Lights & Sirens Reduction Initiative Additional Information

What is the Current Quality Improvement Project, and why is McGregor Involved?

McGregor was recently one of 50 EMS agencies nationwide selected for the National EMS Quality Improvement initiative. The project is sponsored by the National EMS Quality Alliance (NEMSQA), a nationally recognized organization striving to improve patient care by defining evidence-based metrics and best practices in the prehospital setting. Participation in this project provides McGregor access to subject matter experts and collaboration with others in the project ranging from very large organizations (including Mecklenburg, Geisinger, and Indianapolis EMS) to much smaller, rural services more similar to McGregor.

 

The current area of improvement focuses on increasing the safety of patients, first responders, and the public by reducing the use of lights and sirens during ambulance calls on the way to the scene and during patient transport to the hospital.  

Why does reducing the use of lights & sirens matter?

Using lights and sirens in medical responses is grounded in tradition, but there is very little evidence that it improves patient outcomes and significant evidence that it increases the risk for everyone on the road. In addition to the many documented accidents involving emergency vehicles every year, there is also evidence that disruptions created by passing emergency vehicles result in many more crashes among civilian vehicles.

 

A recent Joint Position Statement by numerous organizations including the American Ambulance Association, American College of Emergency Physicians, and International Association of Fire Chiefs states in part: “For EMS, the purpose of using L&S (Lights and Siren) 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. Emergency vehicle crashes cause delays to care and injuries to patients, EMS practitioners, and the public.”

 

To summarize, national statistics suggest that:

  • Responses with lights and sirens increase the risk of an accident by 50%

  • Transporting patients with lights and sirens increases risk by 300%

  • That emergency vehicles passing by with lights and sirens cause other accidents on the roadway (an estimated four accidents for every 1 involving an emergency vehicle)

How do you decide whether to respond or transport without lights & sirens?

To safely judge which calls are appropriate for a response without lights & sirens, McGregor has long taken advantage of the information provided by the State of New Hampshire 9-1-1, which uses a nationally accredited screening program to classify responses when a 9-1-1 call is placed. McGregor has, for several years, utilized these call determinants and responds accordingly.

 

As part of this initiative, McGregor is seeking to further reduce the number of lights and siren responses over time while also evaluating safety and patient outcomes. We are also working closely with the local hospitals to ensure patients who require urgent medical interventions still receive a lights and sirens transport.

Won’t this increase response times?

Yes. For some patients who receive a no lights and sirens response, this will have a small impact on response times. While the impact varies based on location, time of day, etc., we find that even daytime responses to the edges of our primary response area only save about 2-4 minutes through the use of lights and sirens. This is rarely meaningful from a clinical perspective and often less than the wait time for many patients to see a doctor or nurse when they arrive at the hospital.

 

Those calls where a few minutes could make a meaningful difference (e.g., cardiac arrest, etc.) are identified reliably by the 9-1-1 system and will still receive a lights and sirens response. For those patients who require time-critical interventions, McGregor’s ambulances carry the personnel and equipment to initiate many of the same life-saving care that would be provided upon arrival at the emergency room, often negating the need for rapid transport.

Most experts in Emergency Medicine no longer consider response times to be a reliable indicator of EMS system quality because there is scant evidence that it improves patient care or outcomes. While McGregor still tracks response times, we are much more focused on other evidence-based performance measures to monitor the quality of care and drive areas for improvement.  

 

What else is McGregor doing to improve safety?

McGregor does a number of things to ensure that those who operate our vehicles do so in a safe manner. This begins with the background and interviewing process and continues during the initial training new volunteers receive when joining McGregor. All members receive significant training on how to operate emergency vehicles safely and also go through supervised driving courses both formally and throughout their 3+ month probationary period. In addition, driving is evaluated at multiple stages as volunteers progress through the ranks at McGregor.

 

In addition, as noted above, our Quality Assurance Committee also monitors an increasing number of key performance measures to monitor the quality of care and drive areas for improvement and training within the organization. This group also regularly collaborates with the hospitals to ensure feedback from those teams is incorporated into our review process.