Scholar
16. Clawson, J, Martin, R, Cady, G, Maio, R. The wake effect: emergency vehicle-related collisions. Prehosp Disaster Med. 1997;12(4):274-277.CrossRefGoogle ScholarPubMed
17. Saunders, C, Heye, C. Ambulance Collisions in an urban environment. Prehosp Disaster Med. 1994;9(2):118-124.CrossRefGoogle Scholar
18. Kahn, CA, Pirrallo, RG, Kuhn, EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis. Prehosp Emerg Care. 2001;5(3):261-269.CrossRefGoogle ScholarPubMed
19. National Association of Emergency Medical Services Physicians (NAEMSP) and the National Association of State EMS Directors (NASEMSD). Use of Warning Lights and Siren in Emergency Medical Vehicle Response and Patient Transport. Prehosp Disaster Med. 1994;9(2):133-136.Google Scholar
20. Biggers, WA, Zachariah, BS, Pepe, PE. Emergency medical vehicle collisions in an urban system. Prehosp Disaster Med. 1996;11(3):195-201.Google Scholar
21. Maguire, BJ, Hunting, KL, Smith, GS, Levick, NR. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med. 2002;40(6):625-632.Google Scholar
22. Slattery, D, Silver, A. The hazards of providing care in emergency vehicles: an opportunity for reform. Prehosp Emerg Care. 2009;13(3):388-397.CrossRefGoogle ScholarPubMed
23. Leonard, W.H. EMS System Failure. The Gold Cross. 1991;11-13.Google Scholar
24. Cook, RTJ, Meador, SA, Buckingham, BD, Groff, LV. Opportunity for Seatbelt Usage by ALS Providers. Prehosp Disaster Med. 1991;6(4):469-471.Google Scholar
25. National Highway Traffic Safety Administration. 2008 traffic safety annual assessment – highlights. http://www-nrd.nhtsa.dot.gov/Pubs/811172.pdf. Accessed March 19, 2016.Google Scholar
26. Levick, NR, Li, G, Yannaccone, J. Biomechanics of the patient compartment of ambulance vehicles under crash conditions: testing countermeasures to mitigate injury. Paper presented at: Society of Automotive Engineering World Congress; 2001; Warrendale, PA, USA.Google Scholar
27. De Graaf, B, Van Weperen, W. The retention of balance: an exploratory study into the limits of acceleration the human body can withstand without losing equilibrium. Hum Factors. 1997;39(1):111-118.Google Scholar
28. Merlin, M, Baldino, K, Lehrfield, DP, et al. Use of a limited lights and siren protocol in the prehospital setting vs standard usage. Am J Emerg Med. 2012;30(4):519-525.Google Scholar
29. Weber, U, Reitinger, A, Szusz, R, et al. Emergency ambulance transport induces stress in patients with acute coronary syndrome. Emerg Med J. 2009;26(7):524-528.Google Scholar
30. Perkins, GD, Davies, RP, Quinton, S, et al. The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol. Scand J Trauma Resusc Emerg Med. 2011;19(1):58.Google Scholar
31. Federal Emergency Management Agency (FEMA) and US Fire Administration. Emergency Vehicle Safety Initiative. https://www.usfa.fema.gov/downloads/pdf/publications/ fa_336.pdf. Accessed March 19, 2016.Google Scholar
32. Stapleton, ER. Comparing CPR during ambulance transport. Manual vs. mechanical methods. JEMS. 1991;16(9):63-72.Google ScholarPubMed
33. Levick, NR, Swanson, J. An Optimal Solution for Enhancing Ambulance Safety: Implementing a Driver Performance Feedback and Monitoring Device in Ground Emergency Medical Service Vehicles. Annu Proc Assoc Adv Automot Med. 2005;49(1):35-50.Google Scholar