4.6 / 100,000 without L&S 5.4 / 100,000 with L/S
7 / 100,000 without L&S
17.1 / 100,000 with L&S
The authors theorize a driving reason behind their observations as such: “During response two providers are in the front and share the cognitive load required to operate an ambulance”.
The general attitude may stem from the genesis of EMS, where First Aid attendants were not trusted to discern if a patient was stable or not. Ergo, the strategy of the time was to rapidly transport all patients with the underlying presumption that all patients “would” deteriorate unless proven otherwise AFTER arrival at a hospital.
With current advances in prehospital care, the vast majority of injury/illnesses can be effectively managed during the out-of-hospital phase of patient care.
The average rate of car crashers per 1 million miles is 2.6 / 1 million miles of travel. (Solomon, 1995)
(Anderson, 2014) Study in Denmark looked for morbidity by studying 94,488 patients transported without L&S and found only 152 patients (0.16%) that died the same day as their ambulance transport. A panel of prehospital anesthesiologists reviewed the patient care reports and found 13 (0.02%) with potentially preventable deaths. If every one of these deaths could have been prevented with L&S transport, the “number needed to treat” would have been 5000 extra L&S transports. (Anderson 2014) (Kupas 1994) Protocol is used to identify patients that may benefit by the time saved with L&S transport. When using this protocol on 1625 patients, only 130 (8%) were transported using L&S. A review of the 92% of cases where L&S was not used, the receiving physicians did not identify any cases of possible morbidity due to a slower transport. (Merlin 2012) Merlin developed an even simpler medical protocol for L&S transport, which reduced L&S transport in this urban New Jersey community from 49.6% to 29.0% for patients transported by ALS providers. (Marques-Batista 2010) 112 patients transported with L&S found that only five of those patients received a time-critical intervention upon arrival to the emergency department, and none of these procedures was done within the 2.62 minutes saved by L&S transport (Newgard 2010) The Resuscitation Outcomes Consortium studied the outcomes for injured patients treated by 146 EMS agencies, transporting to 51 Level I and II trauma centers, in ten North American communities. This large study found no association between survival and EMS time intervals – including response time and transport time.
L&S use generally only shortens response and transport time intervals by 1.7-3.6 minutes, and transport time only by 0.7-3,8 minutes. Greenville, NC; Saved average of 43.5 seconds
9.6 fatalities per 100,000 people per capita related to transportation. Rear Occupants are 2.7 times more likely to die in a crash (Kahn, 2001)
Public Perception: Anecdotally, it is possible some patients hesitate to call EMS for medical emergencies, because they are uncomfortable with L&S responses and increased attention. See the ubiquitous "caller requests no lights or sirens" dispatch. A 1988 phone survey of the public in Connecticut cited sirens and noise (67/604 respondents) as the primary reason for being uncomfortable in calling EMS during an emergency, and this response was followed by “getting lots of attention” (49/604 respondents). (Smackery 1988) Critz reported that the families of terminally ill patients who died at home sometimes felt anger with EMS, and L&S response was listed as one of the reasons for this. One-third of drivers responding to a survey in the United Kingdom reported feeling stress when navigating away from approaching emergency vehicles with L&S, and the authors believed that drivers found the interactions with emergency vehicles inconvenient and potentially dangerous. (Saunders 2003)
Wolfberg 1996 found that ambulance crashes are the most common cause of insurance claims greater than 10,000 dollars in EMS agencies