Is it Time to “Sound Off” about the Use of Lights and Sirens?: NMA E-Newsletter #707

By Stewart Price, NMA Programs Officer

All of us are gradually going deaf. The world is getting louder save for the isolationists that have gone off the grid. Could that prompt Emergency Medical Services (EMS) and law enforcement to make sirens louder? Should flashing lights burn brighter and more intensely to capture our attention?

For me, there’s only one experience more alarming than an ambulance shrieking at ear-splitting decibels. It’s having a police officer blast a siren only one or two car lengths behind me. When it comes to flashing lights, the days of the friendly “cherries on top” with rhythmic waves of light have long since passed – they have been replaced with multi-dimensional lights going berserk, a display that not even a psychedelic rock band’s lighting technicians can duplicate.

Lights and sirens (a.k.a. “L&S” in traffic legislation) is a growing issue in a world of ever-amplified sound. Sustained exposure to 80 – 90 decibels (just beyond the peak range in the new movie, Top Gun) can result in permanent hearing loss. Ambulances, however, can broadcast up to 120 decibels, considered “very loud, if not unbearable” as quoted by those who characterize the impact.

To be sure, EMS staff need to warn others when they are in urgent mode as they carve their way through traffic. And if I’m that person in the ambulance, I want my driver to go as fast as humanly possible, that is, without wrecking the vehicle. After all, it’s my life we’re talking about here!

As everyday drivers, our reaction to an auditory or visual explosion can be more than unsettling. Take my spouse, for example. Since 2004, she has struggled with hyperacusis, a rare condition often simplified as intolerance to sound. In canine fashion, she can almost sense an ambulance or fire truck in the distance and will go straight into panic mode as it approaches. She will frantically reach for ear protection. If not handy, she might even take her hands off the wheel and use her fingers to plug her ears. She knows that if she doesn’t protect herself, she could suffer for hours, if not days to come. Sensory overload can trigger disorientation, nausea, and even seizures.


“Despite considerable research on lights and sirens, there has been little, if any research to date, on the impact on the driving public. Aren’t we the ones who are supposed to perk up and get out of the way?”


The prevailing wisdom is that the quicker EMS gets from the emergency scene to the ER, the better the outcome. This long-held belief was never challenged in the days of yore when one was thrown in the back of an ambulance without any attending medical staff. One’s fate was in the hands of a quasi-race car driver. But that was then. Now ambulances are considered intermediary care centers. Highly trained medical technicians can stabilize a patient while communicating and preparing the ER to take immediate action.

As published in the Annals of Emergency Medicine (1995 Apr;25(4):507-11), “The data suggests that there is a modest reduction in response and transport times. Compiling the results of the various studies, the use of lights and sirens reduces EMS response time between 1.7 to 3.6 minutes and reduces transport time 0.7 to 3.8 minutes. Some of the studies included an independent physician review of the transported medical case. The summary conclusion of the data suggests that the reduction in prehospital time produced a clinical difference in only about 5 percent of the cases.”

And what about the risk of accidents?

According to a 2019 study using National EMS Information System (NEMSIS) Data, “Among 19 million included 911 scene responses, the response phase crash rate was 4.6 of 100,000 without lights and sirens and 5.4 of 100,000 with lights and sirens. For the transport phase, the crash rate was 7.0 of 100,000 without lights and sirens and 17.1 of 100,000 with lights and sirens.”

In other research, police vehicles are cited as being the culprits with studies claiming they are 1.8 times more likely to crash while driving in emergency mode than usual mode.

Either way, the problems brought on by lights and sirens loom large. On the whole, one paper estimated that there were over 12,000 motor vehicle collisions involving responding or transporting EMS vehicles in the United States in the 1980s; four times that many collisions involved non-EMS vehicles that reacted in some way to an EMS response vehicle.

What governs the use of L&S on EMS vehicles?

In general, the regulations are rooted in the Uniform Vehicle Code language. But like any regulatory guidance, there is a lack of standardized laws and practices across various states. Certain states want to limit the use of lights and sirens to only the most risk-averse situations, such as exceeding the speed limit, traveling through intersections, and running red lights (if allowed at all). Other states are in a different place. At the NMA, we believe this alternative course is the wise approach to take, and balances the risks for all. But shouldn’t best practices be applied?

What is your experience with lights and sirens?

Feel free to “sound off” by emailing the NMA at

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