Search Terms: Red-light-and-siren response, EMS response agencies, dangerous, unnecessary, EMS personnel, response mode, medical control, difference, needless waste, priority-based dispatch system, time saved, emergency medical dispatchers (EMD), medical dispatching, caller interrogation, pre-arrival patient intervention, Jeff Clawson, JEMS, 1981

Journal of Emergency Medical Services (JEMS), February 1981
Jeff J. Clawson, MD

The Red-Light-and-Siren Response: "Do we need it as much as we use it?"

As never before, EMS response agencies must take a closer look at the number of red-light-and-siren runs that are made to the scene for a number of reasons. First, emergency light-and-siren runs expend a significantly greater amount of fuel. Second, these runs increase wear on emergency vehicles. Third, red-light-and-siren runs are dangerous to the public on the road as well as the EMS personnel responding. And finally, in a sizable number, the use of red-lights-and-siren is unnecessary! Since most EMS personnel prefer an emergency run to the alternative, we find it hard to "slow down" those runs we know really aren‚t so urgent. Instead, we abdicate responsibility for assigning response modes to medically untrained dispatchers and fire chiefs. It is certainly time that medical control found its way into the dispatch office.

The private ambulance service that I worked for as an EMT some years ago has a company policy restricting red-light-and-siren runs to case where the response time actually made a difference in the outcome of the case. When the dictum is applied to most runs, the fact is that in 95 out of 100 runs the time saved by lights-and-siren doesn't make a bit of difference to the morbidity or mortality of the patient. After discounting all nonemergency transfers, take-homes, etc., the number of red-light-and-siren runs in Salt Lake City's pre-1974 BLS system was less than 50 percent. Yet today, many systems still respond red-light-and-siren on every run. Think about the needless waste and increased danger that could be prevented if 50 percent of any city's runs were nonemergent in response mode. Now, think about the last time you responded red-light-and-siren to that "possible appendicitis" (saving one minute and 25 seconds)-only to have the patient, subject to regular Emergency Room routine, undergo surgery more than three hours later. Was that one and a half minute you save significant? I don't think so. But this and thousands of similarly needless red-light-and-siren responses occur daily in this country. What can be done about it/

First, if you don't have a selective, priority-based dispatch system, you need one. The need for emergency response should be a medical decision, made best by emergency physicians and physician advisors to emergency medical systems. The number of vehicles sent as well as the response mode should be carefully evaluated. The following questions should be answered for each type of call to appropriately assign the correct level of response.

    1. Will time saved make a difference in the final outcome? (i.e., is the problem a true time-priority requiring a response of less than five minutes such as):
      a) Cardiac or respiratory arrest
    1. Airway problems
    2. Unconsciousness
    3. Severe trauma/hypovolemic shock
    4. True obstetrical emergencies
    1. How much time leeway do you have?
    2. How much time can you save by going red-light-and-siren?
    3. How much time can be saved sending a closer but larger unit (engine)?
    4. When the victim gets to the hospital, will the time you saved be significant compared to the time spent awaiting care (i.e., waiting turn, X-rays, lab tests, etc)?

These items must be addressed or you are just not functioning at today‚s expected level of responsible prehospital care.

Second, all dispatchers, especially ALS system dispatchers, should be trained and certified as emergency medical dispatchers (EMDs). What's an EMD? The Department of Transportation's National Highway Traffic Safety Administration will shortly be offering a new program called Emergency Medical Dispatch Priority Training. This 25-hour partially physician-taught course will provide the dispatcher with specific skills and knowledge as it relates to selective medical dispatching, caller-interrogation, and pre-arrival patient intervention.

Certainly, medically trained dispatchers operating from medically approved, selective dispatch protocols will make sure that we use our red-light-and-sirens only as much as we, the public, and the patients really need them.