April 10, 2025 • 45 mins
You might think unbelievably loud, shrill sirens on ambulances and fire trucks are just a fact of life. But what if we got the facts all wrong?
In this episode we ask how we got here in the first place. It’s a story involving a TV show from the 1970s, hearses serving as ambulances, and a dog with a big voice.
You can see a list of the sources we consulted while making this episode here.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Pushkin.
Speaker 2 (00:20):
Hello, Hello everyone. This is the first of what are
going to be a couple of episodes in this mini
season from my colleague Ben Adaph Haffrey. Ben is the
guy when you're hiking through the wilderness who says let's
go this way and there's no trail and you think, oh,
I'm going to get eaten by bears, and then no,
you find some lost civilization and large piles of glittering gold.
(00:44):
Ben started telling me this story and I stopped him
halfway through and I said, oh, Ben, this is a spandrel.
And what's a spandrel? One of my all time favorite concepts.
Invented by Stephen J. Gould, the spandrel is a thing
that doesn't have a function, but which hangs around like
a random hitchhiker, because it happens to be riding along
(01:05):
with things that do have a function, like your ear lobes.
I mean, what are they there for? Doesn't it seem
like they were all just along for the ride with
a part of our ear that actually does useful things.
Or your chin? What's up with the chin. We look
at a spandrel and we assume there has to be
a reason for it, and there isn't They're just spandrels.
(01:30):
My name is Malcolm Gladwell. This is Revisionist History, my
podcast about things overlooked and misunderstood. In this episode, my
colleague Bend daph Haffrey investigates a spandrel. You don't even
realize you've been living with something that none of us
would ever think to question, because it's such a bedrock
part of our world. We all just assume it has
to be there, and it doesn't. I'm talking, of course,
(01:55):
about sirens.
Speaker 1 (02:10):
Walk me through. No, you really do walk me through
what we're looking at here. I'm talking with my wife
Julia Conrad, who happens to share an apartment with me
on quite a noisy street in Brooklyn.
Speaker 3 (02:23):
This is a log that you created. Although I am
represented in it, I think it looks like we only
did it for one day. Of how many times we
heard the siren and where we heard it. Wow, what
a day.
Speaker 1 (02:37):
Julia and I live opposite this grocery store that's all local,
small batch whatnot. So instead of getting just one delivery
a day, they get like fifteen, sometimes from trucks bearing
I assume one sprig of artismal basil next door there's
a noisy playground and crucially a fire station, a really
active fire station. What happens is the grocery store trucks
(03:00):
block traffic, which means the fire trucks can't get out,
and so sirens all the time. This, for me, as
a writer, podcaster and light sleeper, is a problem. So
I decided to do some research. I made a spreadsheet.
(03:20):
We counted from nine am till ten at night, and
we heard a siren twenty four times. Twenty four times,
and this is reliable data. Julia is a data scientist.
She works for the New York City government, and she
has held my spreadsheet to the highest of standards.
Speaker 3 (03:37):
First, I have to say I never understand your way
of doing Google sheets because the color coding seems to
just be aesthetic. It's not actually representing anything in the data.
Speaker 1 (03:49):
I don't need this in it. I could get enough
of this in my job. I don't hear from you.
I will confess that the spreadsheet, consisting of mauv baby blue,
puked green, a cheery yellow, and several pleasingly varied shades
of red, isn't even complete because it does not count
the times we heard the siren in the middle of
the night when there is no one on the road.
(04:09):
Maybe you didn't realize this, but emergency vehicles will sometimes
run their lights and sirens even if there's seemingly no
one around. Sirens can run anywhere from one hundred and
ten decibels to over one hundred and thirty That is
ear damagingly loud. The classic fire siren sound like what
you hear in your head if you imagine a fire
truck right now. Is called the Federal Q TWOV, and
(04:31):
it's a whopping one hundred and twenty three decibels at
one hundred feet away. There's an actual corporation that makes
the siren. Federal Signal Fans post videos about the siren online.
Here's what it sounds like. Maybe turn your volume down.
Speaker 4 (04:46):
As we say, it's not a firetruck unless it's got.
Speaker 1 (04:48):
A key siren. According to a helpful chart from Yale University,
one hundred twenty three decibels is just two decibels lower
(05:12):
than the point at which quote pain begins. This would
all be fine, except I kind of need my ears
for my job, and this is why I began the log.
The log has fields for all relevant data date, time,
branch of emergency service. Location in the house from which
(05:34):
we have heard the siren.
Speaker 3 (05:35):
Well, there's really just two possibilities. You're either in the
front of the house or the back of the house.
But actually some of these entries are logged for front
and back, so that's when you know it's a really
big siren.
Speaker 1 (05:48):
There's also a field for reporter Ben slash Julia and
another for notes and then what is the final column.
Speaker 3 (05:56):
The final column is called dog question mark.
Speaker 1 (06:00):
This is the only field that matters. You See, there's
a dog in my neighborhood who howls almost every time
the siren goes off, and he sounds like this, a
(06:21):
dog who, by the standards of people on my block
is practically famous. Have you heard a dog who howls
every time the sirens go off? Yeah? I have.
Speaker 5 (06:30):
I mean they're pretty consistent with it.
Speaker 2 (06:32):
They're they're dedicated to their.
Speaker 5 (06:36):
Howling.
Speaker 4 (06:37):
I think I feel like my wife has heard the dog.
Speaker 1 (06:39):
But there's a guy, Kevin that lives after that garage
right there, and he does so he's talked about this
dog here. Yeah, what does he say? Oh, he's ready
to do something about it.
Speaker 3 (06:52):
It starts really low and guttural.
Speaker 6 (06:54):
I thought it was like a wearwolf or something.
Speaker 7 (06:56):
Oh.
Speaker 1 (07:03):
I decided to take a two pronged approach to my
siren problem. Planet I had to see if I could.
I proved that the sirens in my neighborhood were dangerously
unnecessarily loud, and Plan B. I needed a sympathetic face
for my cause. Nobody really cares about podcasters, but everybody
cares about dogs. And I had to assume that that
(07:25):
dog was howling along with the siren because he was,
like me, in serious pain. So find the dog, stop
the siren. It'd be that simple, except the dog was
not immediately forthcoming. So I pushed ahead with Plan A
noise research, which led me straight to doctor Arlene Bronze Aft.
Speaker 7 (07:49):
We're going to take you into the noise troom.
Speaker 1 (07:51):
What's the noise troop?
Speaker 8 (07:52):
Oh?
Speaker 7 (07:52):
Okay, no, see when you get there.
Speaker 1 (07:54):
Sarah doctor Bronze Aft, is an eighty nine year old
environmental psychologist who has been called the noise Queen of
New York City. She's done major noise studies worked for
five mayors. She grew up in Brooklyn and lives in
a lovely tidy apartment on the Upper East Side someone
was jackhammering the street outside the building, and yet you
couldn't hear a thing. Double glazed windows. Of course, she
(08:18):
took me to her noise room. The noise room sounds
possibly like the opposite of what I mean.
Speaker 7 (08:23):
Let me tell you it is a very quiet room.
This is quiet.
Speaker 1 (08:34):
Wow. How did you get it so quiet? Oh?
Speaker 7 (08:37):
Did I help make it quiet? Answer? Yes, I did
have a role and making it quieter than it would
have been. Can you see the cooling units?
Speaker 1 (08:47):
Yep?
Speaker 7 (08:47):
Are they all closed?
Speaker 1 (08:49):
Yep?
Speaker 7 (08:49):
Who do anythink made that request?
Speaker 1 (08:52):
Bronze Aft started her work during the golden age of
noise control the nineteen seventies, when the EPA began regulating noise.
Her early work demonstrated that noise isn't just annoying. They
can get in the way of kids learning in school,
and she just kept going from there. When the city
updated its noise code in two thousand and seven.
Speaker 7 (09:10):
In fact, it was my suggestion that they updated, it
carried quite a bit of weight. However, the literature that
they were depending upon was it was older. So today
we have much more solid literature on the link between
noise and health. That's critical, and that includes mental health.
(09:31):
As well in learning that.
Speaker 1 (09:34):
All checked out for me. Of course, the sirens are
too loud, but it can take a while for the
research to make its way into policy. Now we have
research linking even small changes and overall noise to significantly
increased risk of heart disease, to say nothing of stress,
poor sleep and its associated elements, and crucially the effective
noise on easpirated podcasters.
Speaker 7 (09:56):
Now you mentioned sirens, all right, that deals with safety,
That deals with getting someone to the hospital on time. However,
the sirens in Europe are less offensive, are less intrusive.
Europe mean people aren't dying, aren't they. The point is,
(10:17):
if Europe can have quiet at once, you could come
up with a method of quieting the sirens and still
be as effective. I have not seen a study I
has shown that if you have a less offensive intrusive
siren that more people die.
Speaker 1 (10:35):
Have you no? So here?
Speaker 7 (10:38):
I am, I'm a data person. Show me the data.
Speaker 1 (10:44):
I left that meeting full of hope. There's no doubt
that sirens are dangerously loud. I just need to find
the data to back this up and figure out a
new solution. Like Arlene said, I went straight to the
library and started digging around. But the more I saw
about how clear it is already that these sirens are crazy,
the less I believe that that data was going to
(11:05):
make any difference in the world. And then I found
a different set of data, not something about noise, but
something that undermined the very foundation of the sirens existence.
We'll be right back. Barrion County, Michigan, sits on the
(11:39):
southeastern shore of Lake Michigan. It's not too far from Kalamazoo,
quaint lake front towns, golf courses, quiet unless you work
as a paramedic.
Speaker 4 (11:50):
I have like four jobs because it doesn't everyone. And
I'm like, right now, I'm at the Barrion County Health Department.
Speaker 1 (11:56):
Jonathan Byer, former EMT and now medical director for the
Barrion County Health Department.
Speaker 4 (12:03):
I am not speaking on behalf of the Barian County
Health Department.
Speaker 1 (12:06):
Buyer was a boy scout, scrupulous. The reason he was
speaking to me is because, in his capacity as the
EMS medical director of the Baryon County Medical Control Authority,
he is responsible for the ambulances of Barrion County, and
that means he's thought a lot about the noises that
those ambulances make and he's arrived at a very controversial position.
Speaker 4 (12:29):
There is no evidence that lights and sirens helps anybody.
There's plenty of evidence that it hurts people.
Speaker 1 (12:34):
No evidence that lights and sirens helps anybody. This, even
to me an inveterate complainer about sirens, was a huge surprise.
Speaker 4 (12:42):
I started life as a paramedic before I got demoted
to doctor. I was a paramedic for eleven years. And
when I was a paramedic in the Philadelphia area, we
responded lights and sirens for everything. Like you called nine
to one, we just let you know, there we go.
When I got here to Michigan, they had two sets
(13:02):
of priorities, Priority one in Priority two.
Speaker 1 (13:05):
A lot of ems across the country has a similar
kind of tiered into system, a way to rank every
incoming nine to one one call based not on its
importance but on its time sensitivity. In Barryon County, they
would tag a call with priority one or two, depending
on what the issue was.
Speaker 4 (13:24):
There are more calls for service than there are ambulances,
so we have to find some way to prioritize them.
Speaker 1 (13:29):
Except the system wasn't really working.
Speaker 4 (13:32):
And a lot of these triggers for things were like,
if you ever complained of shortness of breath in any way,
shape or form, it made it a Priority one. The
problem is shortness of breath or do you feel like
you're having trouble breathing? An incredibly subjective question, and so
the medics were coming to me complaining. It's like, why
are we getting Priority one dental pain because the person's like,
(13:53):
I have a toothpain. Oh yeah, it's making hard to break.
We were about fifty to fifty for Priority ones, which
were lights and sirens, and Priority twos, which were not
lights and siren. Speed of traffic.
Speaker 1 (14:04):
So you only have a certain number of ambulances, but
if a full half of your calls are coming in
as urgent, how do you fix the problem? How do
you get all those ambulances where they need to be. Well,
an easy way is to get more places faster, which
theoretically you can do very easily if you're exempt from
all typical traffic laws, precisely why we have sirens. But
(14:26):
it's a little more complicated than that.
Speaker 4 (14:29):
So when you drive your car, you're used to things
like red lights. Everyone's going to stop. Once something interferes
with that, the chances of an accident increase.
Speaker 1 (14:39):
Specifically, it increases your chance of an accident by over
fifty percent, which is crazy. This is according to a
peer reviewed twenty nineteen study published in the Annals of
Emergency Medicine. The risk is even higher when transporting a
patient than when initially responding. But either way, the chance
of an accident is a lot higher when you're using
(15:00):
lights and sirens than if you're not. Also, these are
very often bad accidents. Ambulances are heavy, not a risk
worth taking if you're just responding to a toothache.
Speaker 4 (15:12):
I started going, why are we responding to dental pain
priority one? So myself and I have a residency program here,
and I had a couple of my high performing medics
and another EMS position and myself. We spent a couple
of weeks going through hundreds of these determined codes, going
does that really need priority one?
Speaker 1 (15:30):
So there's the accident's risk. But also, and this is
really surprising, using lights and sirens doesn't actually save that
much time on your route to the patient. For decades now,
studies have shown that lights and sirens seem to save
on average between forty two seconds and three minutes and
forty eight seconds. It's about one and a half minutes
(15:52):
of savings if you're in a city, and a little
over three and a half minutes if you're in the country.
Speaker 4 (15:57):
On average, yes, it's about forty five seconds or three minutes.
Speaker 1 (16:02):
And there are that's not a critical that's not a
critical interval most of the time for.
Speaker 4 (16:07):
Most disease process. Cardiac arrest is one that I would
put in the that's the time makes sense because in
cardiac arrest, for every every minute that you go without
CPR being done, there's about a ten percent increase in
mortality and decrease in survivable brain function coming.
Speaker 1 (16:26):
That's huge. Yeah, serta's huge. But heart attacks are actually
one of the few exceptions, not the rule, and yet
they are the exception on which the rule is largely based.
So all of these factors led Buyer to do something big.
He restructured the tears.
Speaker 4 (16:43):
I tell the medics, and this is how I presented
it is consider lights and sirens a medical therapy. Right,
there's for every medicine that you give, there is an
indication and there's a contraindication.
Speaker 1 (16:54):
Right.
Speaker 4 (16:55):
If I were going to say I'm going to give
you up an effort, well, why would I give you
epin effort and the benefits have to outweigh the risks.
So I wanted to think of lights and sirens that way.
It is a high risk procedure. When are we going
to do it when the risks are outweighed by the benefits.
Speaker 1 (17:11):
They ran through their data on all the calls that
they had responded to Priority one lights and sirens, and
they reassessed whether those really needed to be lights and sirens.
Speaker 4 (17:20):
So cardiac arrest, people choking, respiratory arrest, things where seconds
could make a difference, yep, that is worth the risk
to try to get someone there quicker. But other things
like well she fell and broke her hip, Okay, that's
an emergency and that person needs to get to a hospital.
I don't doubt that is the three minutes going to
(17:42):
make a difference in that person's outcome.
Speaker 1 (17:45):
No, So with all this data, Buyer and his team
changed how the calls were coded.
Speaker 4 (17:52):
I wiped out about fifty percent of the Priority one
calls in burying down.
Speaker 1 (17:56):
Let that sink in ambulance lights and sirens and Barrion
County were sounding half as often as they had before.
Now even I was wondering, could you really know that
this switch was putting anyone at risk? Well, eventually they
followed up on the people the ambulances had picked up
in the field to see how the hospital coded the
(18:16):
patients as they came in. So if you went to
someone as a priority too not that urgent, and they
showed up to the hospital as a priority one, that
would mean that you'd made a mistake. How much more
often was that happening under the new coding system than
the old It was the same number. Wow, there was
basically no difference, as in, he had the number of
(18:40):
lights and sirens responses in Barrion County. He reduced the
risk of accidents as a result, and it cost the
people of Barrion County nothing.
Speaker 4 (18:52):
When I instituted the change, I didn't really have much
of a problem. Nine to one one didn't have a
problem with this because it just was a difference in
coding for them.
Speaker 1 (19:01):
It didn't affect them.
Speaker 4 (19:02):
The medics themselves really liked it because the medics were like, yep,
most of these things we were going on are not
priority on board.
Speaker 1 (19:09):
The paramedics are on board. Smooth sailing, except what ended.
Speaker 4 (19:14):
Up happening and I'm not exactly sure how this got out.
It went through all the proper channels on my side,
like medical control in the hospital in the county, so
that was okay, But it started getting publicized, and I
don't exactly know how, but it started showing up on
the hospital Facebook page about Burian County medical Control is
(19:36):
killing people with slow responses, and oh boy.
Speaker 1 (19:40):
Unbeknownst to Bayer, word had gotten out to the people
who call ambulances big problem.
Speaker 6 (19:47):
Hey, if you're drive in Barrian County, you won't see
as many lights and sirens as you're driving. Ambulances will
be using them only for time sensitive cases like a
heart attack.
Speaker 1 (19:56):
The local news began doing man on the street interviews.
Speaker 4 (19:58):
Literally, they were out on the bluff overlooking Lake Michigan,
just interviewing people walking by, going what do you think
about ambulances coming to your house slower?
Speaker 1 (20:05):
And of course people explode over what did they say?
Speaker 4 (20:09):
It's like, I can't believe this, and you know that
this is terrible. Of course I won't ambulance there fast.
And the hospital started getting a lot of flack, some
of it was very nasty. So people started on Facebook
attacking the hospital. Oh this is Lakeland just killing patients again?
You know, just very bad vitriol.
Speaker 1 (20:27):
At the time, though Bayer was blissfully unaware any of
this was happening. Other jobs were keeping him very busy.
But then one morning he got a call.
Speaker 4 (20:36):
I'd done a six p to two am shift and
at eight am I got a call from the administrative
assistant to the CEO of the hospital. Hi there, doctor Buyer,
It's eight am. What are you doing at eight thirty?
I'm like, and I'm still swaking up because again I've
had four hours of sleep, and she's like, doctor Hamill.
At that point, the CEO of the hospital would like
(20:57):
to speak to you.
Speaker 1 (20:58):
Buyer gets dressed in hurries to doctor Hamill's office.
Speaker 4 (21:02):
And I'm met by them in the hospital attorney and
being shown this Facebook page and they're like, what did
you do? This is terrible?
Speaker 1 (21:11):
Buyers stunned, and then he begins to lay out the
case against Sirens in a very doctor buyer way.
Speaker 4 (21:17):
I try to explain what I had done. Is have
you ever taken physics?
Speaker 1 (21:24):
Buyer explained his move, maybe a little inefficiently, by using
the equation for velocity distance divided by time changed to
solve for time or Tea. It amounted to this, If
you're trying to get time down and you can't reduce
the distance between you and a patient by putting more
ambulances on the street, because it's expensive, the easiest way
(21:45):
to get it done is to increase your velocity, which
means running your lights and sirens. But the problem is,
we now know that running lights and sirens significantly increases
the risk of an accident, So maybe you don't want
to do that either. Then the thing to do is
to take a second look at tea. Does time really
need to come down by the small increment that we
(22:06):
now know lights and sirens is going to reduce it?
Not for most things.
Speaker 4 (22:11):
I showed him some of the studies. He's like, your
science is sound. You may you go next time, do
a press conference. Oh I had a press conference, which
is what you saw.
Speaker 1 (22:19):
Online Buyer confronted the outrage masses.
Speaker 4 (22:23):
And once that went out, all complaints disappeared in six
weeks and I've heard not a thing since then. In fact,
now we are considered we right now are the leader
in Michigan for the lowest rates of lights and sirens
use in the state of Michigan.
Speaker 1 (22:34):
For ems. Things worked out for buyer in the end.
But I'm interested in that initial freak out because it
reveals a basic assumption people make, myself included. Everything is urgent,
so we accept this social loophole where you can break
all known traffic laws provided you possess a device that
emits the loudest, shrillest sound imaginable. What kind of world
(22:57):
does this? I'm not arguing that we shouldn't have sirens
at all, but it seems to me that they're not
only too loud and crazy sounding, but like we use
them way more often than is necessary because we're unwilling
to let go of them. But of course, Barrion County
is just one place. Approximately twenty thousand the MS calls
(23:18):
a year, and paramedics are just one branch of the
emergency service. I shouldn't get ahead of myself. I was
left with two big questions to answer. Next, where did
we get the idea that sirens are so necessary? And
exactly how unnecessary are they? A good place to look
(23:39):
is the same place we fell in love with the
MS once upon a time. We'll be right back.
Speaker 8 (24:05):
If you would have asked eighteen year old Jeff when
I first drove lights and sirens. I would have said
that they are always life saving and we absolutely need
to use it. But I'm not eighteen anymore.
Speaker 1 (24:18):
Jeff Jarvis the chief Medical Officer for the Metropolitan Area
EMS Authority in Fort Worth, Texas, an emergency medical service
that serves over a million people in Fort Worth and
fourteen surrounding cities. He's been a paramedic since the nineteen eighties.
He served around New York City in Austin. So eighteen
(24:39):
year old Jeff who's made his decision to begin to
be a paramedic. So let me ask you. Let me
ask you a question. In the nineteen seventies, did you
ever watch the television show Emergency?
Speaker 8 (24:52):
Oh?
Speaker 1 (24:52):
Of course? And did that have an effect on your
becoming a paramedic?
Speaker 8 (24:57):
It did. I thought it was the coolest thing ever.
Speaker 1 (24:59):
In nineteen seventy two, NBC began airing a television show
called Emergency. That's got an exclamation point at the end.
By the way, the theme song is the music they'd
play in my version of Hell. The show is about
(25:21):
Johnny and Roy, two young paramedics working out of fire
Station fifty one in Los Angeles, except they're not paramedics
in the beginning that.
Speaker 9 (25:29):
Special training program.
Speaker 8 (25:31):
Remember we were talking about it a couple of days ago.
Speaker 1 (25:33):
Yes, sir, the para something or other paramedics. The series
begins in a world where there basically aren't any paramedics,
which was our world fifty three years ago. Fifty three
years in nineteen seventy one, there were a slim twelve
paramedic units in the entire country and it was kind
(25:54):
of a Wild West situation. Details varied from place to place,
but in some areas it was illegal to give someone
medical care if you weren't a doctor or a nurse.
So about fifty percent of ambulances were just hearses driven
out of funeral homes by morticians whose sole purpose was
to get patients to doctors as quickly as possible. In
(26:15):
that failed back to the funeral home, you go. This
is actually how it worked. Emergency was a show dreamed
up in partnership with the father of modern ms, a
guy named James Page who worked at one of the
first firehouses with a paramedic unit in Los Angeles, and
the show was literally meant to make the case for paramedics.
(26:37):
Every Saturday night nationwide on NBC thirty million viewers at
a time, not a few of whom became paramedics.
Speaker 9 (26:45):
People at dying at the scene, people who could stay
alive if there was somebody on the spot who knew
what to do.
Speaker 1 (26:51):
Look, if that.
Speaker 9 (26:52):
Bill passed the legislature today, do you know how many
people we'd have ready for the job?
Speaker 8 (26:56):
Six men for six and a half million people.
Speaker 1 (26:59):
I learned about emergency in a brilliant essay by UCLA
emeritis law professor Paul Bergman, where he traces the profound
influence the show had not just on par metics, but
on lawmakers too, by dramatizing just how urgent every single
nine to one call is.
Speaker 8 (27:17):
We almost head him back.
Speaker 9 (27:18):
Damn it, we almost head him back.
Speaker 1 (27:20):
If you could have been defibrillated the moment they pulled
him off the wire. This is from the first episode,
right after a maintenance man gets electrocuted and eventually dies.
The doctor and nurse, who by the way, are of
course romantically involved, are talking.
Speaker 9 (27:35):
Somebody should have been there with a machine in their bucket,
not somebody The paramedics again.
Speaker 1 (27:43):
Call him paramedics a rescue team. That doesn't matter.
Speaker 9 (27:47):
Cal if somebody with the right equipment and trained to
use it.
Speaker 8 (27:50):
Had gotten to this man in time, he'd be alive.
Speaker 9 (27:52):
Now, I won't use this situation that justify setting amaters
out to practice medicine on the street, trained amaters trained
by you, and doctors like you, amateurs, Dixie. I spent
twelve years in school and residency and I'm still learning
my trade.
Speaker 1 (28:06):
It's a doubleheader pilot, and both episodes are full of
these situations that dramatized the resistance to paramedics, which was
very real. But the show argues that we need paramedics
and why do we need them because there are so
many accidents where if only someone had been there in time,
we could have saved.
Speaker 5 (28:24):
Them, including myself, and thought it could possibly be a success.
Speaker 9 (28:31):
Well, or arm may not function as well as it
used to, but at least it'll be your own.
Speaker 1 (28:36):
You're getting out here as fast as you did.
Speaker 9 (28:38):
Made the difference, Randy, to have around, doc, you gotta give.
Speaker 8 (28:41):
Us a try.
Speaker 1 (28:42):
Bergmann, the law professor, talked to the legends of ems
and he heard all these emergency references. Dug through California
hearings on the Paramedic Act, and he found emergency references
letters from senators emergency references. In the early years of
the show, forty six states legalized paramedicine. To be clear,
(29:04):
this was a movement that was already in process, but
emergency was a big part of establishing the cultural expectations
for what those units would look like. And it looked
like lights and sirens to every call, because every call
was all about time.
Speaker 9 (29:21):
But you can't ask someone not to die while you're
trying to find out what's wrong with him. And they
do die, gentlemen, on the way from where it happens
to my hospital.
Speaker 1 (29:31):
This is from the second part of the pilot episode,
when the skeptical doctor has come around.
Speaker 9 (29:36):
They die by the hundreds every year, not from mortal wounds,
but neglected wounds, not from incompetence or indifference, but from time,
from lack of time. I'm in favor of more doctors,
more hospitals, and better equipment. And I'm also in favor
of this bill until those other things come along, because
(29:57):
it will save lives, maybe a dozen lives, maybe a thousand,
maybe just one.
Speaker 1 (30:06):
He's looking directly into the camera, those thirty million viewers,
and who knows which one time, time time, And if
you succeed at convincing people that every situation is urgent.
They're going to come to expect lights and sirens every
(30:27):
time they call nine one one, And how many of
the calls in emergency do they respond to with lights
and si.
Speaker 8 (30:34):
Absolutely, so think about it this way. On Emergency, every
call was a life threatening emergency. Now I say that
knowing the first call they went on was not but
in the team the first episode of the pilot, but
the vast majority were life threatening emergencies. So sure people
got that that notion and expectation that that's what would happen.
(30:57):
There are a lot of paramedics who joined up for
those life threatening emergencies only to find out that eighty
five percent of the calls is holding somebody's hand.
Speaker 1 (31:08):
Sirens are all over the show. You may recall that
the literal theme song of Emergency features sirens, and I
think a lot of this time sireen obsession is due
to the fact that early ems departments were part of
fire departments, and a fire is a very specific kind
of emergency. If you don't contain it, it spreads. So
(31:29):
every fire is an urgent situation, and according to FEMA, anecdotally,
firefighters use their sirens way more often than the police.
But these days even the fire service in most places
seems to be based on an outdated sense of its mission.
As of twenty twenty three, less than four percent of
all nine one one calls firefighters responded to or for fires,
(31:53):
most or for ems and rescue. So then it looks
like the argument about siren reform broadly applies to firefighters too.
The US Fire Administration actually cited a bunch of studies
about reducing siren u usage just last year. Sirens are dangerous,
they save time, but not that much, and things are
(32:16):
often less urgent than they appear.
Speaker 8 (32:19):
Sometimes that three or four minutes is clinically valuable. Most
of the time it's not.
Speaker 1 (32:25):
Jeff Jarvis did a massive study on lights and sirens
using something called the ESO data set, a national collection
of emergency calls with unbelievably granular data attached.
Speaker 8 (32:37):
Seven and a half million records. Five point nine million
of those were non Wollown responses. We analyzed every one
of those and calculated the proportion that used lights and sirens,
and eighty five point eight eighty six percent of them
responded to the scene with lights and sirens.
Speaker 1 (32:55):
Oh my, God.
Speaker 8 (32:56):
The fundamental question we ask is of those responses where
you use lightcense sirens, how many of them did we
do something potentially life saving? And what we ended up
finding is six point nine of those nine one one
lights and sirens responses, did we do something even vaguely
potentially life saving? And we were rather generous with our
(33:19):
description of what potentially life saving is.
Speaker 1 (33:23):
So this is crucial. Paramedics are responding with lights and
sirens to around eighty six percent of calls when only
seven percent of them are resulting in a vaguely potentially
life saving intervention, So why were they urgent? That means
that in the United States, we're using lights and sirens
(33:44):
somewhere between eighty percent and ninety percent more often than
we need to. The question I have that I can
imagine people who are skeptical might ask, is, well, how
much do you really know from the call? Can you tell?
Speaker 8 (33:59):
Most folks are using some type of emergency medical dispatch
where there are scripted questions, and they will give each type.
Speaker 1 (34:08):
Of call.
Speaker 8 (34:10):
A number and a letter, and the letter is called
the determinant and it goes from your echo level calls
which are most likely to be life threatening down to
Omega level calls which are not very likely at all
to be life threatening. And those criteria have been evaluated
multiple times with multiple data sets. Again, they're not perfect,
(34:33):
but they are pretty accurate. For example, there is a
call nature called eye problem. Zero point sixty seven percent
of those calls resulted in a potentially life saving intervention.
Speaker 1 (34:47):
And how many do people run hot to all of them?
Speaker 8 (34:50):
It's just dangerous, and it's dangerous, and it's not really
doing what we think it is. So it seems like
it is an intervention whose time has come and gone.
Speaker 1 (35:01):
So I want to play for you again a very
specific moment from the pilot episode of Emergency and the
speech that doctor gave to the legislature about why we
need ems.
Speaker 9 (35:11):
I'm in favor of more doctors, more hospitals, and better equipment,
and I'm also in favor of this bill until those
other things come along.
Speaker 1 (35:19):
But those other things have come along. More doctors, advances
in the ways we take nine to one one calls,
better in more emergency rooms, better in more emergency medicine, better,
and more paramedics to use Buyer's formula. We have reduced distance.
Paramedic units are all over the place now in a
(35:40):
way they just weren't in the world of emergency. But
it seems to me like in our minds and on TV,
it's as if nothing has changed since the nineteen seventies.
Emergency was the most significant early example of an entire
genre of TV show that dramatized the emergency services. Before
there was Cops or Rescue nine one one, there was emergency.
(36:03):
And here's the trick. All of those TV shows are
based on the narrative conventions that emergency pioneer, a world
in which the TV show had not yet done its work,
and help was always too far away and always came
with lights and sirens blaring, because that's what firefighters did.
And these shows are everywhere. Rescue Me, sky Mett, Live Rescue,
(36:28):
Helicopter Heroes, Island Medics, Air Ambulance Er, a show that
was literally called Sirens, which is what they'll play on
TV in Hell for me. They even make this stuff
for kids. This is what Paw Patrol is, start them young.
Speaker 8 (36:47):
There is in emergency departments everywhere I see as there's
this concept called alarm fatigue, where when everything is an alarm,
nothing is an alarm. To paraphrase, The Incredibles, the Car
Chain movie. So you just get immune to these sirens
that are not doing the job.
Speaker 1 (37:08):
So Jarvis, like Buyer, reduce the use of lights and sirens.
He cut them by about a third. Did their response
time increase, Yes, by a median of six seconds, and
in the vast majority of cases by less.
Speaker 8 (37:25):
So it's turning out it's not making that much of
a difference in we're being much safer.
Speaker 1 (37:29):
And this I realized this is purely in the realm
of hypothesis, but it seems to me common sensical that
were lights and sirens reserved for truly emergency use, you
would see a more potent reaction to them, and likely
then it would it could it could possibly decrease response times.
Speaker 8 (37:49):
So I'll put my scientist hat on and say that's
an interesting hypothesis that needs to be tested. I will
put my realist in my pragmatic public health hat on
and say, absolutely, giddy up. I absolutely think you'll see that.
Speaker 1 (38:04):
I like that hat. That's a very stylish hat. You're
all right, So here it is. Lights and sirens are
a tool that currently seem to be way overused, and
that overuse has real consequences. Most of all, for our
burnt out, overstretched first responders who go to work to
save lives and wind up responding to everything as if
(38:26):
it's a crisis, wearing themselves out and losing their hearing
in the process. In twenty fifteen, fifteen hundred firemen sued
that company Federal Signal, the one that makes the iconic
fire siren, for causing mass loss of hearing. A lawyer
opposing them said, and I, quote, what's their solution. If
(38:48):
you don't have sirens, people would get mowed down in
the streets. The siren works exactly the way it should
end quote. I could not disagree more. And you know
who else disagrees that's right? I found him. Okay, I
(39:25):
am approaching Davy's house, which is coincidentally directly behind my house.
I was just walking down my street one day when
an ambulance rushed by and I saw this dopey yellow
lab stiffening owl. I'd know that owl anywhere. I rushed
(39:46):
over it and I was like, hey, I've got a
question about your dog, and his owner was very obliging.
His name is Joe. The dog's name Davy, And a
while later I came by their house for an interview
(40:08):
that was a very that was very satisfied. Sniff said,
I got Jen and Joe live one street over from
me and Julia, a beautiful brownstone, two kids, and a
noisy dog. We sat down at their kitchen table. I
am curious if you could tell me about when you
realize that you had a sort of eccentric dog.
Speaker 4 (40:33):
Well, I guess it.
Speaker 6 (40:34):
Was like the first time we heard him howling at sirens,
because he didn't seem particularly distressed by it. Like a
lot of times his tail wags and he does get
quite a reaction from like the neighbors, like the neighborhood,
Like everyone usually turns around and stops and like laughs
and was there, like I've never heard that before.
Speaker 1 (40:56):
It turns out Davy is starting a movement.
Speaker 6 (40:58):
His dog walker always like posts like sends us emails
like describing their walk. So you know, sometimes Davy has
gotten his his co his co partners in walking the
other dogs to start to howl with him.
Speaker 1 (41:11):
But he's always the first towler.
Speaker 6 (41:13):
It's definitely always the first howlur. But I think he
has taught some of the other dogs like how to
maybe start doing this, so.
Speaker 1 (41:19):
Their owners must be thrilled. Jen is a psychologist, Joe
is a composer for film and television, so together they're
experts on mammalian behavior and sound. So I'm inclined to
believe their analysis of Davy's views on the sirens subject.
He's not in distress, which means he's not going to
be the poster child for my anti siren campaign. But
(41:40):
I hadn't given up yet. Do you share this view
of Davy's howl origins or what? So?
Speaker 5 (41:46):
There's there's another theory, which this is the one I
think I if I had to choose one that I
would like to believe the most, it is. It is
that the sirens harken back to a lost dog who
has been separated from the group, and they are howling
to reconnect with the pack like a like a call
and answer from a lost dog. That's one of the series,
(42:11):
And that Davy is saying, we're over here. Come on,
lost buddy, this is where we are.
Speaker 6 (42:18):
He is a very nigh early dog.
Speaker 5 (42:20):
It loves to hang.
Speaker 1 (42:22):
Jen and Joe are very neighborly people. I'm glad to
know them now, even if their dog is a huge disappointment.
My anti Siren cusade, seeing as he really love sirens.
But it makes sense. It goes back to that evolutionary
theory Malcolm was talking about at the top of the episode,
the idea of the spandrel and the things in our
(42:43):
bodies and our worlds that we think we're selected for
but actually are just there and maybe not doing us
a whole lot of good. Davy's howl isn't quite a spandrel,
if we're being banantic. It's more like a vestige. He
thinks he's living with a pack of dogs in the wild,
but he's not. He's a house dog who lives in Brooklyn,
(43:07):
a block away from a busy grocery store or a playground,
a frustrated podcaster, a New York City government employee and
a fire station, a celebrity ignorant of his own fame,
and a howler who howls just because that's what he's
always done. Revisionist History is produced by me Ben matt
(43:48):
of Haffrey, Nina Bird Lawrence, and Lucy Sullivan. Our editor
is Karen Chakerji. Original scoring and theme by Louis Garra,
Additional scoring by Jake Gorski. Jacob Smith is our executive
producer engineering by Marcelo d Olivera. I relied on quite
a few studies in researching this and put a link
(44:10):
to the bibliography in the show notes should you want
any references for starting your own local movement. Special things
also to Douglas Koupas, whose work helped launch the field
of sign reform studies, Mike Tageman, Helen k Rosenthal, Stephen Solomon,
and Paul Bergman. I'm Ben Mattahaffrey. The really Alarming music
(44:44):
You're hearing right Now was composed by davi's owner Joe
Saba for the trailer of the Michael Bay film Ambulance.
Speaker 2 (45:30):
Get add free episodes of Revision's history by subscribing to
Pushkin Plus. Sign up on the show page on Apple Podcasts,
or at pushkin dot fm, slash plus. Pushkin Plus subscribers
can access ad free episodes, full audiobooks, exclusive binges, and
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Pushkin.
Speaker 2 (00:20):
Hello, Hello everyone. This is the first of what are
going to be a couple of episodes in this mini
season from my colleague Ben Adaph Haffrey. Ben is the
guy when you're hiking through the wilderness who says let's
go this way and there's no trail and you think, oh,
I'm going to get eaten by bears, and then no,
you find some lost civilization and large piles of glittering gold.
(00:44):
Ben started telling me this story and I stopped him
halfway through and I said, oh, Ben, this is a spandrel.
And what's a spandrel? One of my all time favorite concepts.
Invented by Stephen J. Gould, the spandrel is a thing
that doesn't have a function, but which hangs around like
a random hitchhiker, because it happens to be riding along
(01:05):
with things that do have a function, like your ear lobes.
I mean, what are they there for? Doesn't it seem
like they were all just along for the ride with
a part of our ear that actually does useful things.
Or your chin? What's up with the chin. We look
at a spandrel and we assume there has to be
a reason for it, and there isn't They're just spandrels.
(01:30):
My name is Malcolm Gladwell. This is Revisionist History, my
podcast about things overlooked and misunderstood. In this episode, my
colleague Bend daph Haffrey investigates a spandrel. You don't even
realize you've been living with something that none of us
would ever think to question, because it's such a bedrock
part of our world. We all just assume it has
to be there, and it doesn't. I'm talking, of course,
(01:55):
about sirens.
Speaker 1 (02:10):
Walk me through. No, you really do walk me through
what we're looking at here. I'm talking with my wife
Julia Conrad, who happens to share an apartment with me
on quite a noisy street in Brooklyn.
Speaker 3 (02:23):
This is a log that you created. Although I am
represented in it, I think it looks like we only
did it for one day. Of how many times we
heard the siren and where we heard it. Wow, what
a day.
Speaker 1 (02:37):
Julia and I live opposite this grocery store that's all local,
small batch whatnot. So instead of getting just one delivery
a day, they get like fifteen, sometimes from trucks bearing
I assume one sprig of artismal basil next door there's
a noisy playground and crucially a fire station, a really
active fire station. What happens is the grocery store trucks
(03:00):
block traffic, which means the fire trucks can't get out,
and so sirens all the time. This, for me, as
a writer, podcaster and light sleeper, is a problem. So
I decided to do some research. I made a spreadsheet.
(03:20):
We counted from nine am till ten at night, and
we heard a siren twenty four times. Twenty four times,
and this is reliable data. Julia is a data scientist.
She works for the New York City government, and she
has held my spreadsheet to the highest of standards.
Speaker 3 (03:37):
First, I have to say I never understand your way
of doing Google sheets because the color coding seems to
just be aesthetic. It's not actually representing anything in the data.
Speaker 1 (03:49):
I don't need this in it. I could get enough
of this in my job. I don't hear from you.
I will confess that the spreadsheet, consisting of mauv baby blue,
puked green, a cheery yellow, and several pleasingly varied shades
of red, isn't even complete because it does not count
the times we heard the siren in the middle of
the night when there is no one on the road.
(04:09):
Maybe you didn't realize this, but emergency vehicles will sometimes
run their lights and sirens even if there's seemingly no
one around. Sirens can run anywhere from one hundred and
ten decibels to over one hundred and thirty That is
ear damagingly loud. The classic fire siren sound like what
you hear in your head if you imagine a fire
truck right now. Is called the Federal Q TWOV, and
(04:31):
it's a whopping one hundred and twenty three decibels at
one hundred feet away. There's an actual corporation that makes
the siren. Federal Signal Fans post videos about the siren online.
Here's what it sounds like. Maybe turn your volume down.
Speaker 4 (04:46):
As we say, it's not a firetruck unless it's got.
Speaker 1 (04:48):
A key siren. According to a helpful chart from Yale University,
one hundred twenty three decibels is just two decibels lower
(05:12):
than the point at which quote pain begins. This would
all be fine, except I kind of need my ears
for my job, and this is why I began the log.
The log has fields for all relevant data date, time,
branch of emergency service. Location in the house from which
(05:34):
we have heard the siren.
Speaker 3 (05:35):
Well, there's really just two possibilities. You're either in the
front of the house or the back of the house.
But actually some of these entries are logged for front
and back, so that's when you know it's a really
big siren.
Speaker 1 (05:48):
There's also a field for reporter Ben slash Julia and
another for notes and then what is the final column.
Speaker 3 (05:56):
The final column is called dog question mark.
Speaker 1 (06:00):
This is the only field that matters. You See, there's
a dog in my neighborhood who howls almost every time
the siren goes off, and he sounds like this, a
(06:21):
dog who, by the standards of people on my block
is practically famous. Have you heard a dog who howls
every time the sirens go off? Yeah? I have.
Speaker 5 (06:30):
I mean they're pretty consistent with it.
Speaker 2 (06:32):
They're they're dedicated to their.
Speaker 5 (06:36):
Howling.
Speaker 4 (06:37):
I think I feel like my wife has heard the dog.
Speaker 1 (06:39):
But there's a guy, Kevin that lives after that garage
right there, and he does so he's talked about this
dog here. Yeah, what does he say? Oh, he's ready
to do something about it.
Speaker 3 (06:52):
It starts really low and guttural.
Speaker 6 (06:54):
I thought it was like a wearwolf or something.
Speaker 7 (06:56):
Oh.
Speaker 1 (07:03):
I decided to take a two pronged approach to my
siren problem. Planet I had to see if I could.
I proved that the sirens in my neighborhood were dangerously
unnecessarily loud, and Plan B. I needed a sympathetic face
for my cause. Nobody really cares about podcasters, but everybody
cares about dogs. And I had to assume that that
(07:25):
dog was howling along with the siren because he was,
like me, in serious pain. So find the dog, stop
the siren. It'd be that simple, except the dog was
not immediately forthcoming. So I pushed ahead with Plan A
noise research, which led me straight to doctor Arlene Bronze Aft.
Speaker 7 (07:49):
We're going to take you into the noise troom.
Speaker 1 (07:51):
What's the noise troop?
Speaker 8 (07:52):
Oh?
Speaker 7 (07:52):
Okay, no, see when you get there.
Speaker 1 (07:54):
Sarah doctor Bronze Aft, is an eighty nine year old
environmental psychologist who has been called the noise Queen of
New York City. She's done major noise studies worked for
five mayors. She grew up in Brooklyn and lives in
a lovely tidy apartment on the Upper East Side someone
was jackhammering the street outside the building, and yet you
couldn't hear a thing. Double glazed windows. Of course, she
(08:18):
took me to her noise room. The noise room sounds
possibly like the opposite of what I mean.
Speaker 7 (08:23):
Let me tell you it is a very quiet room.
This is quiet.
Speaker 1 (08:34):
Wow. How did you get it so quiet? Oh?
Speaker 7 (08:37):
Did I help make it quiet? Answer? Yes, I did
have a role and making it quieter than it would
have been. Can you see the cooling units?
Speaker 1 (08:47):
Yep?
Speaker 7 (08:47):
Are they all closed?
Speaker 1 (08:49):
Yep?
Speaker 7 (08:49):
Who do anythink made that request?
Speaker 1 (08:52):
Bronze Aft started her work during the golden age of
noise control the nineteen seventies, when the EPA began regulating noise.
Her early work demonstrated that noise isn't just annoying. They
can get in the way of kids learning in school,
and she just kept going from there. When the city
updated its noise code in two thousand and seven.
Speaker 7 (09:10):
In fact, it was my suggestion that they updated, it
carried quite a bit of weight. However, the literature that
they were depending upon was it was older. So today
we have much more solid literature on the link between
noise and health. That's critical, and that includes mental health.
(09:31):
As well in learning that.
Speaker 1 (09:34):
All checked out for me. Of course, the sirens are
too loud, but it can take a while for the
research to make its way into policy. Now we have
research linking even small changes and overall noise to significantly
increased risk of heart disease, to say nothing of stress,
poor sleep and its associated elements, and crucially the effective
noise on easpirated podcasters.
Speaker 7 (09:56):
Now you mentioned sirens, all right, that deals with safety,
That deals with getting someone to the hospital on time. However,
the sirens in Europe are less offensive, are less intrusive.
Europe mean people aren't dying, aren't they. The point is,
(10:17):
if Europe can have quiet at once, you could come
up with a method of quieting the sirens and still
be as effective. I have not seen a study I
has shown that if you have a less offensive intrusive
siren that more people die.
Speaker 1 (10:35):
Have you no? So here?
Speaker 7 (10:38):
I am, I'm a data person. Show me the data.
Speaker 1 (10:44):
I left that meeting full of hope. There's no doubt
that sirens are dangerously loud. I just need to find
the data to back this up and figure out a
new solution. Like Arlene said, I went straight to the
library and started digging around. But the more I saw
about how clear it is already that these sirens are crazy,
the less I believe that that data was going to
(11:05):
make any difference in the world. And then I found
a different set of data, not something about noise, but
something that undermined the very foundation of the sirens existence.
We'll be right back. Barrion County, Michigan, sits on the
(11:39):
southeastern shore of Lake Michigan. It's not too far from Kalamazoo,
quaint lake front towns, golf courses, quiet unless you work
as a paramedic.
Speaker 4 (11:50):
I have like four jobs because it doesn't everyone. And
I'm like, right now, I'm at the Barrion County Health Department.
Speaker 1 (11:56):
Jonathan Byer, former EMT and now medical director for the
Barrion County Health Department.
Speaker 4 (12:03):
I am not speaking on behalf of the Barian County
Health Department.
Speaker 1 (12:06):
Buyer was a boy scout, scrupulous. The reason he was
speaking to me is because, in his capacity as the
EMS medical director of the Baryon County Medical Control Authority,
he is responsible for the ambulances of Barrion County, and
that means he's thought a lot about the noises that
those ambulances make and he's arrived at a very controversial position.
Speaker 4 (12:29):
There is no evidence that lights and sirens helps anybody.
There's plenty of evidence that it hurts people.
Speaker 1 (12:34):
No evidence that lights and sirens helps anybody. This, even
to me an inveterate complainer about sirens, was a huge surprise.
Speaker 4 (12:42):
I started life as a paramedic before I got demoted
to doctor. I was a paramedic for eleven years. And
when I was a paramedic in the Philadelphia area, we
responded lights and sirens for everything. Like you called nine
to one, we just let you know, there we go.
When I got here to Michigan, they had two sets
(13:02):
of priorities, Priority one in Priority two.
Speaker 1 (13:05):
A lot of ems across the country has a similar
kind of tiered into system, a way to rank every
incoming nine to one one call based not on its
importance but on its time sensitivity. In Barryon County, they
would tag a call with priority one or two, depending
on what the issue was.
Speaker 4 (13:24):
There are more calls for service than there are ambulances,
so we have to find some way to prioritize them.
Speaker 1 (13:29):
Except the system wasn't really working.
Speaker 4 (13:32):
And a lot of these triggers for things were like,
if you ever complained of shortness of breath in any way,
shape or form, it made it a Priority one. The
problem is shortness of breath or do you feel like
you're having trouble breathing? An incredibly subjective question, and so
the medics were coming to me complaining. It's like, why
are we getting Priority one dental pain because the person's like,
(13:53):
I have a toothpain. Oh yeah, it's making hard to break.
We were about fifty to fifty for Priority ones, which
were lights and sirens, and Priority twos, which were not
lights and siren. Speed of traffic.
Speaker 1 (14:04):
So you only have a certain number of ambulances, but
if a full half of your calls are coming in
as urgent, how do you fix the problem? How do
you get all those ambulances where they need to be. Well,
an easy way is to get more places faster, which
theoretically you can do very easily if you're exempt from
all typical traffic laws, precisely why we have sirens. But
(14:26):
it's a little more complicated than that.
Speaker 4 (14:29):
So when you drive your car, you're used to things
like red lights. Everyone's going to stop. Once something interferes
with that, the chances of an accident increase.
Speaker 1 (14:39):
Specifically, it increases your chance of an accident by over
fifty percent, which is crazy. This is according to a
peer reviewed twenty nineteen study published in the Annals of
Emergency Medicine. The risk is even higher when transporting a
patient than when initially responding. But either way, the chance
of an accident is a lot higher when you're using
(15:00):
lights and sirens than if you're not. Also, these are
very often bad accidents. Ambulances are heavy, not a risk
worth taking if you're just responding to a toothache.
Speaker 4 (15:12):
I started going, why are we responding to dental pain
priority one? So myself and I have a residency program here,
and I had a couple of my high performing medics
and another EMS position and myself. We spent a couple
of weeks going through hundreds of these determined codes, going
does that really need priority one?
Speaker 1 (15:30):
So there's the accident's risk. But also, and this is
really surprising, using lights and sirens doesn't actually save that
much time on your route to the patient. For decades now,
studies have shown that lights and sirens seem to save
on average between forty two seconds and three minutes and
forty eight seconds. It's about one and a half minutes
(15:52):
of savings if you're in a city, and a little
over three and a half minutes if you're in the country.
Speaker 4 (15:57):
On average, yes, it's about forty five seconds or three minutes.
Speaker 1 (16:02):
And there are that's not a critical that's not a
critical interval most of the time for.
Speaker 4 (16:07):
Most disease process. Cardiac arrest is one that I would
put in the that's the time makes sense because in
cardiac arrest, for every every minute that you go without
CPR being done, there's about a ten percent increase in
mortality and decrease in survivable brain function coming.
Speaker 1 (16:26):
That's huge. Yeah, serta's huge. But heart attacks are actually
one of the few exceptions, not the rule, and yet
they are the exception on which the rule is largely based.
So all of these factors led Buyer to do something big.
He restructured the tears.
Speaker 4 (16:43):
I tell the medics, and this is how I presented
it is consider lights and sirens a medical therapy. Right,
there's for every medicine that you give, there is an
indication and there's a contraindication.
Speaker 1 (16:54):
Right.
Speaker 4 (16:55):
If I were going to say I'm going to give
you up an effort, well, why would I give you
epin effort and the benefits have to outweigh the risks.
So I wanted to think of lights and sirens that way.
It is a high risk procedure. When are we going
to do it when the risks are outweighed by the benefits.
Speaker 1 (17:11):
They ran through their data on all the calls that
they had responded to Priority one lights and sirens, and
they reassessed whether those really needed to be lights and sirens.
Speaker 4 (17:20):
So cardiac arrest, people choking, respiratory arrest, things where seconds
could make a difference, yep, that is worth the risk
to try to get someone there quicker. But other things
like well she fell and broke her hip, Okay, that's
an emergency and that person needs to get to a hospital.
I don't doubt that is the three minutes going to
(17:42):
make a difference in that person's outcome.
Speaker 1 (17:45):
No, So with all this data, Buyer and his team
changed how the calls were coded.
Speaker 4 (17:52):
I wiped out about fifty percent of the Priority one
calls in burying down.
Speaker 1 (17:56):
Let that sink in ambulance lights and sirens and Barrion
County were sounding half as often as they had before.
Now even I was wondering, could you really know that
this switch was putting anyone at risk? Well, eventually they
followed up on the people the ambulances had picked up
in the field to see how the hospital coded the
(18:16):
patients as they came in. So if you went to
someone as a priority too not that urgent, and they
showed up to the hospital as a priority one, that
would mean that you'd made a mistake. How much more
often was that happening under the new coding system than
the old It was the same number. Wow, there was
basically no difference, as in, he had the number of
(18:40):
lights and sirens responses in Barrion County. He reduced the
risk of accidents as a result, and it cost the
people of Barrion County nothing.
Speaker 4 (18:52):
When I instituted the change, I didn't really have much
of a problem. Nine to one one didn't have a
problem with this because it just was a difference in
coding for them.
Speaker 1 (19:01):
It didn't affect them.
Speaker 4 (19:02):
The medics themselves really liked it because the medics were like, yep,
most of these things we were going on are not
priority on board.
Speaker 1 (19:09):
The paramedics are on board. Smooth sailing, except what ended.
Speaker 4 (19:14):
Up happening and I'm not exactly sure how this got out.
It went through all the proper channels on my side,
like medical control in the hospital in the county, so
that was okay, But it started getting publicized, and I
don't exactly know how, but it started showing up on
the hospital Facebook page about Burian County medical Control is
(19:36):
killing people with slow responses, and oh boy.
Speaker 1 (19:40):
Unbeknownst to Bayer, word had gotten out to the people
who call ambulances big problem.
Speaker 6 (19:47):
Hey, if you're drive in Barrian County, you won't see
as many lights and sirens as you're driving. Ambulances will
be using them only for time sensitive cases like a
heart attack.
Speaker 1 (19:56):
The local news began doing man on the street interviews.
Speaker 4 (19:58):
Literally, they were out on the bluff overlooking Lake Michigan,
just interviewing people walking by, going what do you think
about ambulances coming to your house slower?
Speaker 1 (20:05):
And of course people explode over what did they say?
Speaker 4 (20:09):
It's like, I can't believe this, and you know that
this is terrible. Of course I won't ambulance there fast.
And the hospital started getting a lot of flack, some
of it was very nasty. So people started on Facebook
attacking the hospital. Oh this is Lakeland just killing patients again?
You know, just very bad vitriol.
Speaker 1 (20:27):
At the time, though Bayer was blissfully unaware any of
this was happening. Other jobs were keeping him very busy.
But then one morning he got a call.
Speaker 4 (20:36):
I'd done a six p to two am shift and
at eight am I got a call from the administrative
assistant to the CEO of the hospital. Hi there, doctor Buyer,
It's eight am. What are you doing at eight thirty?
I'm like, and I'm still swaking up because again I've
had four hours of sleep, and she's like, doctor Hamill.
At that point, the CEO of the hospital would like
(20:57):
to speak to you.
Speaker 1 (20:58):
Buyer gets dressed in hurries to doctor Hamill's office.
Speaker 4 (21:02):
And I'm met by them in the hospital attorney and
being shown this Facebook page and they're like, what did
you do? This is terrible?
Speaker 1 (21:11):
Buyers stunned, and then he begins to lay out the
case against Sirens in a very doctor buyer way.
Speaker 4 (21:17):
I try to explain what I had done. Is have
you ever taken physics?
Speaker 1 (21:24):
Buyer explained his move, maybe a little inefficiently, by using
the equation for velocity distance divided by time changed to
solve for time or Tea. It amounted to this, If
you're trying to get time down and you can't reduce
the distance between you and a patient by putting more
ambulances on the street, because it's expensive, the easiest way
(21:45):
to get it done is to increase your velocity, which
means running your lights and sirens. But the problem is,
we now know that running lights and sirens significantly increases
the risk of an accident, So maybe you don't want
to do that either. Then the thing to do is
to take a second look at tea. Does time really
need to come down by the small increment that we
(22:06):
now know lights and sirens is going to reduce it?
Not for most things.
Speaker 4 (22:11):
I showed him some of the studies. He's like, your
science is sound. You may you go next time, do
a press conference. Oh I had a press conference, which
is what you saw.
Speaker 1 (22:19):
Online Buyer confronted the outrage masses.
Speaker 4 (22:23):
And once that went out, all complaints disappeared in six
weeks and I've heard not a thing since then. In fact,
now we are considered we right now are the leader
in Michigan for the lowest rates of lights and sirens
use in the state of Michigan.
Speaker 1 (22:34):
For ems. Things worked out for buyer in the end.
But I'm interested in that initial freak out because it
reveals a basic assumption people make, myself included. Everything is urgent,
so we accept this social loophole where you can break
all known traffic laws provided you possess a device that
emits the loudest, shrillest sound imaginable. What kind of world
(22:57):
does this? I'm not arguing that we shouldn't have sirens
at all, but it seems to me that they're not
only too loud and crazy sounding, but like we use
them way more often than is necessary because we're unwilling
to let go of them. But of course, Barrion County
is just one place. Approximately twenty thousand the MS calls
(23:18):
a year, and paramedics are just one branch of the
emergency service. I shouldn't get ahead of myself. I was
left with two big questions to answer. Next, where did
we get the idea that sirens are so necessary? And
exactly how unnecessary are they? A good place to look
(23:39):
is the same place we fell in love with the
MS once upon a time. We'll be right back.
Speaker 8 (24:05):
If you would have asked eighteen year old Jeff when
I first drove lights and sirens. I would have said
that they are always life saving and we absolutely need
to use it. But I'm not eighteen anymore.
Speaker 1 (24:18):
Jeff Jarvis the chief Medical Officer for the Metropolitan Area
EMS Authority in Fort Worth, Texas, an emergency medical service
that serves over a million people in Fort Worth and
fourteen surrounding cities. He's been a paramedic since the nineteen eighties.
He served around New York City in Austin. So eighteen
(24:39):
year old Jeff who's made his decision to begin to
be a paramedic. So let me ask you. Let me
ask you a question. In the nineteen seventies, did you
ever watch the television show Emergency?
Speaker 8 (24:52):
Oh?
Speaker 1 (24:52):
Of course? And did that have an effect on your
becoming a paramedic?
Speaker 8 (24:57):
It did. I thought it was the coolest thing ever.
Speaker 1 (24:59):
In nineteen seventy two, NBC began airing a television show
called Emergency. That's got an exclamation point at the end.
By the way, the theme song is the music they'd
play in my version of Hell. The show is about
(25:21):
Johnny and Roy, two young paramedics working out of fire
Station fifty one in Los Angeles, except they're not paramedics
in the beginning that.
Speaker 9 (25:29):
Special training program.
Speaker 8 (25:31):
Remember we were talking about it a couple of days ago.
Speaker 1 (25:33):
Yes, sir, the para something or other paramedics. The series
begins in a world where there basically aren't any paramedics,
which was our world fifty three years ago. Fifty three
years in nineteen seventy one, there were a slim twelve
paramedic units in the entire country and it was kind
(25:54):
of a Wild West situation. Details varied from place to place,
but in some areas it was illegal to give someone
medical care if you weren't a doctor or a nurse.
So about fifty percent of ambulances were just hearses driven
out of funeral homes by morticians whose sole purpose was
to get patients to doctors as quickly as possible. In
(26:15):
that failed back to the funeral home, you go. This
is actually how it worked. Emergency was a show dreamed
up in partnership with the father of modern ms, a
guy named James Page who worked at one of the
first firehouses with a paramedic unit in Los Angeles, and
the show was literally meant to make the case for paramedics.
(26:37):
Every Saturday night nationwide on NBC thirty million viewers at
a time, not a few of whom became paramedics.
Speaker 9 (26:45):
People at dying at the scene, people who could stay
alive if there was somebody on the spot who knew
what to do.
Speaker 1 (26:51):
Look, if that.
Speaker 9 (26:52):
Bill passed the legislature today, do you know how many
people we'd have ready for the job?
Speaker 8 (26:56):
Six men for six and a half million people.
Speaker 1 (26:59):
I learned about emergency in a brilliant essay by UCLA
emeritis law professor Paul Bergman, where he traces the profound
influence the show had not just on par metics, but
on lawmakers too, by dramatizing just how urgent every single
nine to one call is.
Speaker 8 (27:17):
We almost head him back.
Speaker 9 (27:18):
Damn it, we almost head him back.
Speaker 1 (27:20):
If you could have been defibrillated the moment they pulled
him off the wire. This is from the first episode,
right after a maintenance man gets electrocuted and eventually dies.
The doctor and nurse, who by the way, are of
course romantically involved, are talking.
Speaker 9 (27:35):
Somebody should have been there with a machine in their bucket,
not somebody The paramedics again.
Speaker 1 (27:43):
Call him paramedics a rescue team. That doesn't matter.
Speaker 9 (27:47):
Cal if somebody with the right equipment and trained to
use it.
Speaker 8 (27:50):
Had gotten to this man in time, he'd be alive.
Speaker 9 (27:52):
Now, I won't use this situation that justify setting amaters
out to practice medicine on the street, trained amaters trained
by you, and doctors like you, amateurs, Dixie. I spent
twelve years in school and residency and I'm still learning
my trade.
Speaker 1 (28:06):
It's a doubleheader pilot, and both episodes are full of
these situations that dramatized the resistance to paramedics, which was
very real. But the show argues that we need paramedics
and why do we need them because there are so
many accidents where if only someone had been there in time,
we could have saved.
Speaker 5 (28:24):
Them, including myself, and thought it could possibly be a success.
Speaker 9 (28:31):
Well, or arm may not function as well as it
used to, but at least it'll be your own.
Speaker 1 (28:36):
You're getting out here as fast as you did.
Speaker 9 (28:38):
Made the difference, Randy, to have around, doc, you gotta give.
Speaker 8 (28:41):
Us a try.
Speaker 1 (28:42):
Bergmann, the law professor, talked to the legends of ems
and he heard all these emergency references. Dug through California
hearings on the Paramedic Act, and he found emergency references
letters from senators emergency references. In the early years of
the show, forty six states legalized paramedicine. To be clear,
(29:04):
this was a movement that was already in process, but
emergency was a big part of establishing the cultural expectations
for what those units would look like. And it looked
like lights and sirens to every call, because every call
was all about time.
Speaker 9 (29:21):
But you can't ask someone not to die while you're
trying to find out what's wrong with him. And they
do die, gentlemen, on the way from where it happens
to my hospital.
Speaker 1 (29:31):
This is from the second part of the pilot episode,
when the skeptical doctor has come around.
Speaker 9 (29:36):
They die by the hundreds every year, not from mortal wounds,
but neglected wounds, not from incompetence or indifference, but from time,
from lack of time. I'm in favor of more doctors,
more hospitals, and better equipment. And I'm also in favor
of this bill until those other things come along, because
(29:57):
it will save lives, maybe a dozen lives, maybe a thousand,
maybe just one.
Speaker 1 (30:06):
He's looking directly into the camera, those thirty million viewers,
and who knows which one time, time time, And if
you succeed at convincing people that every situation is urgent.
They're going to come to expect lights and sirens every
(30:27):
time they call nine one one, And how many of
the calls in emergency do they respond to with lights
and si.
Speaker 8 (30:34):
Absolutely, so think about it this way. On Emergency, every
call was a life threatening emergency. Now I say that
knowing the first call they went on was not but
in the team the first episode of the pilot, but
the vast majority were life threatening emergencies. So sure people
got that that notion and expectation that that's what would happen.
(30:57):
There are a lot of paramedics who joined up for
those life threatening emergencies only to find out that eighty
five percent of the calls is holding somebody's hand.
Speaker 1 (31:08):
Sirens are all over the show. You may recall that
the literal theme song of Emergency features sirens, and I
think a lot of this time sireen obsession is due
to the fact that early ems departments were part of
fire departments, and a fire is a very specific kind
of emergency. If you don't contain it, it spreads. So
(31:29):
every fire is an urgent situation, and according to FEMA, anecdotally,
firefighters use their sirens way more often than the police.
But these days even the fire service in most places
seems to be based on an outdated sense of its mission.
As of twenty twenty three, less than four percent of
all nine one one calls firefighters responded to or for fires,
(31:53):
most or for ems and rescue. So then it looks
like the argument about siren reform broadly applies to firefighters too.
The US Fire Administration actually cited a bunch of studies
about reducing siren u usage just last year. Sirens are dangerous,
they save time, but not that much, and things are
(32:16):
often less urgent than they appear.
Speaker 8 (32:19):
Sometimes that three or four minutes is clinically valuable. Most
of the time it's not.
Speaker 1 (32:25):
Jeff Jarvis did a massive study on lights and sirens
using something called the ESO data set, a national collection
of emergency calls with unbelievably granular data attached.
Speaker 8 (32:37):
Seven and a half million records. Five point nine million
of those were non Wollown responses. We analyzed every one
of those and calculated the proportion that used lights and sirens,
and eighty five point eight eighty six percent of them
responded to the scene with lights and sirens.
Speaker 1 (32:55):
Oh my, God.
Speaker 8 (32:56):
The fundamental question we ask is of those responses where
you use lightcense sirens, how many of them did we
do something potentially life saving? And what we ended up
finding is six point nine of those nine one one
lights and sirens responses, did we do something even vaguely
potentially life saving? And we were rather generous with our
(33:19):
description of what potentially life saving is.
Speaker 1 (33:23):
So this is crucial. Paramedics are responding with lights and
sirens to around eighty six percent of calls when only
seven percent of them are resulting in a vaguely potentially
life saving intervention, So why were they urgent? That means
that in the United States, we're using lights and sirens
(33:44):
somewhere between eighty percent and ninety percent more often than
we need to. The question I have that I can
imagine people who are skeptical might ask, is, well, how
much do you really know from the call? Can you tell?
Speaker 8 (33:59):
Most folks are using some type of emergency medical dispatch
where there are scripted questions, and they will give each type.
Speaker 1 (34:08):
Of call.
Speaker 8 (34:10):
A number and a letter, and the letter is called
the determinant and it goes from your echo level calls
which are most likely to be life threatening down to
Omega level calls which are not very likely at all
to be life threatening. And those criteria have been evaluated
multiple times with multiple data sets. Again, they're not perfect,
(34:33):
but they are pretty accurate. For example, there is a
call nature called eye problem. Zero point sixty seven percent
of those calls resulted in a potentially life saving intervention.
Speaker 1 (34:47):
And how many do people run hot to all of them?
Speaker 8 (34:50):
It's just dangerous, and it's dangerous, and it's not really
doing what we think it is. So it seems like
it is an intervention whose time has come and gone.
Speaker 1 (35:01):
So I want to play for you again a very
specific moment from the pilot episode of Emergency and the
speech that doctor gave to the legislature about why we
need ems.
Speaker 9 (35:11):
I'm in favor of more doctors, more hospitals, and better equipment,
and I'm also in favor of this bill until those
other things come along.
Speaker 1 (35:19):
But those other things have come along. More doctors, advances
in the ways we take nine to one one calls,
better in more emergency rooms, better in more emergency medicine, better,
and more paramedics to use Buyer's formula. We have reduced distance.
Paramedic units are all over the place now in a
(35:40):
way they just weren't in the world of emergency. But
it seems to me like in our minds and on TV,
it's as if nothing has changed since the nineteen seventies.
Emergency was the most significant early example of an entire
genre of TV show that dramatized the emergency services. Before
there was Cops or Rescue nine one one, there was emergency.
(36:03):
And here's the trick. All of those TV shows are
based on the narrative conventions that emergency pioneer, a world
in which the TV show had not yet done its work,
and help was always too far away and always came
with lights and sirens blaring, because that's what firefighters did.
And these shows are everywhere. Rescue Me, sky Mett, Live Rescue,
(36:28):
Helicopter Heroes, Island Medics, Air Ambulance Er, a show that
was literally called Sirens, which is what they'll play on
TV in Hell for me. They even make this stuff
for kids. This is what Paw Patrol is, start them young.
Speaker 8 (36:47):
There is in emergency departments everywhere I see as there's
this concept called alarm fatigue, where when everything is an alarm,
nothing is an alarm. To paraphrase, The Incredibles, the Car
Chain movie. So you just get immune to these sirens
that are not doing the job.
Speaker 1 (37:08):
So Jarvis, like Buyer, reduce the use of lights and sirens.
He cut them by about a third. Did their response
time increase, Yes, by a median of six seconds, and
in the vast majority of cases by less.
Speaker 8 (37:25):
So it's turning out it's not making that much of
a difference in we're being much safer.
Speaker 1 (37:29):
And this I realized this is purely in the realm
of hypothesis, but it seems to me common sensical that
were lights and sirens reserved for truly emergency use, you
would see a more potent reaction to them, and likely
then it would it could it could possibly decrease response times.
Speaker 8 (37:49):
So I'll put my scientist hat on and say that's
an interesting hypothesis that needs to be tested. I will
put my realist in my pragmatic public health hat on
and say, absolutely, giddy up. I absolutely think you'll see that.
Speaker 1 (38:04):
I like that hat. That's a very stylish hat. You're
all right, So here it is. Lights and sirens are
a tool that currently seem to be way overused, and
that overuse has real consequences. Most of all, for our
burnt out, overstretched first responders who go to work to
save lives and wind up responding to everything as if
(38:26):
it's a crisis, wearing themselves out and losing their hearing
in the process. In twenty fifteen, fifteen hundred firemen sued
that company Federal Signal, the one that makes the iconic
fire siren, for causing mass loss of hearing. A lawyer
opposing them said, and I, quote, what's their solution. If
(38:48):
you don't have sirens, people would get mowed down in
the streets. The siren works exactly the way it should
end quote. I could not disagree more. And you know
who else disagrees that's right? I found him. Okay, I
(39:25):
am approaching Davy's house, which is coincidentally directly behind my house.
I was just walking down my street one day when
an ambulance rushed by and I saw this dopey yellow
lab stiffening owl. I'd know that owl anywhere. I rushed
(39:46):
over it and I was like, hey, I've got a
question about your dog, and his owner was very obliging.
His name is Joe. The dog's name Davy, And a
while later I came by their house for an interview
(40:08):
that was a very that was very satisfied. Sniff said,
I got Jen and Joe live one street over from
me and Julia, a beautiful brownstone, two kids, and a
noisy dog. We sat down at their kitchen table. I
am curious if you could tell me about when you
realize that you had a sort of eccentric dog.
Speaker 4 (40:33):
Well, I guess it.
Speaker 6 (40:34):
Was like the first time we heard him howling at sirens,
because he didn't seem particularly distressed by it. Like a
lot of times his tail wags and he does get
quite a reaction from like the neighbors, like the neighborhood,
Like everyone usually turns around and stops and like laughs
and was there, like I've never heard that before.
Speaker 1 (40:56):
It turns out Davy is starting a movement.
Speaker 6 (40:58):
His dog walker always like posts like sends us emails
like describing their walk. So you know, sometimes Davy has
gotten his his co his co partners in walking the
other dogs to start to howl with him.
Speaker 1 (41:11):
But he's always the first towler.
Speaker 6 (41:13):
It's definitely always the first howlur. But I think he
has taught some of the other dogs like how to
maybe start doing this, so.
Speaker 1 (41:19):
Their owners must be thrilled. Jen is a psychologist, Joe
is a composer for film and television, so together they're
experts on mammalian behavior and sound. So I'm inclined to
believe their analysis of Davy's views on the sirens subject.
He's not in distress, which means he's not going to
be the poster child for my anti siren campaign. But
(41:40):
I hadn't given up yet. Do you share this view
of Davy's howl origins or what? So?
Speaker 5 (41:46):
There's there's another theory, which this is the one I
think I if I had to choose one that I
would like to believe the most, it is. It is
that the sirens harken back to a lost dog who
has been separated from the group, and they are howling
to reconnect with the pack like a like a call
and answer from a lost dog. That's one of the series,
(42:11):
And that Davy is saying, we're over here. Come on,
lost buddy, this is where we are.
Speaker 6 (42:18):
He is a very nigh early dog.
Speaker 5 (42:20):
It loves to hang.
Speaker 1 (42:22):
Jen and Joe are very neighborly people. I'm glad to
know them now, even if their dog is a huge disappointment.
My anti Siren cusade, seeing as he really love sirens.
But it makes sense. It goes back to that evolutionary
theory Malcolm was talking about at the top of the episode,
the idea of the spandrel and the things in our
(42:43):
bodies and our worlds that we think we're selected for
but actually are just there and maybe not doing us
a whole lot of good. Davy's howl isn't quite a spandrel,
if we're being banantic. It's more like a vestige. He
thinks he's living with a pack of dogs in the wild,
but he's not. He's a house dog who lives in Brooklyn,
(43:07):
a block away from a busy grocery store or a playground,
a frustrated podcaster, a New York City government employee and
a fire station, a celebrity ignorant of his own fame,
and a howler who howls just because that's what he's
always done. Revisionist History is produced by me Ben matt
(43:48):
of Haffrey, Nina Bird Lawrence, and Lucy Sullivan. Our editor
is Karen Chakerji. Original scoring and theme by Louis Garra,
Additional scoring by Jake Gorski. Jacob Smith is our executive
producer engineering by Marcelo d Olivera. I relied on quite
a few studies in researching this and put a link
(44:10):
to the bibliography in the show notes should you want
any references for starting your own local movement. Special things
also to Douglas Koupas, whose work helped launch the field
of sign reform studies, Mike Tageman, Helen k Rosenthal, Stephen Solomon,
and Paul Bergman. I'm Ben Mattahaffrey. The really Alarming music
(44:44):
You're hearing right Now was composed by davi's owner Joe
Saba for the trailer of the Michael Bay film Ambulance.
Speaker 2 (45:30):
Get add free episodes of Revision's history by subscribing to
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Host
Malcolm Gladwell
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