For decades, the wail of a siren has been the universal sound of urgency — a signal to pull over, to brace for impact, to act fast. But is that sound, embedded into emergency response culture and pop culture alike, no longer as necessary — or as helpful — as we’ve assumed?
In a recent episode of Malcolm Gladwell’s podcast “Revisionist History,” producer Ben Naddaff-Hafrey questions whether sirens, especially in EMS, are a “spandrel” — a term from evolutionary biology describing features that persist not because they’re useful, but because they hitch a ride on other important traits. Think earlobes. Or, in this case, sirens.
What began as an annoyance — siren overload outside Naddaff-Hafrey’s Brooklyn apartment — led him to a deeper inquiry. Why are sirens still so loud, and why do we still use them so often?
Some EMS leaders are asking the same thing.
A bold move in Berrien County
Dr. Jonathan Beyer, EMS medical director for Berrien County, Michigan, made the decision to slash lights and siren use by 50%.
Beyer, a former EMT himself, noticed his crews were routinely dispatched Priority 1 with lights and sirens for calls that didn’t appear time-sensitive — toothaches, minor injuries, etc.
“We were about 50-50 for priority ones, which were lights and sirens, and priority twos, which were not lights and sirens,” Beyer said.
He and his team reviewed hundreds of call types and restructured the county’s dispatch coding. Cardiac arrests and choking emergencies still warranted urgency. But for everything else, medics were told to think of sirens as a medical intervention — with risks and benefits.
“If I were going to say, I’m going to give you epinephrine, well, why would I give you epinephrine? 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,” Beyer said.
The results were immediate. Siren usage dropped. Accident risk dropped. And after comparing hospital triage data, Beyer found no increase in patient harm.
National data backs it up
Jeff Jarvis, MD, medical director of the Metropolitan Area EMS Authority in Fort Worth, Texas, took the analysis a step further using the ESO data set —millions of EMS calls nationwide. His team found that EMS crews responded with lights and sirens to 86% of 911 calls. But only 6.9% of those calls resulted in a potentially life-saving intervention.
“We’re running hot for nearly every call,” Jarvis said, “but less than 7% actually need it.”
Even more striking: the time saved by using lights and sirens is minimal — between 42 seconds and 3 minutes, depending on urban or rural settings. Meanwhile, a 2019 study published in Annals of Emergency Medicine found that using lights and sirens increases the risk of ambulance crashes by over 50%.
In the EMS1, Fitch & Associates What Paramedics Want in 2024 report, 15% of respondents reported using lights and sirens to respond to every call, with another 48% responding priority one to “most” calls.
The culture of urgency
So why hasn’t the system changed? Part of the answer lies in how EMS was introduced to the public.
In the 1970s, the NBC show “Emergency!” helped popularize paramedicine. It depicted heroic medics racing to every call with sirens blaring. Lawmakers watched. So did future EMTs. The narrative stuck: Every second matters. Every call is life-or-death.
But in reality, EMS has evolved. Today, most fire calls aren’t fire-related. Most EMS calls aren’t critical. And yet the cultural expectation remains: when help is coming, it better be loud.
Naddaff-Hafrey noted the public’s reaction reveals a deeper assumption: “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.”
Time for a change?
The push to reduce siren use is gaining traction. The U.S. Fire Administration recently acknowledged research on siren overuse. And EMS leaders like Jarvis and Beyer say the shift is not just safer — it’s overdue.
“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,” Jarvis said.
Reducing sirens doesn’t mean compromising care. In fact, Beyer’s system saw no difference in outcomes — only fewer accidents, less stress and quieter nights for both medics and civilians.
“It’s just dangerous, and it’s not really doing what we think it is,” Jarvis said. “So it seems like it is an intervention whose time has come and gone.”
For EMS providers, the challenge now may be reshaping public perception — and embracing a quieter, data-driven future.
