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Hearing Loss in EMS 

hearing loss in ems

Many estimates peg the noise level of a typical ambulance siren in the neighborhood of 120–130 decibels (dB). Exposure at these levels without hearing protection, even for a brief period, can cause permanent hearing damage. Just for some perspective, conversational speech is at 60 db, an alarm clock is 80 db, a live concert is around 100 db, an iPhone at full blast is 110 db in the earbuds, and a handgun firing is 160 db.

Hearing loss is gradual, so your body tends to adapt to it over time. Despite this, estimates show that nearly 45% or more of EMS providers and firefighters have mild to moderate hearing loss. The risk of permanent hearing loss due to work-related noise exposure is well known, with an estimated 22 million U.S. workers exposed to hazardous noise each year. Further, 34% of those report no use of ear-protective gear.

The research shows it: A study conducted in Sweden in 2017 found noise-exposure levels of 80 dB or more during use of sirens on an emergency vehicle and EMS operations, compared to in-hospital controls of 70 dB. The study showed that when the sirens were on, all noise values measured inside the cabin exceeded the national occupational health regulation of 85 dB. The average siren noise exposure during a workday of eight hours was 16.22 minutes, reaching 20.33 on busy days. Evidence suggested noise affected the outer hair cell function of the inner ear, thus potentially reducing the hearing ability of the EMS crew.

The first signs of hearing loss are when you may notice that others need to repeat things to you or talk loudly to get your attention. You may also keep the TV or radio volume up louder to hear dialogue. Exposure to loud sirens and air horns, diesel engines, power tools, radios/pagers, and environmental sounds may contribute, especially if you have a long career in fire and EMS. (Many years of attending rock concerts or listening to loud music in your earbuds can’t help either.)

So what can you do to protect yourself? Here are a few suggestions from the Hearing Loss Association of America:

  • Limit loud noise exposure. This includes lowering the volume on your earbuds and keeping the windows of the ambulance up when the sirens are on.
  • If your sirens and air horns are mounted on the roof, see if they can be moved to the grill, where their impact on the cab is less.
  • If you are exposed repeatedly to loud noises, wear hearing protection, such as in-ear or earmuff-style protection.
  • Don’t inflict loud noises on others. This means keeping the music down in your rig and car. Keep the radios or pagers turned down too. Also, the old “let me toot the siren or air horn in the bay to play a joke on a colleague” is just downright dangerous.
  • See a licensed audiologist for a baseline hearing check. This is even important in your 20s. Most give these evaluations for free or are covered by insurance. 
  • Don’t stick Q-tips in your ears. Their use can damage the inner ear canal.

The Swedish study suggested that “further initiatives to prevent noise exposure should be taken, such as active noise reduction or custom-made in-ear protection with communication systems for EMS personnel.” Furthermore, better sound insulation of ambulances is warranted.

Be aware and protect your hearing!


1. Hansen MCT, Schmidt JH, Brochner AC, et al. Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services. Scand J Trauma Resusc Emerg Med, 2017 Dec 6; 25(1): 119.

Barry Bachenheimer, EdD, FF/EMT, is a firefighter and member of the technical-rescue team with the Roseland (N.J.) Fire Department and an EMT with the South Orange (N.J.) Rescue Squad. With an emergency services career of more than 30 years, he frequently serves as an instructor for both departments. Reach him at 

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