Are You Driving in a Sterile Cockpit?

We already know accident risk rises exponentially when we respond Code 3; we should not add to that risk through distracting driving behaviors

The tones just went off for a multi-vehicle accident with possible entrapment. You slide into the driver’s seat, click your seat belt, call en route and…turn on the music? Send a text message? Perhaps grab a few bites of the sandwich you just ordered? More than many of us care to admit, responding crews multitask to acquire more information, communicate or satisfy hunger while driving at high speeds to get to calls. While all this multitasking might make you more productive or enhance your communication, it also puts you, your partner, your patients and the public at tremendous risk.

Sterile Cockpit

In 1981 the Federal Aviation Administration enacted two policies, FAR 121.542 and FAR 135.100, to help curb the number of accidents from distracted pilots. Commonly known as the “sterile cockpit” rules, these regulations specifically prohibit crew member performance of non-essential duties or activities while the aircraft is involved in taxi, takeoff, landing and all other flight operations. This includes music, visitors or extemporaneous conversation. Departments or individuals might want to consider this “sterile cockpit” concept while responding in ambulances, so that with the exception of the dispatch radio, other distracting behaviors are not taking place. The California Department of Motor Vehicles defines distracted driving as anything that takes your eyes off the road, ears off the sounds of the road, mind off the road or hands off the steering wheel.

Listening to Music

According to several research articles, many emergency vehicles operators already drive too fast. Research shows that mere seconds are saved by driving the ambulance over the speed limit on emergency responses, especially in urban areas. These seconds certainly are not enough to warrant the greater speed and exponential risk increase of an accident. Alex Zozula, an EMT with Princeton (NJ) First Aid and Rescue, suggests music not be played at all in the ambulance: “Listening to loud, fast and/or aggressive music will increase the adrenaline rush and make an already dangerous activity that much more dangerous,” he says.

Sgt. Christopher Strattner, JD, EMT-P, of the Orangetown (NY) Police Department agrees that music can be an unwelcome distraction. “If you are picking your way through traffic, you want to be a bit calmer—there's plenty of adrenaline available for a near crash or two, and the sound of the siren gives you all the extra juice you need. And you definitely don’t want to have the radio cranked up so loud you miss the fire truck responding to the same job but coming through your intersection from a different angle,” Strattner says.

In addition to being a distraction, listening to music is also unprofessional. Deborah Herr, public information officer for the West Orange (NJ) First Aid Squad, believes the patient should be receiving “100% of our attention.”

Chris Stellatella, FF/EMT with the New Brunswick (NJ) Fire Department, also feels it is unprofessional to listen to music en route. “You should be focusing on the call at hand. Regardless if the call is fire-, EMS- or law enforcement-related, your focus should be the patient, structure/occupants and/or nature of call. There are many things that can be prepared for en route if you’re not distracted by outside sources,” Stellatella explains.

Rachelle Burk, an EMT with the East Brunswick (NJ) Rescue Squad, agrees: “Music is entertainment, and therefore doesn’t feel appropriate when a patient is in the rig. I wouldn’t have music on in a business meeting or other professional settings, so why would I do so while tending to a patient?”

Step one to a “sterile cockpit”: Turn off the music.


Many EMS organizations use a text message alert system as a backup to radio dispatch or even as the primary dispatch. While this was designed to ensure accurate addresses and dispatch times, it also unwittingly creates another distraction to Code 3 driving, especially when responding to a text message on an agency-issued or personal device. This also applies to dashboard computers, GPS units and mobile data terminals (MDTs).

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