EMS Myth #4: Lights and sirens save a significant amount of travel time and lives

As a kid growing up in Fort Worth, TX, I remember the funeral home ambulances of the era. In fact, in the late 1950s, my father sold ambulances and hearses for a company named Hess and Eisenhart. Ambulances at that time had little in the way of medical equipment. In terms of patient care, they offered little more than oxygen and rapid horizontal transport. The ambulances of that period were designed for speed. They had high-performance engines, numerous flashing lights and large, loud mechanical sirens. When you heard one coming, if you looked out the window quickly enough you could see a flash and a blur as it sped by. They were neat.
      In the 1960s, the city of Fort Worth had an unusual custom. They used to paint a large white "X" on the street where there had been a traffic fatality. I remember an intersection on Camp Bowie Boulevard where there were two "X" marks. These were the result of two ambulances colliding at tremendous speed at the intersection en route to a 10–50 major (major accident) somewhere west of town. Today, the two "X" marks on Camp Bowie Boulevard are gone, but every time I drive by that intersection, I remember the story of the two ambulance drivers who died there.

History
      Despite being significantly more medically sophisticated, many EMS services still routinely respond to all emergency calls, regardless of the nature, with emergency lights and sirens. Some routinely transport patients to the hospital using emergency lights and sirens, using the argument that they are able to get the unit back in service quickly. Many times, even in large EMS systems, I have seen an ambulance asked to increase to Code 3, not because of patient condition, but just because the system was busy. This practice contradicts one of our EMS prime directives: Patient care comes first.
      Does the use of lights and sirens in emergency response and transport save a great deal of time? Should patient condition and nothing else guide usage of emergency lights and sirens? Do the benefits of lights and sirens transport outweigh the possible risks?