North Dakota Emergency Medical Services Association

Rural EMS Counts Toolkit

Provider Safety

Background and Operational Considerations

Operating with lights and sirens (L&S) has long been an EMS industry norm. Still, this practice is increasingly questioned as it increases the risk to the provider and patient while providing minimal benefit. According to NEMSIS data, 74% of 911 responses and 27% of transports used L&S. Yet studies have found less than 4 minutes saved by L&S. It is estimated that only 5% of patients benefit from the use of L&S. Meanwhile, there are around 12,000 EMS vehicle crashes every year. Over 90% of these occur during L&S driving. One study found 67 EMS providers killed during ground transport crashes in five years. Recognizing the folly of everyday L&S driving, EMSA which is Oklahoma’s largest EMS provider now responds to only 33% of 911 calls with L&S and has done so without increased morbidity or mortality. L&S is a patient care intervention, and like any intervention, the benefit must outweigh the risk.

Consider that use of L&S is a medical intervention. Performance Measure Benchmarks are:

1. L&S during Response to Scene: <50% [For the measure the goal is >50%]

2. L&S during Transport: <5% [For the measure the goal is >95%.]

Performance Improvement and Best Practices

Regularly review a sample of L&S responses and transports and discuss whether L&S ultimately benefitted the patient. Was the lack of benefit predictable at the time? Are there times when L&S should have been used but was not? Refine dispatch protocols to use L&S when most likely to benefit. These might include: o Cardiac or respiratory arrest o Airway problems o Unconsciousness o Severe trauma or hemorrhagic shock o True obstetrical emergencies Consider Implementation of a “sterile cockpit” policy of no unnecessary conversation or interruptions during L&S operations. Provide formal EVOC training or an equivalent course and annual refreshers.

Other Relevant Data and Educational Resources

Kupas DF. Lights and Siren Use by Emergency Medical Services (EMS): Above All Do No Harm. NHTSA 2017.

Rural EMS Counts Provider Safety Measures

Safety- Lights and Sirens Not Used During Response to Scene

Description: This report calculates the percentage of EMS responses originating from a 911 request in which lights and sirens were not used during response.

Safety- Light and Sirens Not Used During Transport

Description: This report calculates the percentage of EMS transports originating from a 911 request during which lights and sirens were not used during patient transport. Specific filters to identify for this report include: 1. Disposition is any of these values: 1) Transported Lights/Siren, 2) Transported Lights/Siren, Downgraded, 3) Transported No Lights/Siren, upgraded, 4) Transported No Lights/Siren  

North Dakota EMS Association

1622 East Interstate Avenue, Bismarck, ND 58503


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