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Lights and Siren Use by EMS: Above All Do No Harm

In his report titled “Lights and Siren Use by Emergency Medical Services (EMS): Above All Do No Harm,” author Douglas F. Kupas, MD, EMT-P, FAEMS, FACEP discusses the reasons emergency warning lights and sirens (L&S) are used by EMS, both traditionally and currently, and how these play into EMS personnel’s primary responsibility of providing healthcare for patients.

The key role of an EMS provider is to effectively deliver care to patients during medical emergencies, but not before carefully weighing the potential costs and benefits of the particular care they decide to implement. One of the main principles of healthcare, primum non nocere, meaning “first do no harm,” should be at the forefront of medical providers’ minds. This will help EMS personnel make the most efficient decisions regarding the care of their patients when assessing the potential outcomes of their actions. One of these actions to be considered is the use of lights and sirens.

Historically, L&S have been utilized to lessen response times and transport times as well as make emergency vehicles more visible when parked on scenes. In recent years, however, certain agencies have decreased their usage of L&S for various reasons. While L&S use can be beneficial by cutting down on response time and patient transport time, there are potential consequences associated with this usage.

For example, based on how EMS personnel are employing L&S, the risk of ambulance crashes and patient and provider injury rises. There is also the chance of providers damaging their hearing and the worsening of patients’ injuries due to an increased anxiety from L&S. Additionally, if particular EMS agencies are known by the community to excessively use L&S, patients might be more inclined to drive themselves to the hospital instead of calling 9-1-1, even in the event of serious emergencies, which could worsen their conditions.

Studies indicate that L&S use is practical when “requesting the right of way,” but during the remainder of transport, it may not be that effective at all, considering some drivers are not even aware of the presence of an ambulance. Findings show that the use of L&S doesn’t actually save a significant amount of time during patient transport, but they are useful when the patient’s health is dependent on shorter transports, such as for stroke or cardiac arrest victims.

Patient outcome is important to evaluate when determining whether or not to use L&S. Most the time, the quality of patient outcome is not lessened due to the use of L&S. If EMS professionals adequately treat the patient during transport, a decrease in transport time shouldn’t be necessary. Keeping in mind the mantra “first do no harm” in regards to medical therapies, L&S should be considered a factor in preventing any potential patient harm.  

Of course, EMS providers must carefully evaluate the needs of their respective communities when determining how L&S are utilized by their agencies. Other factors to consider are the agencies’ vehicle designs, agency policies and general L&S use. Kupas’ report highlights recommendations and considerations for agencies based on jurisdictions and states.



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