Should EMS Reduce the Use of Lights & Sirens? Part II
By Brian Maloney *
When people ask me why I got into emergency medical services I tell them the story of taking a CPR class while in college. I completely fell in love with the idea of being able to help people in their time of need and helping people was the primary reason I got into EMS 24 years ago. I truly still feel that way today. I would also be lying if I did not say it was also about the idea of high adrenaline-type situations and getting the opportunity to drive an emergency vehicle with lights and sirens (L&S). Now that is fun!
The question we must ask ourselves is even though driving with L&S is fun and at times potentially lifesaving, is it the right thing we should be doing as much as we are?
A Collaborative Approach to Improve Safety
In 2022, Plum EMS joined a national project called the “Lights & Siren Collaborative” with 49 other EMS agencies throughout the country. The goal was to work together on increasing the safety of EMS and the community by decreasing the use of L&S during both response and transport to the hospital. The goal for L&S while transporting to the hospital was to be less than 5%. Seeing that we were already at 8.42% I figured we could easily ace this one and the team did just that!
- Discussions continued about the use of L&S, review of the protocol, provided feedback with comparisons in time differences, special reports in the ePCRs, and case reviews were conducted.
- An additional step was added, and the receiving hospital was requested to provide a patient follow-up for anyone transported to the hospital with L&S. This follow-up was added to the feedback provided to the crew.
- The question was always asked if saving 3-5 minutes truly made a difference in the patient’s outcome. The crew was never told they were wrong for using L&S, but they were constantly challenged and encouraged to be the great prehospital care providers they are.
- Weekly updates were also posted on how the team was doing.
By the end of Q1 2022, the team had their L&S use down to 5.33%, and by the end of the year was down to 2.2%. It was completely amazing how great the team was doing and all a sudden that 1% benchmark in the PA protocol did not seem so ridiculous or unachievable.
Up until the start of the L&S collaborative project, not much focus had been spent on the use of L&S while responding to calls. The idea of safety was always talked about; however, Plum EMS never exceeded the PA protocol “performance parameter” of 50% or less.
The one big push we did since 2017, was placed on our chute times (time from getting dispatched to pulling the truck out of the garage) to be 60 seconds or less. Improving chute times is where we could make the biggest improvement in our response times.
When the “Lights and Siren Collaborative” began, this project became a motivator for the crews to start thinking about how they were going to respond to calls and not just go by the dispatch code.
When is it Appropriate to Flip the Switch?
- Time was spent reviewing the protocol as it provides several good examples of when it is appropriate to use L&S.
- An even bigger emphasis was placed on chute times less than 60 seconds from the time of dispatch as this can have one of the most significant impacts on response times.
- During morning meetings conversations were occurring with team members about the appropriate use of L&S and comparisons were provided to show that L&S use does not always save time.
- Constant feedback was provided to the crews and weekly updates were posted to allow everyone to see the progress they were making.
- Case reviews and examples were incorporated into the morning meetings.
- Leadership also started responding appropriately with L&S, so it was not a “do what I say, not what I do.”
As the topic of L&S use occurred with the team, leadership did their best to ensure it was a conversation and dialogue. Concerns were expressed by some crew members specifically about the potential liability of the “what if’s”. One thing that was learned from the L&S Collaborative Project was that there were no known cases of EMS being sued for responding without L&S, who had a prompt response, and that “proximal causation” was extremely difficult to prove.
Of all the concerns, not once was it brought up about the liability if we were to get into an accident while responding to a call that caused injury or worse if we killed someone. There are countless cases of emergency vehicles being involved in crashes and just as many lawsuits to go with those crashes.
The team members of Plum EMS were asked to make the most appropriate decision on the use of L&S based on several factors:
- Dispatch code
- Details regarding the incident on our computers
- Location of call
- Time of day
- Day of week
- Weather conditions
I would be lying if I told you I thought this was going to be an easy task. There was a level of nervousness as this initially felt like this situation was an EMS paradox that did not make sense. Surprisingly, many team members indicated they liked the idea of having the support of leadership to use L&S appropriately. Some reported that it felt like a load had been taken from their shoulders as L&S utilization at times added stress. Another seasoned team member indicated that he could remember using L&S responding to all calls and transporting all patients to the hospital. Surprisingly his reaction was that he was happy to see this type of change.
Results…
- In 2021, Plum EMS utilized L&S 48% of the time when responding to calls.
- By the middle of 2022, the team was 14.1%, and less than 10% by the end of the year.
- The biggest question comes down to were response times sacrificed by electing to use L&S appropriately?
- In 2022, there was only a 33 and 66-second time difference in response times compared to 2021 for E0 and E1 dispatches respectively.
Did altering our response modes affect our customer satisfaction? Based on a patient satisfaction survey the answer is they are still happy with Plum EMS’s response times (majority of responses still a 5/5). Several times throughout the year patients even commented on their survey how they appreciated the ambulance not coming in with L&S through their neighborhood.
At this point, the appropriate use of L&S is second nature with the organization and the team continues to impress me. They continue to strive to have a 60-second or less chute time, protocol review occurs periodically during morning meetings, weekly updates are posted, feedback is provided to the crew for any patient transported L&S to the hospital, and I continue to make sure I am using L&S appropriately.
Whenever I hear an EMS agency responding to L&S, I often wonder if it is truly the right thing to do?
*Brian Maloney is the Operations Director for Plum EMS in Plum, PA. He has over 24 years of experience in the EMS Industry.
