WEBVTT - Running Hot 0:00:15.356 --> 0:00:15.796 Pushkin. 0:00:20.796 --> 0:00:23.756 Hello, Hello everyone. This is the first of what are 0:00:23.796 --> 0:00:25.556 going to be a couple of episodes in this mini 0:00:25.636 --> 0:00:29.836 season from my colleague Ben Adaph Haffrey. Ben is the 0:00:29.876 --> 0:00:33.356 guy when you're hiking through the wilderness who says let's 0:00:33.356 --> 0:00:36.036 go this way and there's no trail and you think, oh, 0:00:36.116 --> 0:00:38.116 I'm going to get eaten by bears, and then no, 0:00:38.676 --> 0:00:43.436 you find some lost civilization and large piles of glittering gold. 0:00:44.556 --> 0:00:47.116 Ben started telling me this story and I stopped him 0:00:47.116 --> 0:00:51.116 halfway through and I said, oh, Ben, this is a spandrel. 0:00:51.916 --> 0:00:55.156 And what's a spandrel? One of my all time favorite concepts. 0:00:55.476 --> 0:00:58.356 Invented by Stephen J. Gould, the spandrel is a thing 0:00:58.396 --> 0:01:01.556 that doesn't have a function, but which hangs around like 0:01:01.636 --> 0:01:04.676 a random hitchhiker, because it happens to be riding along 0:01:05.076 --> 0:01:08.236 with things that do have a function, like your ear lobes. 0:01:08.556 --> 0:01:11.356 I mean, what are they there for? Doesn't it seem 0:01:11.396 --> 0:01:13.036 like they were all just along for the ride with 0:01:13.076 --> 0:01:15.196 a part of our ear that actually does useful things. 0:01:16.156 --> 0:01:20.956 Or your chin? What's up with the chin. We look 0:01:20.996 --> 0:01:23.076 at a spandrel and we assume there has to be 0:01:23.116 --> 0:01:29.196 a reason for it, and there isn't They're just spandrels. 0:01:30.076 --> 0:01:32.956 My name is Malcolm Gladwell. This is Revisionist History, my 0:01:33.076 --> 0:01:37.516 podcast about things overlooked and misunderstood. In this episode, my 0:01:37.636 --> 0:01:41.276 colleague Bend daph Haffrey investigates a spandrel. You don't even 0:01:41.316 --> 0:01:43.836 realize you've been living with something that none of us 0:01:43.836 --> 0:01:46.836 would ever think to question, because it's such a bedrock 0:01:46.916 --> 0:01:49.676 part of our world. We all just assume it has 0:01:49.716 --> 0:01:54.596 to be there, and it doesn't. I'm talking, of course, 0:01:55.196 --> 0:01:57.116 about sirens. 0:02:10.036 --> 0:02:15.676 Walk me through. No, you really do walk me through 0:02:16.036 --> 0:02:18.196 what we're looking at here. I'm talking with my wife 0:02:18.276 --> 0:02:20.796 Julia Conrad, who happens to share an apartment with me 0:02:21.036 --> 0:02:22.876 on quite a noisy street in Brooklyn. 0:02:23.116 --> 0:02:27.916 This is a log that you created. Although I am 0:02:27.996 --> 0:02:30.316 represented in it, I think it looks like we only 0:02:30.356 --> 0:02:33.036 did it for one day. Of how many times we 0:02:33.076 --> 0:02:36.396 heard the siren and where we heard it. Wow, what 0:02:36.516 --> 0:02:36.876 a day. 0:02:37.716 --> 0:02:41.076 Julia and I live opposite this grocery store that's all local, 0:02:41.196 --> 0:02:44.676 small batch whatnot. So instead of getting just one delivery 0:02:44.716 --> 0:02:48.516 a day, they get like fifteen, sometimes from trucks bearing 0:02:48.556 --> 0:02:52.556 I assume one sprig of artismal basil next door there's 0:02:52.556 --> 0:02:56.476 a noisy playground and crucially a fire station, a really 0:02:56.596 --> 0:03:00.356 active fire station. What happens is the grocery store trucks 0:03:00.356 --> 0:03:02.996 block traffic, which means the fire trucks can't get out, 0:03:03.996 --> 0:03:12.276 and so sirens all the time. This, for me, as 0:03:12.356 --> 0:03:16.556 a writer, podcaster and light sleeper, is a problem. So 0:03:16.596 --> 0:03:19.756 I decided to do some research. I made a spreadsheet. 0:03:20.396 --> 0:03:23.156 We counted from nine am till ten at night, and 0:03:23.196 --> 0:03:27.756 we heard a siren twenty four times. Twenty four times, 0:03:28.236 --> 0:03:31.876 and this is reliable data. Julia is a data scientist. 0:03:32.276 --> 0:03:34.436 She works for the New York City government, and she 0:03:34.476 --> 0:03:37.476 has held my spreadsheet to the highest of standards. 0:03:37.716 --> 0:03:40.476 First, I have to say I never understand your way 0:03:40.516 --> 0:03:43.436 of doing Google sheets because the color coding seems to 0:03:43.516 --> 0:03:48.556 just be aesthetic. It's not actually representing anything in the data. 0:03:49.156 --> 0:03:51.316 I don't need this in it. I could get enough 0:03:51.316 --> 0:03:52.676 of this in my job. I don't hear from you. 0:03:53.676 --> 0:03:57.036 I will confess that the spreadsheet, consisting of mauv baby blue, 0:03:57.076 --> 0:04:00.596 puked green, a cheery yellow, and several pleasingly varied shades 0:04:00.596 --> 0:04:03.876 of red, isn't even complete because it does not count 0:04:03.876 --> 0:04:06.196 the times we heard the siren in the middle of 0:04:06.236 --> 0:04:09.436 the night when there is no one on the road. 0:04:09.676 --> 0:04:12.636 Maybe you didn't realize this, but emergency vehicles will sometimes 0:04:12.716 --> 0:04:15.436 run their lights and sirens even if there's seemingly no 0:04:15.516 --> 0:04:19.876 one around. Sirens can run anywhere from one hundred and 0:04:19.916 --> 0:04:22.916 ten decibels to over one hundred and thirty That is 0:04:22.996 --> 0:04:26.676 ear damagingly loud. The classic fire siren sound like what 0:04:26.796 --> 0:04:28.476 you hear in your head if you imagine a fire 0:04:28.476 --> 0:04:31.356 truck right now. Is called the Federal Q TWOV, and 0:04:31.396 --> 0:04:34.676 it's a whopping one hundred and twenty three decibels at 0:04:34.716 --> 0:04:38.036 one hundred feet away. There's an actual corporation that makes 0:04:38.076 --> 0:04:42.356 the siren. Federal Signal Fans post videos about the siren online. 0:04:42.836 --> 0:04:45.916 Here's what it sounds like. Maybe turn your volume down. 0:04:46.156 --> 0:04:49.076 As we say, it's not a firetruck unless it's got. 0:04:48.916 --> 0:05:08.156 A key siren. According to a helpful chart from Yale University, 0:05:08.476 --> 0:05:12.676 one hundred twenty three decibels is just two decibels lower 0:05:12.716 --> 0:05:17.836 than the point at which quote pain begins. This would 0:05:17.876 --> 0:05:20.996 all be fine, except I kind of need my ears 0:05:20.996 --> 0:05:24.716 for my job, and this is why I began the log. 0:05:27.316 --> 0:05:30.716 The log has fields for all relevant data date, time, 0:05:30.956 --> 0:05:34.356 branch of emergency service. Location in the house from which 0:05:34.396 --> 0:05:35.476 we have heard the siren. 0:05:35.636 --> 0:05:39.196 Well, there's really just two possibilities. You're either in the 0:05:39.236 --> 0:05:41.596 front of the house or the back of the house. 0:05:41.636 --> 0:05:44.676 But actually some of these entries are logged for front 0:05:44.716 --> 0:05:46.756 and back, so that's when you know it's a really 0:05:46.796 --> 0:05:47.636 big siren. 0:05:48.676 --> 0:05:51.996 There's also a field for reporter Ben slash Julia and 0:05:52.076 --> 0:05:56.076 another for notes and then what is the final column. 0:05:56.596 --> 0:05:59.036 The final column is called dog question mark. 0:06:00.556 --> 0:06:04.476 This is the only field that matters. You See, there's 0:06:04.516 --> 0:06:08.436 a dog in my neighborhood who howls almost every time 0:06:08.556 --> 0:06:21.876 the siren goes off, and he sounds like this, a 0:06:21.956 --> 0:06:24.236 dog who, by the standards of people on my block 0:06:24.676 --> 0:06:27.516 is practically famous. Have you heard a dog who howls 0:06:27.556 --> 0:06:30.436 every time the sirens go off? Yeah? I have. 0:06:30.596 --> 0:06:32.036 I mean they're pretty consistent with it. 0:06:32.476 --> 0:06:34.076 They're they're dedicated to their. 0:06:36.356 --> 0:06:36.796 Howling. 0:06:37.076 --> 0:06:38.996 I think I feel like my wife has heard the dog. 0:06:39.156 --> 0:06:43.356 But there's a guy, Kevin that lives after that garage 0:06:43.436 --> 0:06:46.116 right there, and he does so he's talked about this 0:06:46.156 --> 0:06:48.676 dog here. Yeah, what does he say? Oh, he's ready 0:06:48.676 --> 0:06:52.156 to do something about it. 0:06:52.156 --> 0:06:53.996 It starts really low and guttural. 0:06:54.356 --> 0:06:55.996 I thought it was like a wearwolf or something. 0:06:56.196 --> 0:06:56.436 Oh. 0:07:03.116 --> 0:07:05.396 I decided to take a two pronged approach to my 0:07:05.476 --> 0:07:08.916 siren problem. Planet I had to see if I could. 0:07:09.116 --> 0:07:11.716 I proved that the sirens in my neighborhood were dangerously 0:07:12.036 --> 0:07:16.716 unnecessarily loud, and Plan B. I needed a sympathetic face 0:07:16.756 --> 0:07:22.716 for my cause. Nobody really cares about podcasters, but everybody 0:07:22.716 --> 0:07:25.356 cares about dogs. And I had to assume that that 0:07:25.436 --> 0:07:28.036 dog was howling along with the siren because he was, 0:07:28.276 --> 0:07:33.876 like me, in serious pain. So find the dog, stop 0:07:33.916 --> 0:07:37.996 the siren. It'd be that simple, except the dog was 0:07:37.996 --> 0:07:42.716 not immediately forthcoming. So I pushed ahead with Plan A 0:07:42.876 --> 0:07:47.516 noise research, which led me straight to doctor Arlene Bronze Aft. 0:07:49.636 --> 0:07:51.756 We're going to take you into the noise troom. 0:07:51.796 --> 0:07:52.836 What's the noise troop? 0:07:52.876 --> 0:07:52.956 Oh? 0:07:52.996 --> 0:07:54.716 Okay, no, see when you get there. 0:07:54.916 --> 0:07:57.676 Sarah doctor Bronze Aft, is an eighty nine year old 0:07:57.836 --> 0:08:01.476 environmental psychologist who has been called the noise Queen of 0:08:01.516 --> 0:08:04.796 New York City. She's done major noise studies worked for 0:08:04.836 --> 0:08:07.596 five mayors. She grew up in Brooklyn and lives in 0:08:07.636 --> 0:08:10.996 a lovely tidy apartment on the Upper East Side someone 0:08:11.076 --> 0:08:14.236 was jackhammering the street outside the building, and yet you 0:08:14.236 --> 0:08:18.756 couldn't hear a thing. Double glazed windows. Of course, she 0:08:18.836 --> 0:08:21.316 took me to her noise room. The noise room sounds 0:08:21.396 --> 0:08:23.196 possibly like the opposite of what I mean. 0:08:23.996 --> 0:08:31.676 Let me tell you it is a very quiet room. 0:08:31.876 --> 0:08:32.796 This is quiet. 0:08:34.556 --> 0:08:37.316 Wow. How did you get it so quiet? Oh? 0:08:37.476 --> 0:08:40.796 Did I help make it quiet? Answer? Yes, I did 0:08:40.836 --> 0:08:43.956 have a role and making it quieter than it would 0:08:43.996 --> 0:08:46.996 have been. Can you see the cooling units? 0:08:47.436 --> 0:08:47.636 Yep? 0:08:47.676 --> 0:08:48.916 Are they all closed? 0:08:49.156 --> 0:08:49.436 Yep? 0:08:49.716 --> 0:08:51.756 Who do anythink made that request? 0:08:52.196 --> 0:08:54.716 Bronze Aft started her work during the golden age of 0:08:54.796 --> 0:08:59.156 noise control the nineteen seventies, when the EPA began regulating noise. 0:09:00.076 --> 0:09:03.116 Her early work demonstrated that noise isn't just annoying. They 0:09:03.116 --> 0:09:05.116 can get in the way of kids learning in school, 0:09:05.676 --> 0:09:08.396 and she just kept going from there. When the city 0:09:08.436 --> 0:09:10.876 updated its noise code in two thousand and seven. 0:09:10.756 --> 0:09:13.716 In fact, it was my suggestion that they updated, it 0:09:14.156 --> 0:09:17.876 carried quite a bit of weight. However, the literature that 0:09:17.916 --> 0:09:22.956 they were depending upon was it was older. So today 0:09:22.996 --> 0:09:27.196 we have much more solid literature on the link between 0:09:27.236 --> 0:09:31.356 noise and health. That's critical, and that includes mental health. 0:09:31.676 --> 0:09:34.076 As well in learning that. 0:09:34.076 --> 0:09:36.556 All checked out for me. Of course, the sirens are 0:09:36.556 --> 0:09:38.836 too loud, but it can take a while for the 0:09:38.916 --> 0:09:41.836 research to make its way into policy. Now we have 0:09:41.916 --> 0:09:45.796 research linking even small changes and overall noise to significantly 0:09:45.876 --> 0:09:48.996 increased risk of heart disease, to say nothing of stress, 0:09:49.236 --> 0:09:53.316 poor sleep and its associated elements, and crucially the effective 0:09:53.316 --> 0:09:55.596 noise on easpirated podcasters. 0:09:56.236 --> 0:10:01.956 Now you mentioned sirens, all right, that deals with safety, 0:10:02.796 --> 0:10:06.756 That deals with getting someone to the hospital on time. However, 0:10:06.876 --> 0:10:13.196 the sirens in Europe are less offensive, are less intrusive. 0:10:13.636 --> 0:10:17.116 Europe mean people aren't dying, aren't they. The point is, 0:10:17.276 --> 0:10:20.076 if Europe can have quiet at once, you could come 0:10:20.196 --> 0:10:25.636 up with a method of quieting the sirens and still 0:10:25.676 --> 0:10:28.756 be as effective. I have not seen a study I 0:10:28.836 --> 0:10:32.596 has shown that if you have a less offensive intrusive 0:10:32.756 --> 0:10:35.396 siren that more people die. 0:10:35.916 --> 0:10:38.556 Have you no? So here? 0:10:38.596 --> 0:10:43.916 I am, I'm a data person. Show me the data. 0:10:44.956 --> 0:10:47.756 I left that meeting full of hope. There's no doubt 0:10:47.756 --> 0:10:50.836 that sirens are dangerously loud. I just need to find 0:10:50.836 --> 0:10:52.756 the data to back this up and figure out a 0:10:52.756 --> 0:10:55.716 new solution. Like Arlene said, I went straight to the 0:10:55.756 --> 0:10:59.036 library and started digging around. But the more I saw 0:10:59.156 --> 0:11:02.516 about how clear it is already that these sirens are crazy, 0:11:03.156 --> 0:11:05.316 the less I believe that that data was going to 0:11:05.396 --> 0:11:09.996 make any difference in the world. And then I found 0:11:09.996 --> 0:11:13.436 a different set of data, not something about noise, but 0:11:13.556 --> 0:11:18.276 something that undermined the very foundation of the sirens existence. 0:11:20.676 --> 0:11:39.676 We'll be right back. Barrion County, Michigan, sits on the 0:11:39.676 --> 0:11:43.676 southeastern shore of Lake Michigan. It's not too far from Kalamazoo, 0:11:44.236 --> 0:11:49.156 quaint lake front towns, golf courses, quiet unless you work 0:11:49.596 --> 0:11:50.396 as a paramedic. 0:11:50.676 --> 0:11:53.316 I have like four jobs because it doesn't everyone. And 0:11:54.036 --> 0:11:56.476 I'm like, right now, I'm at the Barrion County Health Department. 0:11:56.716 --> 0:12:01.316 Jonathan Byer, former EMT and now medical director for the 0:12:01.356 --> 0:12:02.836 Barrion County Health Department. 0:12:03.316 --> 0:12:05.636 I am not speaking on behalf of the Barian County 0:12:05.636 --> 0:12:06.236 Health Department. 0:12:06.876 --> 0:12:09.916 Buyer was a boy scout, scrupulous. The reason he was 0:12:09.956 --> 0:12:12.956 speaking to me is because, in his capacity as the 0:12:12.996 --> 0:12:16.836 EMS medical director of the Baryon County Medical Control Authority, 0:12:17.276 --> 0:12:21.516 he is responsible for the ambulances of Barrion County, and 0:12:21.556 --> 0:12:24.076 that means he's thought a lot about the noises that 0:12:24.116 --> 0:12:28.916 those ambulances make and he's arrived at a very controversial position. 0:12:29.436 --> 0:12:32.076 There is no evidence that lights and sirens helps anybody. 0:12:32.076 --> 0:12:34.076 There's plenty of evidence that it hurts people. 0:12:34.276 --> 0:12:38.076 No evidence that lights and sirens helps anybody. This, even 0:12:38.116 --> 0:12:41.756 to me an inveterate complainer about sirens, was a huge surprise. 0:12:42.116 --> 0:12:44.476 I started life as a paramedic before I got demoted 0:12:44.516 --> 0:12:47.716 to doctor. I was a paramedic for eleven years. And 0:12:47.836 --> 0:12:50.636 when I was a paramedic in the Philadelphia area, we 0:12:50.756 --> 0:12:53.796 responded lights and sirens for everything. Like you called nine 0:12:53.836 --> 0:12:56.516 to one, we just let you know, there we go. 0:12:57.756 --> 0:13:02.236 When I got here to Michigan, they had two sets 0:13:02.276 --> 0:13:04.636 of priorities, Priority one in Priority two. 0:13:05.076 --> 0:13:07.716 A lot of ems across the country has a similar 0:13:07.796 --> 0:13:11.476 kind of tiered into system, a way to rank every 0:13:11.596 --> 0:13:14.196 incoming nine to one one call based not on its 0:13:14.276 --> 0:13:19.676 importance but on its time sensitivity. In Barryon County, they 0:13:19.676 --> 0:13:22.876 would tag a call with priority one or two, depending 0:13:22.916 --> 0:13:23.796 on what the issue was. 0:13:24.196 --> 0:13:26.796 There are more calls for service than there are ambulances, 0:13:26.796 --> 0:13:28.636 so we have to find some way to prioritize them. 0:13:29.236 --> 0:13:32.516 Except the system wasn't really working. 0:13:32.916 --> 0:13:36.196 And a lot of these triggers for things were like, 0:13:36.956 --> 0:13:39.276 if you ever complained of shortness of breath in any way, 0:13:39.276 --> 0:13:42.036 shape or form, it made it a Priority one. The 0:13:42.076 --> 0:13:43.956 problem is shortness of breath or do you feel like 0:13:43.956 --> 0:13:47.756 you're having trouble breathing? An incredibly subjective question, and so 0:13:48.196 --> 0:13:49.996 the medics were coming to me complaining. It's like, why 0:13:49.996 --> 0:13:53.316 are we getting Priority one dental pain because the person's like, 0:13:53.356 --> 0:13:56.236 I have a toothpain. Oh yeah, it's making hard to break. 0:13:56.476 --> 0:13:58.956 We were about fifty to fifty for Priority ones, which 0:13:58.956 --> 0:14:02.316 were lights and sirens, and Priority twos, which were not 0:14:02.476 --> 0:14:04.076 lights and siren. Speed of traffic. 0:14:04.596 --> 0:14:07.156 So you only have a certain number of ambulances, but 0:14:07.396 --> 0:14:09.636 if a full half of your calls are coming in 0:14:09.676 --> 0:14:12.716 as urgent, how do you fix the problem? How do 0:14:12.756 --> 0:14:15.676 you get all those ambulances where they need to be. Well, 0:14:15.836 --> 0:14:19.116 an easy way is to get more places faster, which 0:14:19.156 --> 0:14:22.356 theoretically you can do very easily if you're exempt from 0:14:22.396 --> 0:14:26.836 all typical traffic laws, precisely why we have sirens. But 0:14:26.876 --> 0:14:28.436 it's a little more complicated than that. 0:14:29.036 --> 0:14:31.436 So when you drive your car, you're used to things 0:14:31.436 --> 0:14:35.236 like red lights. Everyone's going to stop. Once something interferes 0:14:35.276 --> 0:14:37.916 with that, the chances of an accident increase. 0:14:39.676 --> 0:14:43.276 Specifically, it increases your chance of an accident by over 0:14:43.436 --> 0:14:47.756 fifty percent, which is crazy. This is according to a 0:14:47.796 --> 0:14:51.076 peer reviewed twenty nineteen study published in the Annals of 0:14:51.076 --> 0:14:54.756 Emergency Medicine. The risk is even higher when transporting a 0:14:54.796 --> 0:14:58.196 patient than when initially responding. But either way, the chance 0:14:58.196 --> 0:15:00.596 of an accident is a lot higher when you're using 0:15:00.676 --> 0:15:03.916 lights and sirens than if you're not. Also, these are 0:15:04.036 --> 0:15:07.996 very often bad accidents. Ambulances are heavy, not a risk 0:15:08.036 --> 0:15:11.276 worth taking if you're just responding to a toothache. 0:15:12.236 --> 0:15:15.156 I started going, why are we responding to dental pain 0:15:15.276 --> 0:15:19.676 priority one? So myself and I have a residency program here, 0:15:19.676 --> 0:15:21.756 and I had a couple of my high performing medics 0:15:21.796 --> 0:15:24.796 and another EMS position and myself. We spent a couple 0:15:24.796 --> 0:15:28.116 of weeks going through hundreds of these determined codes, going 0:15:28.516 --> 0:15:30.036 does that really need priority one? 0:15:30.756 --> 0:15:34.036 So there's the accident's risk. But also, and this is 0:15:34.076 --> 0:15:38.396 really surprising, using lights and sirens doesn't actually save that 0:15:38.516 --> 0:15:41.956 much time on your route to the patient. For decades now, 0:15:42.316 --> 0:15:45.196 studies have shown that lights and sirens seem to save 0:15:45.236 --> 0:15:49.356 on average between forty two seconds and three minutes and 0:15:49.436 --> 0:15:52.676 forty eight seconds. It's about one and a half minutes 0:15:52.716 --> 0:15:55.236 of savings if you're in a city, and a little 0:15:55.236 --> 0:15:57.596 over three and a half minutes if you're in the country. 0:15:57.916 --> 0:16:02.476 On average, yes, it's about forty five seconds or three minutes. 0:16:02.516 --> 0:16:05.356 And there are that's not a critical that's not a 0:16:05.396 --> 0:16:07.756 critical interval most of the time for. 0:16:07.836 --> 0:16:11.116 Most disease process. Cardiac arrest is one that I would 0:16:11.116 --> 0:16:14.516 put in the that's the time makes sense because in 0:16:14.596 --> 0:16:18.796 cardiac arrest, for every every minute that you go without 0:16:18.836 --> 0:16:22.876 CPR being done, there's about a ten percent increase in 0:16:22.956 --> 0:16:26.156 mortality and decrease in survivable brain function coming. 0:16:26.196 --> 0:16:29.716 That's huge. Yeah, serta's huge. But heart attacks are actually 0:16:29.756 --> 0:16:33.396 one of the few exceptions, not the rule, and yet 0:16:33.476 --> 0:16:36.356 they are the exception on which the rule is largely based. 0:16:37.036 --> 0:16:40.916 So all of these factors led Buyer to do something big. 0:16:41.636 --> 0:16:43.396 He restructured the tears. 0:16:43.636 --> 0:16:45.956 I tell the medics, and this is how I presented 0:16:45.996 --> 0:16:49.876 it is consider lights and sirens a medical therapy. Right, 0:16:49.916 --> 0:16:52.156 there's for every medicine that you give, there is an 0:16:52.156 --> 0:16:54.276 indication and there's a contraindication. 0:16:54.716 --> 0:16:54.916 Right. 0:16:55.156 --> 0:16:56.476 If I were going to say I'm going to give 0:16:56.476 --> 0:16:58.156 you up an effort, well, why would I give you 0:16:58.156 --> 0:17:00.836 epin effort and the benefits have to outweigh the risks. 0:17:01.436 --> 0:17:03.636 So I wanted to think of lights and sirens that way. 0:17:03.716 --> 0:17:07.476 It is a high risk procedure. When are we going 0:17:07.556 --> 0:17:11.196 to do it when the risks are outweighed by the benefits. 0:17:11.436 --> 0:17:13.516 They ran through their data on all the calls that 0:17:13.556 --> 0:17:16.916 they had responded to Priority one lights and sirens, and 0:17:16.956 --> 0:17:20.436 they reassessed whether those really needed to be lights and sirens. 0:17:20.876 --> 0:17:26.836 So cardiac arrest, people choking, respiratory arrest, things where seconds 0:17:26.876 --> 0:17:30.156 could make a difference, yep, that is worth the risk 0:17:30.756 --> 0:17:33.316 to try to get someone there quicker. But other things 0:17:33.396 --> 0:17:36.556 like well she fell and broke her hip, Okay, that's 0:17:36.596 --> 0:17:38.796 an emergency and that person needs to get to a hospital. 0:17:38.836 --> 0:17:42.076 I don't doubt that is the three minutes going to 0:17:42.156 --> 0:17:44.516 make a difference in that person's outcome. 0:17:45.076 --> 0:17:49.036 No, So with all this data, Buyer and his team 0:17:49.476 --> 0:17:51.036 changed how the calls were coded. 0:17:52.396 --> 0:17:54.836 I wiped out about fifty percent of the Priority one 0:17:54.916 --> 0:17:56.076 calls in burying down. 0:17:56.796 --> 0:18:00.596 Let that sink in ambulance lights and sirens and Barrion 0:18:00.636 --> 0:18:04.476 County were sounding half as often as they had before. 0:18:05.636 --> 0:18:08.396 Now even I was wondering, could you really know that 0:18:08.476 --> 0:18:11.876 this switch was putting anyone at risk? Well, eventually they 0:18:11.956 --> 0:18:14.476 followed up on the people the ambulances had picked up 0:18:14.476 --> 0:18:16.996 in the field to see how the hospital coded the 0:18:16.996 --> 0:18:19.796 patients as they came in. So if you went to 0:18:19.836 --> 0:18:22.836 someone as a priority too not that urgent, and they 0:18:22.836 --> 0:18:25.596 showed up to the hospital as a priority one, that 0:18:25.636 --> 0:18:28.356 would mean that you'd made a mistake. How much more 0:18:28.396 --> 0:18:31.116 often was that happening under the new coding system than 0:18:31.156 --> 0:18:34.836 the old It was the same number. Wow, there was 0:18:34.916 --> 0:18:40.076 basically no difference, as in, he had the number of 0:18:40.156 --> 0:18:43.476 lights and sirens responses in Barrion County. He reduced the 0:18:43.556 --> 0:18:46.916 risk of accidents as a result, and it cost the 0:18:46.956 --> 0:18:49.596 people of Barrion County nothing. 0:18:52.956 --> 0:18:56.036 When I instituted the change, I didn't really have much 0:18:56.036 --> 0:18:58.796 of a problem. Nine to one one didn't have a 0:18:58.796 --> 0:19:00.956 problem with this because it just was a difference in 0:19:00.996 --> 0:19:01.636 coding for them. 0:19:01.636 --> 0:19:02.476 It didn't affect them. 0:19:02.756 --> 0:19:05.916 The medics themselves really liked it because the medics were like, yep, 0:19:06.036 --> 0:19:07.556 most of these things we were going on are not 0:19:07.876 --> 0:19:09.756 priority on board. 0:19:09.916 --> 0:19:15.036 The paramedics are on board. Smooth sailing, except what ended. 0:19:14.916 --> 0:19:17.516 Up happening and I'm not exactly sure how this got out. 0:19:18.836 --> 0:19:21.436 It went through all the proper channels on my side, 0:19:21.476 --> 0:19:23.996 like medical control in the hospital in the county, so 0:19:24.076 --> 0:19:28.076 that was okay, But it started getting publicized, and I 0:19:28.116 --> 0:19:30.556 don't exactly know how, but it started showing up on 0:19:31.356 --> 0:19:35.996 the hospital Facebook page about Burian County medical Control is 0:19:36.116 --> 0:19:39.796 killing people with slow responses, and oh boy. 0:19:40.556 --> 0:19:43.476 Unbeknownst to Bayer, word had gotten out to the people 0:19:43.516 --> 0:19:47.436 who call ambulances big problem. 0:19:47.556 --> 0:19:49.596 Hey, if you're drive in Barrian County, you won't see 0:19:49.596 --> 0:19:52.516 as many lights and sirens as you're driving. Ambulances will 0:19:52.556 --> 0:19:55.236 be using them only for time sensitive cases like a 0:19:55.236 --> 0:19:55.796 heart attack. 0:19:56.116 --> 0:19:58.756 The local news began doing man on the street interviews. 0:19:58.876 --> 0:20:01.836 Literally, they were out on the bluff overlooking Lake Michigan, 0:20:01.876 --> 0:20:04.076 just interviewing people walking by, going what do you think 0:20:04.076 --> 0:20:05.916 about ambulances coming to your house slower? 0:20:05.916 --> 0:20:08.396 And of course people explode over what did they say? 0:20:09.276 --> 0:20:11.596 It's like, I can't believe this, and you know that 0:20:11.636 --> 0:20:13.876 this is terrible. Of course I won't ambulance there fast. 0:20:14.076 --> 0:20:17.156 And the hospital started getting a lot of flack, some 0:20:17.236 --> 0:20:20.516 of it was very nasty. So people started on Facebook 0:20:20.556 --> 0:20:24.156 attacking the hospital. Oh this is Lakeland just killing patients again? 0:20:24.196 --> 0:20:25.996 You know, just very bad vitriol. 0:20:27.436 --> 0:20:30.156 At the time, though Bayer was blissfully unaware any of 0:20:30.196 --> 0:20:33.156 this was happening. Other jobs were keeping him very busy. 0:20:33.596 --> 0:20:35.916 But then one morning he got a call. 0:20:36.716 --> 0:20:39.596 I'd done a six p to two am shift and 0:20:39.676 --> 0:20:42.636 at eight am I got a call from the administrative 0:20:42.636 --> 0:20:45.716 assistant to the CEO of the hospital. Hi there, doctor Buyer, 0:20:46.476 --> 0:20:49.276 It's eight am. What are you doing at eight thirty? 0:20:49.356 --> 0:20:51.676 I'm like, and I'm still swaking up because again I've 0:20:51.676 --> 0:20:55.036 had four hours of sleep, and she's like, doctor Hamill. 0:20:55.156 --> 0:20:57.196 At that point, the CEO of the hospital would like 0:20:57.276 --> 0:20:58.116 to speak to you. 0:20:58.676 --> 0:21:02.516 Buyer gets dressed in hurries to doctor Hamill's office. 0:21:02.236 --> 0:21:05.996 And I'm met by them in the hospital attorney and 0:21:06.316 --> 0:21:08.876 being shown this Facebook page and they're like, what did 0:21:08.916 --> 0:21:10.516 you do? This is terrible? 0:21:11.236 --> 0:21:14.316 Buyers stunned, and then he begins to lay out the 0:21:14.316 --> 0:21:17.276 case against Sirens in a very doctor buyer way. 0:21:17.636 --> 0:21:21.916 I try to explain what I had done. Is have 0:21:21.996 --> 0:21:23.476 you ever taken physics? 0:21:24.196 --> 0:21:27.676 Buyer explained his move, maybe a little inefficiently, by using 0:21:27.716 --> 0:21:32.356 the equation for velocity distance divided by time changed to 0:21:32.436 --> 0:21:36.396 solve for time or Tea. It amounted to this, If 0:21:36.396 --> 0:21:38.756 you're trying to get time down and you can't reduce 0:21:38.796 --> 0:21:41.356 the distance between you and a patient by putting more 0:21:41.396 --> 0:21:45.116 ambulances on the street, because it's expensive, the easiest way 0:21:45.156 --> 0:21:48.556 to get it done is to increase your velocity, which 0:21:48.636 --> 0:21:51.396 means running your lights and sirens. But the problem is, 0:21:51.556 --> 0:21:55.396 we now know that running lights and sirens significantly increases 0:21:55.436 --> 0:21:57.676 the risk of an accident, So maybe you don't want 0:21:57.716 --> 0:22:00.716 to do that either. Then the thing to do is 0:22:00.756 --> 0:22:04.276 to take a second look at tea. Does time really 0:22:04.356 --> 0:22:06.636 need to come down by the small increment that we 0:22:06.716 --> 0:22:08.716 now know lights and sirens is going to reduce it? 0:22:09.516 --> 0:22:10.556 Not for most things. 0:22:11.076 --> 0:22:13.436 I showed him some of the studies. He's like, your 0:22:13.476 --> 0:22:16.316 science is sound. You may you go next time, do 0:22:16.356 --> 0:22:19.236 a press conference. Oh I had a press conference, which 0:22:19.236 --> 0:22:19.996 is what you saw. 0:22:19.836 --> 0:22:23.076 Online Buyer confronted the outrage masses. 0:22:23.156 --> 0:22:25.796 And once that went out, all complaints disappeared in six 0:22:25.836 --> 0:22:28.796 weeks and I've heard not a thing since then. In fact, 0:22:28.836 --> 0:22:31.236 now we are considered we right now are the leader 0:22:31.236 --> 0:22:33.396 in Michigan for the lowest rates of lights and sirens 0:22:33.476 --> 0:22:34.316 use in the state of Michigan. 0:22:34.396 --> 0:22:37.196 For ems. Things worked out for buyer in the end. 0:22:37.836 --> 0:22:41.236 But I'm interested in that initial freak out because it 0:22:41.276 --> 0:22:46.116 reveals a basic assumption people make, myself included. Everything is urgent, 0:22:46.476 --> 0:22:49.436 so we accept this social loophole where you can break 0:22:49.596 --> 0:22:52.636 all known traffic laws provided you possess a device that 0:22:52.716 --> 0:22:56.956 emits the loudest, shrillest sound imaginable. What kind of world 0:22:57.036 --> 0:23:00.196