The hidden problem with ambulances | Andrew Garrett | TEDxFoggyBottom

Quick Overview

Dr. Andrew Garrett argues that the prevalent use of lights and sirens (L&S) in Emergency Medical Services (EMS) is driven by tradition rather than evidence, as studies show L&S use significantly increases the risk of ambulance crashes (1.5x during response, 2.9x during transport) without clinically benefiting most patients, leading to the conclusion that EMS culture must shift to evidence-based decision-making for appropriate L&S use.

Key Points: The use of lights and sirens (L&S) in EMS is primarily rooted in tradition, not evidence, as demonstrated by the high frequency of use (75% of responses, 25% of transports). L&S use is associated with a 1.5-fold increased risk of ambulance crashes during response and a 2.9-fold increased risk during transport (Watanabe, et al 2022). The time saved by using L&S is only clinically relevant for about 1 in 20 patients (5% of the time). Ambulance crashes cost EMS agencies millions, with over 2,500 injuries occurring annually in the U.S., frequently involving the public rather than EMS personnel. The speaker advocates for a cultural shift, urging EMS providers to make evidence-based decisions about L&S use instead of relying on outdated protocols. The Medical Director's role is to establish protocols that guide clinicians to use L&S judiciously, only when the clinical benefit outweighs the inherent risk.

Context: Dr. Andrew Garrett, an EMS physician with two decades of experience, discusses the deeply ingrained tradition within Emergency Medical Services (EMS) of routinely using lights and sirens (L&S) during emergency responses and transports. He contrasts this tradition with modern evidence suggesting that this practice significantly elevates crash risks for EMS providers and the public without providing substantial clinical benefit to the majority of patients.

Detailed Analysis

Dr. Andrew Garrett challenges the long-standing tradition in EMS of routinely using lights and sirens (L&S), asserting that this practice is not supported by current evidence and introduces unnecessary risk. He notes that EMS is a medical specialty focused on the quality of care delivered to patients before they reach the hospital. Garrett recounts his extensive career, including time as a Park Ranger and on a National Disaster Medical System SWAT team, before settling into his role as a Medical Director. He highlights that L&S use is common—75% of ambulances use them for responses and 25% while transporting—and this behavior is deeply ingrained in the culture, a mindset exemplified by the fire service's historical focus on response time. However, citing research by Watanabe, et al (2022), Garrett presents evidence showing that L&S use is associated with an increased risk of ambulance crashes: 1.5 times higher during response and 2.9 times higher during transport. Furthermore, the time saved (about 1 to 3 minutes) is only clinically relevant for about 5% of patients (1 in 20). This small clinical benefit must be weighed against the significant risks of crashes, which cost agencies millions and injure thousands annually, often harming the public. He points out that EMTs are five times more likely to be involved in a traffic accident. As a Medical Director, Garrett states his goal is to shift protocols away from reflexive L&S use towards evidence-based decisions, ensuring L&S are used only when they directly benefit the patient's outcome, rather than being used simply because 'that's how we've always done it.' He concludes by pointing to professional organizations that are starting to advocate for this culture change.