Do speeding ambulances save lives?

I am continually fascinated by “obvious truths” that turn out to be very questionable. This article on ambulance rides is a case in point. Perhaps, speeding ambulances and blaring sirens do not provide overall benefits, though, of course, in some cases they do.

from a Slate article by emergency physicians Meisel and Pines

… Now a recent study in the Annals of Emergency Medicine casts further doubt to the concept of the golden hour for patients with severe injury. The authors studied more than 3,000 trauma patients—those with low blood pressures from bleeding, head injuries, and difficulty breathing—and looked at various time intervals after a 9-1-1 call. The times were compared with outcomes for the patients in the hospital. The result: shorter intervals did not appear to improve survival. These results are fascinating, in part because the principal question—how important is speed in the care of trauma patients before they get to the hospital?—has never been so elegantly explored. Previous efforts to measure the effect of ambulance time on survival have been plagued by the fundamental problem that medics may behave differently, like driving faster or spending more time working on patients, depending on the severity of the condition, making it impossible to tease out the effect of time on survival. While some of these biases remain, the authors of this study used sophisticated methods to account for many of these problems, allowing the reader to reasonably conclude that for ambulance care, a few minutes either way neither saves nor costs lives for patients with severe trauma.

What are the consequences of this new information? It may encourage some changes in the way ambulances behave on the roads. The editors of the journal that published the study proclaim, “Routine lights-and-sirens transport for trauma patients … may not be warranted.” This conclusion is driven, in part, by increased awareness of the dangers of speeding ambulances. Ambulance crashes occur relatively frequently, killing medics at a rate that is nearly three times higher than that of the average U.S. worker. In some places, three in four ambulance crashes occur while the vehicles are running hot, even though lights and sirens don’t save much time at all. More alarming are how bad the injuries are for people who aren’t even in the ambulance, such as when drivers swerve out of their path to cause another crash or strike an unlucky pedestrian….

much more at SLATE

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