Running Hot

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 https://open.substack.com/pub/bennaddaffhafrey/p/the-siren-myth?r=1u9ne&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true. Get ad-free episodes to Revisionist History by subscribing to Pushkin+ on Apple Podcasts or Pushkin.fm. Pushkin+ subscribers can access ad-free episodes, full audiobooks, exclusive binges, and bonus content for all Pushkin shows. Subscribe on Apple: apple.co/pushkin http://apple.co/pushkin Subscribe on Pushkin: pushkin.fm/plus https://www.pushkin.fm/join-pushkin See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:09Speaker 00

  This is Jacob Goldstein. When you're a business owner interested in expanding to new markets, there's a lot to consider and countless questions to answer before making the call. The most important one being, are you ready? That's where ChatGPT comes in. Give it a goal, add your files, and ask Chat to help you map out different scenarios for the future of your business. So when growth is on the table, you've got an expansion plan ready to implement. Get started today at ChatGPT.com.

• 0:37Malcolm Gladwell?

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• 1:21Malcolm Gladwell?

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• 2:08Malcolm Gladwell?

  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 Nadaf Hafrin. 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. 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 the thing that doesn't have a function, but which hangs around like a random hitchhiker

• 2:50Malcolm Gladwell?

  because it happens to be riding along with things that do have a function. Like your earlobes. I mean, what are they there for? Doesn't it seem like they were all just along for the ride with the 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.

• 3:17Malcolm Gladwell?

  My name is Malcolm Gladwell. This is Revisionist History, my podcast about things overlooked and misunderstood. In this episode, my colleague Ben Nadaf Hafrin 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, about sirens.

• 3:57Speaker 02

  Walk me through.

• 3:59Speaker 03

  Oh, no. You really do.

• 4:02Speaker 02

  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.

• 4:10Speaker 03

  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.

• 4:25Speaker 02

  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 15, sometimes from trucks bearing, I assume, one sprig of artisanal 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 block traffic, which means the fire trucks can't get out. And so sirens all the time.

• 4:58Speaker 02

  This, for me, as a writer, podcaster and light sleeper, is a problem. So I decided to do some research. I made a spreadsheet. We counted from 9:00 AM till 10:00 at night, and we heard a siren 24 times, 24 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.

• 5:25Speaker 03

  First, I have to say I never understand your way of doing Google Sheets because the color coding seems to just be aesthetic, not actually representing anything in the data.

• 5:36Speaker 02

  I don't need this. I can't get enough of this in my job. I don't need it from you. I will confess that the spreadsheet, consisting of mauve, baby blue, puke 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. 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 110 decibels to over 130. That is ear-damagingly loud. The classic fire siren sound, like what you hear in your head if you imagine a fire

• 6:16Speaker 02

  truck right now, is called the Federal Q2B, and it's a whopping 123 decibels at 100 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.

• 6:33Speaker 04

  As we say, it's not a fire truck unless it's got a Q siren.

• 6:53Speaker 02

  According to a helpful chart from Yale University, 123 decibels is just 2 decibels lower 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 we have heard the siren.

• 7:23Speaker 03

  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.

• 7:36Speaker 02

  There's also a field for reporter, Ben slash Julia, and another for notes. And then, what is the final column?

• 7:44Speaker 03

  The final column is called dog, question mark?

• 7:48Speaker 02

  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.

• 8:09Speaker 02

  A dog who, by the standards of people on my blog, is practically famous. Have you heard a dog who howls every time the sirens go off?

• 8:16Speaker 05

  Yeah.

• 8:17Speaker 02

  You have?

• 8:17Speaker 05

  I have. I mean, they're pretty consistent with it. They're dedicated to their howling.

• 8:24Speaker 02

  I think, I feel like my wife has heard the dog.

• 8:26Speaker 06

  But there's a guy, Kevin, that lives after that garage right there, and he does.

• 8:32Speaker 02

  So he's talked about this dog, dude?

• 8:34Speaker 06

  Yeah.

• 8:34Speaker 02

  What has he said?

• 8:35Speaker 06

  Oh, he's ready to do something about it.

• 8:39Speaker 05

  It starts really low and guttural. I thought it was like a werewolf or something.

• 8:50Speaker 02

  I decided to take a two-pronged approach to my siren problem. Plan A: I had to see if I could prove 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 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 Dr. Arlene Bronzhaft.

• 9:37Speaker 05

  We're gonna take you into the noise room.

• 9:39Speaker 02

  What's the noise room?

• 9:40Speaker 05

  Ah, okay. You'll see where you get there, sir.

• 9:43Speaker 02

  Dr. Bronzhaft is an 89-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 took me to her noise room. Noise room sounds possibly like the opposite of what I mean.

• 10:11Speaker 05

  Let me tell you. It is a very quiet room.

• 10:19Speaker 05

  This is quiet.

• 10:22Speaker 02

  Wow. How did you get it so quiet?

• 10:24Speaker 05

  Oh, did I help make it quiet? The answer is yes, I did have a role in making it quieter than it would have been. Can you see the cooling units?

• 10:35Speaker 02

  Yep.

• 10:35Speaker 05

  Are they all enclosed?

• 10:36Speaker 02

  Yep.

• 10:37Speaker 05

  Who do you think made that request?

• 10:39Speaker 02

  Bronzaf started her work during the golden age of noise control, the 1970s, when the EPA began regulating noise. Her early work demonstrated that noise isn't just annoying, it 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 2007?

• 10:58Speaker 05

  In fact, it was my suggestion that they update it. It carried quite a bit of weight. However, the literature that they were depending upon 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 as well in learning.

• 11:21Speaker 02

  That 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 in overall noise to significantly increased risk of heart disease, to say nothing of stress, poor sleep and its associated ailments, and crucially, the effect of noise on exasperated podcasters.

• 11:43Speaker 05

  Now you mention 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. European people aren't dying, are they? The point is, if Europe can have quieter ones, you could come up with a method of quieting the sirens and still be as effective. I have not seen a study that has shown that if you have a less offensive intrusive siren, that more people will die. Have you?

• 12:24Speaker 02

  No.

• 12:25Speaker 05

  So here I am. I'm a data person. Show me the data.

• 12:32Speaker 02

  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 believed that that data was going to 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.

• 13:22Speaker 00

  This is Jacob Goldstein. With ChatGPT, you can do more than get answers. You can get things done. When you're running a business and looking to expand, you need a clear view of the landscape before making any decisions. ChatGPT can help you prepare. Connect your Google Drive, point to relevant files and reports, and ask it to research competitors, industry forecasts, and market signals. It can turn the findings into a strategic deck in your team's template that you can review before presenting to your leadership team. Growing a business is ambitious, and ChatGPT can help you do it with confidence. Get started today at chatgpt.com.

• 14:00Malcolm Gladwell?

  These days, there are more people than ever telling you how to manage your health. And we've all gone down an internet rabbit hole, exploring the latest health trends. Your social media feed is packed with wellness advice, telling you to cold plunge, protein max, detox, track your sleep. But what's actually real? What's exaggerated? What's just wrong? That's exactly what Health vs. Hype from the American Medical Association and iHeartMedia's Ruby Studio is here to find out. Each episode, Emmy-nominated science communicator Trace Dominguez, who's racked up billions of views across PBS, Discovery Channel, and YouTube, talks to health influencers, real people, and most importantly, doctors, to separate fact from fiction.

• 14:44Malcolm Gladwell?

  Because when it comes to your health, who you listen to matters. Listen to Health vs. Hype on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This show is brought to you by BetterHelp. I have a question. When you wake up at three in the morning and start stewing over something that happened in your life, or some problem you're mulling over, what is that thing? What's that annoying, troublesome stone in your shoe that you just can't get rid of? Well, the truth is that you really can get rid of those experiences that haunt us, but you need help, and that's where BetterHelp comes in. BetterHelp therapists are licensed, experienced professionals, such as psychologists, marriage

• 15:27Malcolm Gladwell?

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• 16:07Speaker 02

  Marion County, Michigan, sits on the southeastern shore of Lake Michigan. It's not too far from Kalamazoo. Quaint, lakefront towns, golf courses, quiet, unless you work as a paramedic.

• 16:20Speaker 05

  I have like four jobs because doesn't everyone? And like right now, I'm at the Marion County Health Department.

• 16:26Speaker 02

  Jonathan Byer, former EMT, and now medical director for the Marion County Health Department.

• 16:32Speaker 05

  I am not speaking on behalf of the Marion County Health Department.

• 16:36Speaker 02

  Byer was a Boy Scout, scrupulous. The reason he was speaking to me is because in his capacity as the EMS medical director of the Marion County Medical Control Authority, he is responsible for the ambulances of Marion 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.

• 16:58Speaker 05

  There is no evidence that lights and sirens helps anybody.

• 17:01Speaker 06

  Plenty of evidence that it hurts people.

• 17:03Speaker 02

  No evidence that lights and sirens helps anybody? This, even to me, an inveterate complainer about sirens was a huge surprise.

• 17:11Speaker 06

  I started life as a paramedic before I got demoted to doctor. I was a paramedic for 11 years. And when I was a paramedic in the Philadelphia area, we responded lights and sirens to everything. Like you called 911, we just let, you know, there we go.

• 17:27Speaker 06

  When I got here to Michigan, they had two sets of priorities, priority one and priority two.

• 17:34Speaker 02

  A lot of EMS across the country has a similar kind of tiered intake system, a way to rank every incoming 911 call based not on its importance, but on its time sensitivity. In Bari and County, they would tag a call with priority one or two, depending on what the issue was.

• 17:53Speaker 06

  There are more calls for service than there are ambulances. So we have to find some way to prioritize that.

• 17:58Speaker 02

  Except the system wasn't really working.

• 18:02Speaker 06

  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, I have a tooth pain. Oh yeah, it's making it hard to breathe. We were about 50 50 for priority ones, which were lights and sirens and priority twos, which were not lights and sirens, speed of traffic.

• 18:34Speaker 02

  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 it's a little more complicated than that.

• 18:58Speaker 06

  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.

• 19:09Speaker 02

  Specifically, it increases your chance of an accident by over 50%, which is crazy.

• 19:16Speaker 02

  This is according to a peer-reviewed 2019 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 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.

• 19:41Speaker 06

  I started going, why are we responding to dental pain priority one? So myself and some, and I have a residency program here and I had a couple of my high performing medics and another EMS physician and myself. We spent a couple of weeks going through hundreds of these determinate codes going, does that really need priority one?

• 20:00Speaker 02

  So there's the accidents 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 42 seconds and three minutes and 48 seconds. It's about one and a half minutes of savings if you're in a city and a little over three and a half minutes if you're in the country on average.

• 20:29Speaker 06

  Yes, it's about 45 seconds and three minutes and there are.

• 20:32Speaker 02

  That's not a critical, that's not a critical interval most of the time.

• 20:36Speaker 06

  For most disease processes, 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 10% increase in mortality and decrease in survivable brain function. I mean, that's huge.

• 20:56Speaker 02

  Yeah, that is 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 Bayer to do something big. He restructured the tiers.

• 21:13Speaker 06

  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. Right? 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?

• 21:40Speaker 02

  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.

• 21:50Speaker 06

  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.

• 22:10Speaker 06

  Is the three minutes going to make a difference in that person's outcome? No.

• 22:16Speaker 02

  So with all this data, Byron and his team changed how the calls were coded.

• 22:21Speaker 06

  I wiped out about 50% of the priority one calls in Berrien County.

• 22:26Speaker 02

  Let that sink in. Ambulance, lights and sirens in Berrien County were sounding half as often as they had before.

• 22:35Speaker 02

  Now, even I was wondering, could you really know that this switch wasn't 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 patients as they came in. So if you went to someone as a priority two, 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?

• 23:01Speaker 06

  It was the same number.

• 23:02Speaker 02

  Wow. There was basically no difference. As in, he halved the number of lights and sirens responses in Berrien County. He reduced the risk of accidents as a result, and it cost the people of Berrien County nothing.

• 23:22Speaker 06

  When I instituted the change, I didn't really have much of a problem. Uh, 911 didn't have a problem with this because it just was a difference in coding for them. It didn't affect them. The medics themselves really liked it because the medics were like, yep, most of these things we are going on are not priority.

• 23:38Speaker 02

  Byron's on board, the paramedics are on board, smooth sailing, except...

• 23:43Speaker 06

  What ended up happening, and I'm not exactly sure how this got out, um... 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 Marion County Medical Control is killing people with slow responses. And oh, boy.

• 24:09Speaker 02

  Unbeknownst to Byer, word had gotten out to the people who call ambulances. Big problem.

• 24:17Speaker 05

  Hey, if you drive in Marion 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.

• 24:25Speaker 02

  The local news began doing man on the street interviews.

• 24:28Speaker 06

  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? And of course, people exploded.

• 24:37Speaker 02

  What did they say?

• 24:38Speaker 06

  It's like, I can't believe this. And, you know, this is terrible. Of course I want an 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.

• 24:56Speaker 02

  At the time, though, Byer was blissfully unaware any of this was happening. Other jobs were keeping him very busy. But then one morning, you got a call.

• 25:06Speaker 06

  I had done a 6 p to 2 a.m. shift. And at 8 a.m., I got a call from the administrative assistant to the CEO of the hospital. Hi there, Dr. Byer. It's 8 a.m. What are you doing at 8:30? I'm like, and I'm still waking up because I, again, I've had four hours of sleep. And she's like, Dr. Hamel, at that point, the CEO of the hospital, would like to speak to you.

• 25:28Speaker 02

  Byer gets dressed and hurries to Dr. Hamel's office.

• 25:31Speaker 06

  And I'm met by them and the hospital attorney and being shown this Facebook page. And they're like, what did you do? This is terrible.

• 25:40Speaker 02

  Byer stunned. And then he begins to lay out the case against sirens in a very Dr. Byer way.

• 25:47Speaker 06

  I tried to explain what I had done is, have you ever taken physics?

• 25:53Speaker 02

  Bayer explained his move, maybe a little inefficiently, by using the equation for velocity. Distance divided by time changed to solve for time, or t. 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 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 t. Does time really need to come down by the small increment that we now know lights and sirens is going to reduce it?

• 26:38Speaker 02

  Not for most things.

• 26:40Speaker 06

  I showed him some of the studies. He's like, your science is sound. You may, you go next time, do a press conference. Well, I had a press conference, which is what you saw online.

• 26:50Speaker 02

  Bayer confronted the outrage masses.

• 26:52Speaker 06

  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, we right now are the leader in Michigan for the lowest rates of lights and sirens used in the state of Michigan for EMS.

• 27:05Speaker 02

  Things worked out for Bayer 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 is 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.

• 27:42Speaker 02

  But of course, Barien County is just one place. Approximately 20,000 EMS calls 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 is the same place we fell in love with EMS once upon a time. We'll be right back.

• 28:31Speaker 00

  This is Jacob Goldstein. With ChatGPT, you can do more than get answers. You can get things done. When you're running a business and looking to expand, you need a clear view of the landscape before making any decisions. ChatGPT can help you prepare. Connect your Google Drive, point to relevant files and reports, and ask it to research competitors, industry forecasts, and market signals. It can turn the findings into a strategic deck in your team's template that you can review before presenting to your leadership team. Growing a business is ambitious, and ChatGPT can help you do it with confidence. Get started today at chatgpt.com.

• 29:08Malcolm Gladwell?

  These days, there are more people than ever telling you how to manage your health. And we've all gone down an internet rabbit hole, exploring the latest health trends. Your social media feed is packed with wellness advice, telling you to cold plunge, protein max, detox, track your sleep. But what's actually real? What's exaggerated? What's just wrong? That's exactly what Health vs. Hype from the American Medical Association and iHeartMedia's Ruby Studio is here to find out. Each episode, Emmy-nominated science communicator Trace Dominguez, who's racked up billions of views across PBS, Discovery Channel, and YouTube, talks to health influencers, real people, and most importantly, doctors,

• 29:51Malcolm Gladwell?

  to separate fact from fiction. Because when it comes to your health, who you listen to matters. Listen to Health vs. Hype on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is a paid message from Apple Card. It's easy, I think, in the hubbub of our lives to lose track of our spending. We pay the bills and move on, and don't understand the deeper patterns in our spending, the many different decisions we're making knowingly or unknowingly. You have to understand where your money is going in order to make better decisions about it. That's one reason Apple Card stands out to me. You can earn unlimited daily cash back on every purchase you make.

• 30:34Malcolm Gladwell?

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• 31:15Malcolm Gladwell?

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• 31:38Speaker 00

  If you would have asked 18-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 18 anymore.

• 31:51Speaker 02

  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 14 surrounding cities. He's been a paramedic since the 1980s. He served around New York City and Austin. So 18-year-old Jeff, who's made his decision to be a paramedic. So let me ask you a question. In the 1970s, did you ever watch the television show Emergency?

• 32:25Speaker 00

  Oh, of course.

• 32:26Speaker 02

  And did that have an effect on your becoming a paramedic?

• 32:29Speaker 00

  It did. I thought it was the coolest thing ever.

• 32:32Speaker 02

  In 1972, 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.

• 32:52Speaker 02

  The show is about Johnny and Roy, two young paramedics working at a fire station 51 in Los Angeles. Except they're not paramedics in the beginning.

• 33:02Speaker 04

  That special training program, remember? We were talking about it a couple of days ago. Yes, sir, the para something or other. Paramedics.

• 33:10Speaker 02

  The series begins in a world where there basically aren't any paramedics, which was our world 53 years ago. 53 years. In 1971, there were a slim 12 paramedic units in the entire country, and it was kind 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 50% of ambulances were just purses, driven out of funeral homes by morticians whose sole purpose was to get patients to doctors as quickly as possible. And if that failed, back to the funeral home you go.

• 33:52Speaker 02

  This is actually how it worked. Emergency was a show dreamed up in partnership with the father of modern EMS, 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. Every Saturday night, nationwide, on NBC, 30 million viewers at a time, not a few of whom became paramedics.

• 34:18Speaker 00

  People are dying at the scene. People who could stay alive if there was somebody on the spot who knew what to do. Look, if that bill passed the legislature today, do you know how many people we'd have ready for the job? Six men for 6.5 million people.

• 34:32Speaker 02

  I learned about Emergency in a brilliant essay by UCLA emeritus law professor Paul Bergman, where he traces the profound influence the show had, not just on paramedics, but on lawmakers too, by dramatizing just how urgent every single 911 call is.

• 34:49Speaker 04

  We almost had him back. Damn it, we almost had him back. If you could have been defibrillated the moment they pulled him off the wire.

• 34:56Speaker 02

  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.

• 35:08Speaker 04

  Somebody should have been there with a machine in their pocket.

• 35:10Speaker 02

  Not somebody.

• 35:13Speaker 04

  The paramedics again?

• 35:17Speaker 06

  Paramedics or rescue team, that doesn't matter. Cal, if somebody with the right equipment and trained to use it had gotten to this man in time, he'd be alive now.

• 35:25Speaker 04

  I won't use this situation to justify sending amateurs out to practice medicine on the street.

• 35:29Speaker 06

  Trained amateurs, trained by you and doctors like you.

• 35:33Speaker 04

  Amateurs, Dixie. I spent 12 years in school and residency, and I'm still learning my trade.

• 35:39Speaker 02

  It's a doubleheader pilot, and both episodes are full of these situations that dramatize 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 them.

• 35:58Speaker 04

  Including myself, and thought it could possibly be a success.

• 36:04Speaker 04

  Well, her arm may not function as well as it used to, but at least it'll be her own. Your getting out of here as fast as you did made the difference. Randy to have around, Doc. You gotta give us a try.

• 36:15Speaker 02

  Bergman, the law professor, talked to the legends of EMS, and he heard all these emergency references. Doug through California hearings on the Paramedic Act, and he found emergency references, letters from senators, emergency references. In the early years of the show, 46 states legalized paramedicine. To be clear, 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.

• 36:54Speaker 04

  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.

• 37:03Speaker 02

  This is from the second part of the pilot episode, when the skeptical doctor has come around.

• 37:09Speaker 04

  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.

• 37:20Speaker 04

  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 it will save lives. Maybe a dozen lives, maybe a thousand. Maybe just one.

• 37:38Speaker 02

  He's looking directly into the camera. Right at those 30 million viewers.

• 37:45Speaker 04

  And who knows which one?

• 37:48Speaker 02

  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 time they call 911.

• 38:01Speaker 00

  And how many of the calls in emergency do they respond to with lights and sirens? 100%, 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 first episode, the pilot. But the vast majority were life-threatening emergencies. So sure, people got that, um, that notion and expectation that that's what would happen. There are a lot of paramedics who joined up for those life-threatening emergencies only to find out that 85% of the calls is holding somebody's hand.

• 38:41Speaker 02

  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 siren 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 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 2023, less than 4% of all 911 calls firefighters responded to were for fires.

• 39:26Speaker 02

  Most were 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 usage just last year. Sirens are dangerous, they save time, but not that much. And things are often less urgent than they appear.

• 39:51Speaker 00

  Sometimes that three to four minutes is clinically valuable. Most of the time, it's not.

• 39:58Speaker 02

  Jeff Jarvis did a massive study on lights and sirens using something called the ESO dataset, a national collection of emergency calls with unbelievably granular data attached.

• 40:09Speaker 00

  Seven and a half million records, 5.9 million of those were 911 responses. We analyzed every one of those and calculated the proportion that used lights and sirens, and 85.8, 86% of them responded to the scene with lights and sirens.

• 40:28Speaker 02

  Oh, my God.

• 40:28Speaker 00

  The fundamental question we ask is, of those responses where you use lights and sirens, how many of them did we do something potentially lifesaving? And what we ended up finding is 6.9% of those 911 lights and sirens responses, did we do something even vaguely potentially lifesaving? And we were rather generous with our description of what potentially lifesaving is.

• 40:56Speaker 02

  So this is crucial. Paramedics are responding with lights and sirens to around 86% of calls, when only 7% of them are resulting in a vaguely potentially lifesaving intervention. So why were they urgent? That means that in the United States, we're using lights and sirens somewhere between 80% and 90% more often than we need to.

• 41:23Speaker 02

  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?

• 41:32Speaker 00

  Most folks are using some type of emergency medical dispatch where there are scripted questions and they will give each type of call 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, but they are pretty accurate. For example, there is a call nature called I problem.

• 42:14Speaker 00

  0.67% of those calls resulted in a potentially life-saving intervention.

• 42:19Speaker 02

  And how many did people run hot to?

• 42:22Speaker 00

  All of them. 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.

• 42:33Speaker 02

  So I want to play for you again, a very specific moment from the pilot episode of emergency, from the speech that doctor gave to the legislature about why we need EMS.

• 42:44Speaker 04

  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.

• 42:52Speaker 02

  But those other things have come along. More doctors, advances in the ways we take 911 calls, better and more emergency rooms, better and more emergency medicine, better and more paramedics. To use Bayer's formula, we have reduced distance. Paramedic units are all over the place now in a 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 1970s. 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 911,

• 43:35Speaker 02

  there was Emergency. And here's the trick. All of those TV shows are based on the narrative conventions that Emergency pioneered. 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, SkyMed, Live Rescue, 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. Stardom Young.

• 44:20Speaker 00

  There is in, in emergency departments everywhere. I see is there's this concept called alarm fatigue, where when everything is an alarm, nothing is an alarm, to paraphrase The Incredibles, the cartoon movie. So you just get immune to these sirens. They're not doing the job.

• 44:40Speaker 02

  So Jarvis, like Bayer, reduced 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.

• 44:58Speaker 00

  So it's turning out it's not making that much of a difference, and we're being much safer.

• 45:02Speaker 02

  And this, I realize this is purely in the realm of hypothesis, but it seems to me commonsensical 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 plausibly decrease response times.

• 45:22Speaker 00

  So I'll put my scientist hat on and say that's an interesting hypothesis that needs to be tested.

• 45:28Speaker 02

  I will put my realist and my pragmatic public health hat on and say absolutely giddy up. I absolutely think you'll see that. I like that hat. That's a very stylish hat you're wearing.

• 45:41Speaker 02

  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 it's a crisis, wearing themselves out and losing their hearing in the process. In 2015, 1,500 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 you don't have sirens, people would get mowed down in the streets." The

• 46:26Speaker 02

  siren works exactly the way it should, end quote. I could not disagree more. And you know who else disagrees?

• 46:54Speaker 02

  That's right. I found it. Okay, I am approaching Davey'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 stiffen and howl. I'd know that howl anywhere. I rushed over and I was like, hey, I've got a question about your dog. And his owner was very obliging. His name's Joe. The dog's name, Davey. And a while later, I came by their house for an interview. Hello. Hi. Hi, Davey. Hi, Jen. Hi, Ben. Hi, Ben. So nice to meet you.

• 47:40Speaker 02

  That wasn't a very satisfying snort sound 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 realized that you had a sort of eccentric dog.

• 48:04Speaker 05

  Um, well, I guess it 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 like, they're like, I've never heard that before.

• 48:28Speaker 02

  It turns out Davy is starting a movement.

• 48:31Speaker 05

  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.

• 48:44Speaker 02

  But he's always the first howler.

• 48:46Speaker 05

  He's definitely always the first howler, but I think he has taught some of the other dogs like how to maybe start doing this. So.

• 48:52Speaker 02

  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 siren subject. He's not in distress, which means he's not going to be the poster child for my anti-siren campaign. But I hadn't given up yet. Do you share this view of Davy's howl origins or what's?

• 49:19Speaker 06

  So there's, there's another theory, which is 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 hearken 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 another one of the theories. And that Davy is saying, we're over here. Come on, lost buddy. This is where we are.

• 49:51Speaker 05

  He is a very neighborly dog.

• 49:52Speaker 02

  He loves to hang.

• 49:55Speaker 02

  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 crusade, seeing as he really loves 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 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 pedantic. It's more like a vestige. He thinks he's living with a pack of dogs in the wild,

• 50:35Speaker 02

  but he's not. He's a housedog who lives in Brooklyn, a block away from a busy grocery store, 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.

• 51:18Speaker 02

  Revisionist History is produced by me, Ben Nattif Haafrey, Ina Bird Lawrence, and Lucy Sullivan. Our editor is Karen Shakurji. Original scoring and theme by Louis Garra. Additional scoring by Jake Gorski. Jacob Smith is our executive producer. Engineering by Marcelo de Oliveira. I relied on quite a few studies in researching this, and I put a link to the bibliography in the show notes, should you want any references for starting your own local movement. Special thanks also to Douglas Kupas, whose work helped launch the field of siren reform studies, Mike Tejman, Helen K. Rosenthal, Stephen Solomon, and Paul Bergman.

• 52:05Speaker 02

  I'm Ben Nattif Haafrey.

• 52:16Speaker 02

  The really alarming music you're hearing right now was composed by Davy's owner, Joe Saba, for the trailer of the Michael Bay film Ambulance.

• 53:03Malcolm Gladwell?

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• 53:43Malcolm Gladwell?

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• 54:09Speaker 05

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