As a member of several of the sponsoring organizations, REMSA Health is proud to support this Joint Statement on Lights and Siren Vehicle Operations. Our Quality Assurance program, medical director oversight, emergency vehicle training, commitment to continuous clinical improvement, and the medically trained dispatchers in our ACE Accredited EMD center demonstrate our ongoing commitment to raising awareness about the importance of reducing the use of lights and siren in emergency response.
Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses
Douglas F. Kupas, Matt Zavadsky, Brooke Burton, Shawn Baird, Jeff J. Clawson, Chip Decker, Peter Dworsky,
Bruce Evans, Dave Finger, Jeffrey M. Goodloe, Brian LaCroix, Gary G. Ludwig, Michael McEvoy, David K. Tan,
Kyle L. Thornton, Kevin Smith, Bryan R. Wilson
The National Association of EMS Physicians and the then National Association of State EMS Directors created a
position statement on emergency medical vehicle use of lights and siren in 1994 (1). This document updates
and replaces this previous statement and is now a joint position statement with the 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 and Paramedic Chiefs of Canada.
In 2009, there were 1,579 ambulance crash injuries (2), and most EMS vehicle crashes occur when driving with
lights and siren (L&S) (3). When compared with other similar-sized vehicles, ambulance crashes are more
often at intersections, more often at traffic signals, and more often with multiple injuries, including 84%
involving three or more people (4).
From 1996 to 2012, there were 137 civilian fatalities and 228 civilian injuries resulting from fire service vehicle
incidents and 64 civilian fatalities and 217 civilian injuries resulting from ambulance incidents. According to the
U.S. Fire Administration (USFA), 179 firefighters died as the result of vehicle crashes from 2004 to 2013 (5).
The National EMS Memorial Service reports that approximately 97 EMS practitioners were killed in ambulance
collisions from 1993 to 2010 in the United States (6).
Traffic-related fatality rates for law enforcement officers, firefighters, and EMS practitioners are estimated to
be 2.5 to 4.8 times higher than the national average among all occupations (7). In a recent survey of 675 EMS
practitioners, 7.7% reported being involved in an EMS vehicle crash, with 100% of those occurring in clear
weather and while using L&S. 80% reported a broadside strike as the type of MVC (8). Additionally, one survey
found estimates of approximately four “wake effect” collisions (defined as collisions caused by, but not
involving the L&S operating emergency vehicle) for every crash involving an emergency vehicle (9).
For EMS, the purpose of using L&S is to improve patient outcomes by decreasing the time to care at the scene
or to arrival at a hospital for additional care, but only a small percentage of medical emergencies have better
outcomes from L&S use. Over a dozen studies show that the average time saved with L&S response or
transport ranges from 42 seconds to 3.8 minutes. Alternatively, L&S response increases the chance of an EMS
vehicle crash by 50% and almost triples the chance of crash during patient transport (11). Emergency vehicle
crashes cause delays to care and injuries to patients, EMS practitioners, and the public. These crashes also
increase emergency vehicle resource use through the need for additional vehicle responses, have long-lasting
effects on the reputation of an emergency organization, and increases stress and anxiety among emergency
Despite these alarming statistics, L&S continue to be used in 74% of EMS responses, and 21.6% of EMS
transports, with a wide variation in L&S use among agencies and among census districts in the United States
Although L&S response is currently common to medical calls, few (6.9%) of these result in a potentially
lifesaving intervention by emergency practitioners (12). Some agencies have used an evidence-based or
quality improvement approach to reduce their use of L&S during responses to medical calls to 20-33%,
without any discernable harmful effect on patient outcome. Additionally, many EMS agencies transport very
few patients to the hospital with L&S.
Emergency medical dispatch (EMD) protocols have been proven to safely and effectively categorize requests
for medical response by types of call and level of medical acuity and urgency. Emergency response agencies
have successfully used these EMD categorizations to prioritize the calls that justify a L&S response. Physician
medical oversight, formal quality improvement programs, and collaboration with responding emergency
services agencies to understand outcomes is essential to effective, safe, consistent, and high-quality EMD.
The sponsoring organizations of this statement believe that the following principles should guide L&S use
during emergency vehicle response to medical calls and initiatives to safely decrease the use of L&S when
In most settings, L&S response or transport saves less than a few minutes during an emergency medical
response, and there are few time-sensitive medical emergencies where an immediate intervention or
treatment in those minutes is lifesaving. These time-sensitive emergencies can usually be identified through
utilization of high-quality dispatcher call prioritization using approved EMD protocols. For many medical calls,
a prompt response by EMS practitioners without L&S provides high-quality patient care without the risk of
L&S-related crashes. EMS care is part of the much broader spectrum of acute health care, and efficiencies in
the emergency department, operative, and hospital phases of care can compensate for any minutes lost with
non-L&S response or transport.
Sponsoring Organizations and Representatives: