Administration and Leadership, Ambulances & Vehicle Ops, Columns

Pro Bono: EMS Use of Red Lights and Siren Offers High Risk, Little Reward

Issue 2 and Volume 42.

Do you want to save lives? Do you want to live longer? Do you want to reduce legal liability?

By curtailing your use of red lights and siren (RLS), you increase your chances of doing all three.

The use of RLS is engrained into the operational culture of public safety and is used every day by EMS, police and fire professionals. The public is accustomed to seeing emergency vehicles running hot, and citizens continue to demand faster response. To the public, RLS are the most visible (and audible) evidence that we’re treating their needs urgently.

Yet when we look at the actual evidence, a few things become apparent about RLS use. First, it’s proven to be dangerous. Second, it’s not proven to be beneficial.

Clear & Present Danger

As part of the healthcare profession, EMS must be evidence-based, meaning that our profession has an obligation to incorporate only those practices that are proven to benefit patients. With that comes an equal obligation to curtail practices that don’t help patients. And most critically, our profession should work to eliminate practices that have the doubly dubious distinction of being both unhelpful and dangerous.

The evidence shows that RLS use falls into this last category. Among the numerous studies that have looked at RLS use in EMS, one shows that RLS was in use in 80% of all crashes involving ambulances.1 Another showed that 58% of fatalities involving ambulances occurred during RLS use.2

So it’s difficult to dispute that RLS use is more dangerous than operating an ambulance without RLS activated. And use of RLS not only increases the danger in ambulance operation, it’s also a clear contributor to increased lawsuits, payouts, insurance premiums and provider liability.

The fact that RLS use is dangerous is only half of the equation. In healthcare, there are procedures that increase danger but have proven benefits. For instance, chemotherapy is fatal to some patients, but the risk of dying sooner without it in patients with some cancers is reduced.

When it comes to RLS, however, there’s no compelling evidence that the benefits counterbalance the increased risk.

Response Time Reform

The use of RLS is intertwined with the issue of response times, primarily because RLS are used to reach a destination faster. So the real questions become: 1) Does RLS get us to our destination faster (i.e., are time savings statistically significant); and 2) Do those faster times make a difference (i.e., are time savings clinically significant)?

Cardiac arrest or near-arrest patients are an example of when time matters, but those patients constitute a small amount of overall EMS responses. For the vast majority of conditions for which EMS is called, there’s simply no evidence that the response time requirements in place in many communities across the United States are actually making a positive difference in patient outcomes, reducing morbidity or mortality, reducing costs, or improving the patient experience of care.

And yet, response time requirements persist. Citizens and elected officials demand fast EMS responses, mistakenly equating “faster” with “better.” And, response times are easy to measure and even easier to understand, evolving to become a lazy way to measure EMS system “quality”—even though quality usually has nothing to do with speed.

RLS reform first requires a reform of the root cause: artificial response time pressures that aren’t clinically based. Medical priority dispatching with clinically based response determinants should be part of every EMS system, and dangerous RLS responses should be reserved only for those conditions where the evidence establishes that a fast response or transport is necessary.


EMS leaders should ensure their agencies have appropriate policies regarding RLS use, provide suitable training to emergency vehicle operators, educate local elected officials and stakeholders why RLS use should be curtailed, and make use of RLS part of their clinical quality assessment and improvement programs.

Safety—of providers and patients—needs to be an integral part of our focus in EMS. RLS use puts providers at risk and endangers the public, all with little or no benefit to show for it when it comes to the vast majority of patient conditions.


1. Sanddal TL, Sanddal ND, Ward N, et al. Ambulance crash characteristics in the U.S. defined by the popular press: A retrospective analysis. Emerg Med Int. 2010;2010:525979.

2. Kahn CA, Pirrallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: An 11-year retrospective analysis. Prehosp Emerg Care. 2001;5(3):261–269.

National Conference on EMS Law & Policy

Learn about Emerging Legal & Policy Issues

Page, Wolfberg & Wirth (PWW) and JEMS are proud to be teaming up to bring you the National Conference on EMS Law and Policy. This unique and insightful one-day workshop will be held on Wed., Feb. 22, 2017, in Salt Lake City in conjunction with the EMS Today Conference and Exposition.

PWW and JEMS have gathered nationally recognized EMS law attorneys, EMS regulatory officials, EMS experts and EMS educators to present on topics that include:

>> Emerging EMS liability trends;

>> The evolution of state EMS laws on critical issues such as scope of practice and community paramedicine;

>> The status of Good Samaritan immunity and other EMS provider legal protections;

>> Discipline with due process in the EMS workplace; and

>> How to become an effective expert witness in an EMS case.

For a complete agenda and registration information go to

EMS Today