Joint Statement on Lights & Siren Vehicle Operations on EMS Responses

The problem, in their words

The purpose of lights and siren is to get care to the patient faster — but the statement notes that only a small share of medical emergencies have better outcomes because of it. Across more than a dozen studies, the average time saved ranges from 42 seconds to 3.8 minutes, while L&S response raises the chance of a crash by about 50% and nearly triples it during patient transport. Most EMS vehicle crashes happen while running L&S; they cluster at intersections and traffic signals, and a large majority involve multiple people.

The statement also describes the “wake effect” — roughly four collisions caused by a responding emergency vehicle for every crash that involves one — and reports that traffic-related fatality rates for responders run an estimated 2.5 to 4.8 times the average across all occupations.

What they recommend

• Use L&S only when minutes matter clinically. It should be reserved for situations where the time saved is anticipated to be clinically important to the patient’s outcome — and never when returning to station or posting on stand-by.
• Decide at dispatch, under medical oversight. Communication centers should use approved Emergency Medical Dispatch (EMD) protocols with structured call triage to identify which calls justify L&S, with active physician oversight and formal quality assurance.
• Write it into agency policy. Responding agencies should use EMD categories and local policies to define when L&S is clinically justified, with the medical director and QA program engaged.
• Base response plans on a community risk assessment. Response assignments should be developed locally, using a thorough community risk assessment together with physician medical oversight.
• Train every operator, continuously. All emergency vehicle operators should complete robust initial driver training and ongoing continuing education on appropriate L&S use.
• For city leaders: contract on quality, not speed. Municipal government leaders should recognize the crash risk. Service agreements can use tiered response-time expectations by call category — and quality-care metrics, rather than time metrics, should drive these contracts.
• Monitor the numbers, review every crash. Leadership should track rates of use, appropriateness, EMD compliance, and outcomes; crashes and near-misses should trigger QA review, and states should monitor and report emergency-vehicle crashes.
• Reset public expectations. EMS and fire leaders should improve public education about the risks of L&S to create safer expectations among the public and government officials.

Who stands behind it

This is not one agency’s opinion. It is the shared position of fourteen national bodies spanning EMS physicians, dispatchers, fire chiefs, paramedics, ambulance services, and state EMS officials:

• Academy of International Mobile Healthcare Integration
• American Ambulance Association
• American College of Emergency Physicians
• Center for Patient Safety
• International Academies of Emergency Dispatch
• International Association of EMS Chiefs
• International Association of Fire Chiefs
• National Association of EMS Physicians
• National Association of Emergency Medical Technicians
• National Association of State EMS Officials
• National EMS Management Association
• National EMS Quality Alliance
• National Volunteer Fire Council
• Paramedic Chiefs of Canada

The bottom line

In most settings, the statement concludes, lights and siren save less than a few minutes, and there are few medical emergencies where an intervention in those minutes is life-saving. Those time-sensitive cases can usually be identified by a well-run dispatch system. For most calls, a prompt response without lights and siren delivers high-quality care without the crash risk — and later phases of hospital care readily absorb any minutes lost.