Sharron Rose Frieburg was 18 years old when a Bloomington Fire Department ambulance ran a red light and struck the vehicle in which she was traveling. She sustained permanent injuries including cognitive impairment and hemiparesis and has persistent difficulty ambulating and speaking.1 Bloomington, Illinois, paid out nearly $5 million to care for Sharon’s lifetime of medical needs. The ambulance was transporting a patient with an ankle injury to the hospital.
Potential Benefit Versus Risk
A medical therapy has associated risks and benefits and the likelihood of each should be weighed with every single administration. That evaluation starts in the field when your local EMS agency is responding to a scene. Just like any other medical management, ambulance lights and sirens (L&S) during response to the scene and transport to the hospital should be considered a medical therapy and prescribed for the patient population with a potential for benefit. Clearly, there are conditions that would benefit from L&S medical therapy in which the potential benefits outweigh the risk of harm. However, in order to improve EMS and public safety, as well as enhance the delivery of patient care, it is important to judiciously evaluate the risks and benefits of all aspects of prehospital care, including L&S. The current status quo that an EMS agency responds to the scene greater than 50 percent of its call volume with L&S or transports patients with L&S greater than 25 percent of the time should not be permitted any longer.
The clinical utility of L&S has been questioned since 1953, when studies revealed that 88 percent of patients arriving by ambulance did not require time sensitive medical management.2 A 1994 study found that limiting L&S to 8 percent of transported patients did not increase the mortality rate. Furthermore, a 2014 study determined the number needed to treat with L&S to prevent one patient’s death is 5,000. With these findings, the safety, role, and proper utilization of L&S must be evaluated and reconsidered.2
The National Highway Traffic Safety Administration (NHTSA) estimates 4,500 ambulance crashes resulting in 33 deaths annually.3 About 25 percent of the fatalities are of the patients or EMS providers in the ambulance, with the remaining being pedestrian bystanders or other vehicle occupants. EMS providers die from transportation collisions at a greater rate (9.6 per 100,000) than police officers (6.1) or firefighters (5.7). Rear occupants are 2.7 times more likely to die in an ambulance crash, often due to lack of seatbelts. Research has shown that most of these collisions are attributed to human error and thus preventable.