The use of warning lights and sirens by neonatal and pediatric critical care ground transport services has been a debated practice for emergency response and patient transport. The risk associated with ambulance crashes in terms of injury, death, and financial costs is high. Morbidity and mortality from collisions involving emergency vehicles is a major public health hazard. Roughly 70% of fatal ambulance crashes occur during the utilization of warning lights and sirens. Our neonatal/pediatric transport team began to track use of emergency lights and sirens. A review of the current literature revealed that we were considering a service area different from those in previous studies. Our team serves all of Eastern and Central Kentucky. Our critical care transport team tracked the use of emergency lights and sirens as well as reasons for utilization, time differences based on location, in addition to evaluating whether a simple intervention could decrease the use.
Retrospective chart review of 588 neonatal and pediatric transports from July 1, 2010 through March 30, 2012 was conducted to determine transport times, mileage, and utilization of warning lights and sirens from 21 hospitals within the referral area. Transport distances ranged from 1 – 147 miles one way with an average of 80 miles. The charts were subsequently analyzed after implementing that every lights and sirens transport would be reviewed by the medical director for appropriateness.
588 patients were included in the analysis. Time savings varied from 3-25 minutes based on the geographic location. There was not a common diagnosis or symptom that prompted lights and sirens. The use of lights and sirens decreased to a mean of 30% with the intervention of medical director overview.
In our preliminary study, the greater the distance traveled, the more time was saved by the use of lights and sirens. With the closer referral hospitals, there was little difference in overall time savings. As a result, a better geographic map can be established with which lights and sirens are unlikely to save a significant proportion of time. In addition, there was no consistent symptom or diagnosis that prompted the use of lights and sirens. The decision was usually a subjective one made by the medical crew based on their perception of the acuity of the patient. With the implementation of a simple intervention, medical director review of every lights and sirens transport, there was a significant reduction in its utilization presumably as the transport staff became more aware of the implications of their use. However, further investigation is warranted to determine whether time savings at greater distances outweighs the risk of lights and sirens in regard to patient outcomes and transport team safety.