Mount Sinai ambulance outside of the Mount Sinai/Morningside Hospital. Photo: Susan Crawford
It’s 3 a.m. From 20 to 30 blocks away I start to hear it: the higher-than-high-pitched shriek of an ambulance siren. As it comes closer, I soon have to clamp two fingers into my ears to save them from the worst of the piercing sound the truck emits until it has passed on below my windows. That part alone can take up to two minutes. If I’m lucky, that’s the only siren I’ll hear that night.
At 3 p.m., on the other hand, the same shriek can come at intervals of five to ten minutes. Deducting the two-minute ear clamp for each one, I can lose up to 20 minutes per hour of work throughout the afternoon.
What gives? Sirens were not always this loud. I know because I’ve lived at the same emergency intersection of Amsterdam and 110th St. for decades.
Before Mount Sinai took over St. Luke’s Hospital several years ago, EMS drivers would cut their (mercifully quieter) sirens as they got to 110th St. Presumably that was because they were near their destination, plus perhaps in deference to the Cathedral of St. John the Divine, its school and the hospital itself at 113th. Two years ago I joined up with like-minded sufferers to see if anything could be done. Invoking a hope, we named our group “Sirenity.” We started by talking with local electeds who, for the most part, directed us to our local Community Board.
“Built Into the Truck”
At the same time, I started talking to ambulance drivers. Why were their sirens so loud compared to years past; could anything be done about them? “They’re aware of the problem,” one driver of a Mount Sinai ambulance told me of his dispatchers. “But it’s built into the truck. We can’t do anything about it.” Retrofit maybe?
As “Sirenity” began to convene meetings with our Community Board and to do more research, it emerged that there actually were alternative sirens built into the trucks, but they were equally loud. The shrieking pitch of the siren most commonly used was apparently arrived at as a way to counter another recent development: cars so well sound-proofed that it took a shrieking pitch to pierce the driver’s ears, if at all. I can attest to this since, under the same conditions, I often only know when an emergency vehicle is behind me when I see its lights flashing in the rear view mirror.
So what is the point of these sirens if the only people who hear them are everyone but drivers? They’re part of the emergency vehicle ecosystem, was all we could glean.
As a result of Sirenity’s meetings via the Community Board, Mount Sinai was prompted to change its EMS routes enough to bypass Morningside Gardens, further north along Amsterdam’s shrieking corridor, and where many of our members live. However, that essentially doubled the cacophony at my intersection since the ambulances were now turning down 110th and continuing to shriek east until they reach whatever avenue they now use to go further north.
Throughout our efforts, we were aware of a broadband alternative in which only drivers ahead of emergency vehicles are alerted. But, but ... back to the ecosystem. A Community Board member explained that the city was unlikely to approve them since they would not work for pedestrians who are blind or partially deaf. They would continue to need the sirens to alert them.
Okay, but still, do they have to be this loud? Do they have be on all the time, even coming up an empty Amsterdam Ave. at 3 a.m.? Evidently not.
The evidence can be found in a publication from the U.S. Department of Transportation, National Highway Traffic Safety Administration, Office of Emergency Medical Services (EMS): Lights and Siren Use by Emergency Medical Services (EMS): Above All Do No Harm, found deep on page 4 of one of my Google “dives” for this article. And yes, I actually read it. You don’t have to, but please urge your electeds to do so.
Lights and Sirens
Dr. Douglas F. Kupas, the study’s author, did a meta-analysis of research going back decades, which continually found that use of lights and sirens (L&S as he calls it) contributes an average of less than two minutes increase in ambulance arrival time. Rather than using L&S to try to speed up the vehicle, he suggests the EMS practitioners’ time would be better spent radioing ahead to the hospital with the patient’s condition so the staff can be prepared.
Regulations for siren use vary by state and locality. For the most part, they stipulate that if an EMS vehicle’s lights are flashing, then the siren needs to be on too. The main purpose of both, Kupas notes, is to alert nearby vehicles that the ambulance is claiming the right of way to get through traffic. Most accidents involving ambulances occur at intersections. It turns out that drivers coming into an intersection that crosses into the ambulance’s path cannot hear the siren until it is about 80 feet away. Meanwhile, it takes a vehicle driving at 45 mph 180 feet to come to a full stop, which explains the high crash rate with ambulances at intersections.
Kupas recommends, for instance, that EMS drivers come to a full stop at intersections where they don’t have the light, and not proceed until making eye contact with drivers perpendicular to the ambulance to make sure they have stopped. His study ends with more than 10 pages of recommendations for states, cities, towns, rural areas, and EMS operators, many in the interest of minimizing reliance on lights and sirens for safely conveying patients to hospitals.
It turns out that concern about accidents is a primary reason EMS drivers keep their sirens running. But the concern is not just out of driver diligence; after all, they are even more affected by the sound of sirens than we are. I had noticed that FDNY ambulances use sirens more intermittently, and mentioned this to another Mount Sinai driver.
“Well, if FDNY drivers get into an accident, they’re covered by insurance through the city,” he explained. “If we get into an accident without our sirens on, we’re personally liable.” So there you have it. Our ears, nervous systems, sleep, conversation and concentration are all being shattered over ... liability insurance... for a practice that, given decades of research, does not even improve outcomes.