Speaker 1: Pushkin.
Speaker 2: Hello, Hello everyone. This is the first of what are
Speaker 2: going to be a couple of episodes in this mini
Speaker 2: season from my colleague Ben Adaph Haffrey. Ben is the
Speaker 2: guy when you're hiking through the wilderness who says let's
Speaker 2: go this way and there's no trail and you think, oh,
Speaker 2: I'm going to get eaten by bears, and then no,
Speaker 2: you find some lost civilization and large piles of glittering gold.
Speaker 2: Ben started telling me this story and I stopped him
Speaker 2: halfway through and I said, oh, Ben, this is a spandrel.
Speaker 2: And what's a spandrel? One of my all time favorite concepts.
Speaker 2: Invented by Stephen J. Gould, the spandrel is a thing
Speaker 2: that doesn't have a function, but which hangs around like
Speaker 2: a random hitchhiker, because it happens to be riding along
Speaker 2: with things that do have a function, like your ear lobes.
Speaker 2: I mean, what are they there for? Doesn't it seem
Speaker 2: like they were all just along for the ride with
Speaker 2: a part of our ear that actually does useful things.
Speaker 2: Or your chin? What's up with the chin. We look
Speaker 2: at a spandrel and we assume there has to be
Speaker 2: a reason for it, and there isn't They're just spandrels.
Speaker 2: My name is Malcolm Gladwell. This is Revisionist History, my
Speaker 2: podcast about things overlooked and misunderstood. In this episode, my
Speaker 2: colleague Bend daph Haffrey investigates a spandrel. You don't even
Speaker 2: realize you've been living with something that none of us
Speaker 2: would ever think to question, because it's such a bedrock
Speaker 2: part of our world. We all just assume it has
Speaker 2: to be there, and it doesn't. I'm talking, of course,
Speaker 2: about sirens.
Speaker 1: Walk me through. No, you really do walk me through
Speaker 1: what we're looking at here. I'm talking with my wife
Speaker 1: Julia Conrad, who happens to share an apartment with me
Speaker 1: on quite a noisy street in Brooklyn.
Speaker 3: This is a log that you created. Although I am
Speaker 3: represented in it, I think it looks like we only
Speaker 3: did it for one day. Of how many times we
Speaker 3: heard the siren and where we heard it. Wow, what
Speaker 3: a day.
Speaker 1: Julia and I live opposite this grocery store that's all local,
Speaker 1: small batch whatnot. So instead of getting just one delivery
Speaker 1: a day, they get like fifteen, sometimes from trucks bearing
Speaker 1: I assume one sprig of artismal basil next door there's
Speaker 1: a noisy playground and crucially a fire station, a really
Speaker 1: active fire station. What happens is the grocery store trucks
Speaker 1: block traffic, which means the fire trucks can't get out,
Speaker 1: and so sirens all the time. This, for me, as
Speaker 1: a writer, podcaster and light sleeper, is a problem. So
Speaker 1: I decided to do some research. I made a spreadsheet.
Speaker 1: We counted from nine am till ten at night, and
Speaker 1: we heard a siren twenty four times. Twenty four times,
Speaker 1: and this is reliable data. Julia is a data scientist.
Speaker 1: She works for the New York City government, and she
Speaker 1: has held my spreadsheet to the highest of standards.
Speaker 3: First, I have to say I never understand your way
Speaker 3: of doing Google sheets because the color coding seems to
Speaker 3: just be aesthetic. It's not actually representing anything in the data.
Speaker 1: I don't need this in it. I could get enough
Speaker 1: of this in my job. I don't hear from you.
Speaker 1: I will confess that the spreadsheet, consisting of mauv baby blue,
Speaker 1: puked green, a cheery yellow, and several pleasingly varied shades
Speaker 1: of red, isn't even complete because it does not count
Speaker 1: the times we heard the siren in the middle of
Speaker 1: the night when there is no one on the road.
Speaker 1: Maybe you didn't realize this, but emergency vehicles will sometimes
Speaker 1: run their lights and sirens even if there's seemingly no
Speaker 1: one around. Sirens can run anywhere from one hundred and
Speaker 1: ten decibels to over one hundred and thirty That is
Speaker 1: ear damagingly loud. The classic fire siren sound like what
Speaker 1: you hear in your head if you imagine a fire
Speaker 1: truck right now. Is called the Federal Q TWOV, and
Speaker 1: it's a whopping one hundred and twenty three decibels at
Speaker 1: one hundred feet away. There's an actual corporation that makes
Speaker 1: the siren. Federal Signal Fans post videos about the siren online.
Speaker 1: Here's what it sounds like. Maybe turn your volume down.
Speaker 4: As we say, it's not a firetruck unless it's got.
Speaker 1: A key siren. According to a helpful chart from Yale University,
Speaker 1: one hundred twenty three decibels is just two decibels lower
Speaker 1: than the point at which quote pain begins. This would
Speaker 1: all be fine, except I kind of need my ears
Speaker 1: for my job, and this is why I began the log.
Speaker 1: The log has fields for all relevant data date, time,
Speaker 1: branch of emergency service. Location in the house from which
Speaker 1: we have heard the siren.
Speaker 3: Well, there's really just two possibilities. You're either in the
Speaker 3: front of the house or the back of the house.
Speaker 3: But actually some of these entries are logged for front
Speaker 3: and back, so that's when you know it's a really
Speaker 3: big siren.
Speaker 1: There's also a field for reporter Ben slash Julia and
Speaker 1: another for notes and then what is the final column.
Speaker 3: The final column is called dog question mark.
Speaker 1: This is the only field that matters. You See, there's
Speaker 1: a dog in my neighborhood who howls almost every time
Speaker 1: the siren goes off, and he sounds like this, a
Speaker 1: dog who, by the standards of people on my block
Speaker 1: is practically famous. Have you heard a dog who howls
Speaker 1: every time the sirens go off? Yeah? I have.
Speaker 5: I mean they're pretty consistent with it.
Speaker 2: They're they're dedicated to their.
Speaker 5: Howling.
Speaker 4: I think I feel like my wife has heard the dog.
Speaker 1: But there's a guy, Kevin that lives after that garage
Speaker 1: right there, and he does so he's talked about this
Speaker 1: dog here. Yeah, what does he say? Oh, he's ready
Speaker 1: to do something about it.
Speaker 3: It starts really low and guttural.
Speaker 6: I thought it was like a wearwolf or something.
Speaker 7: Oh.
Speaker 1: I decided to take a two pronged approach to my
Speaker 1: siren problem. Planet I had to see if I could.
Speaker 1: I proved that the sirens in my neighborhood were dangerously
Speaker 1: unnecessarily loud, and Plan B. I needed a sympathetic face
Speaker 1: for my cause. Nobody really cares about podcasters, but everybody
Speaker 1: cares about dogs. And I had to assume that that
Speaker 1: dog was howling along with the siren because he was,
Speaker 1: like me, in serious pain. So find the dog, stop
Speaker 1: the siren. It'd be that simple, except the dog was
Speaker 1: not immediately forthcoming. So I pushed ahead with Plan A
Speaker 1: noise research, which led me straight to doctor Arlene Bronze Aft.
Speaker 7: We're going to take you into the noise troom.
Speaker 1: What's the noise troop?
Speaker 8: Oh?
Speaker 7: Okay, no, see when you get there.
Speaker 1: Sarah doctor Bronze Aft, is an eighty nine year old
Speaker 1: environmental psychologist who has been called the noise Queen of
Speaker 1: New York City. She's done major noise studies worked for
Speaker 1: five mayors. She grew up in Brooklyn and lives in
Speaker 1: a lovely tidy apartment on the Upper East Side someone
Speaker 1: was jackhammering the street outside the building, and yet you
Speaker 1: couldn't hear a thing. Double glazed windows. Of course, she
Speaker 1: took me to her noise room. The noise room sounds
Speaker 1: possibly like the opposite of what I mean.
Speaker 7: Let me tell you it is a very quiet room.
Speaker 7: This is quiet.
Speaker 1: Wow. How did you get it so quiet? Oh?
Speaker 7: Did I help make it quiet? Answer? Yes, I did
Speaker 7: have a role and making it quieter than it would
Speaker 7: have been. Can you see the cooling units?
Speaker 1: Yep?
Speaker 7: Are they all closed?
Speaker 1: Yep?
Speaker 7: Who do anythink made that request?
Speaker 1: Bronze Aft started her work during the golden age of
Speaker 1: noise control the nineteen seventies, when the EPA began regulating noise.
Speaker 1: Her early work demonstrated that noise isn't just annoying. They
Speaker 1: can get in the way of kids learning in school,
Speaker 1: and she just kept going from there. When the city
Speaker 1: updated its noise code in two thousand and seven.
Speaker 7: In fact, it was my suggestion that they updated, it
Speaker 7: carried quite a bit of weight. However, the literature that
Speaker 7: they were depending upon was it was older. So today
Speaker 7: we have much more solid literature on the link between
Speaker 7: noise and health. That's critical, and that includes mental health.
Speaker 7: As well in learning that.
Speaker 1: All checked out for me. Of course, the sirens are
Speaker 1: too loud, but it can take a while for the
Speaker 1: research to make its way into policy. Now we have
Speaker 1: research linking even small changes and overall noise to significantly
Speaker 1: increased risk of heart disease, to say nothing of stress,
Speaker 1: poor sleep and its associated elements, and crucially the effective
Speaker 1: noise on easpirated podcasters.
Speaker 7: Now you mentioned sirens, all right, that deals with safety,
Speaker 7: That deals with getting someone to the hospital on time. However,
Speaker 7: the sirens in Europe are less offensive, are less intrusive.
Speaker 7: Europe mean people aren't dying, aren't they. The point is,
Speaker 7: if Europe can have quiet at once, you could come
Speaker 7: up with a method of quieting the sirens and still
Speaker 7: be as effective. I have not seen a study I
Speaker 7: has shown that if you have a less offensive intrusive
Speaker 7: siren that more people die.
Speaker 1: Have you no? So here?
Speaker 7: I am, I'm a data person. Show me the data.
Speaker 1: I left that meeting full of hope. There's no doubt
Speaker 1: that sirens are dangerously loud. I just need to find
Speaker 1: the data to back this up and figure out a
Speaker 1: new solution. Like Arlene said, I went straight to the
Speaker 1: library and started digging around. But the more I saw
Speaker 1: about how clear it is already that these sirens are crazy,
Speaker 1: the less I believe that that data was going to
Speaker 1: make any difference in the world. And then I found
Speaker 1: a different set of data, not something about noise, but
Speaker 1: something that undermined the very foundation of the sirens existence.
Speaker 1: We'll be right back. Barrion County, Michigan, sits on the
Speaker 1: southeastern shore of Lake Michigan. It's not too far from Kalamazoo,
Speaker 1: quaint lake front towns, golf courses, quiet unless you work
Speaker 1: as a paramedic.
Speaker 4: I have like four jobs because it doesn't everyone. And
Speaker 4: I'm like, right now, I'm at the Barrion County Health Department.
Speaker 1: Jonathan Byer, former EMT and now medical director for the
Speaker 1: Barrion County Health Department.
Speaker 4: I am not speaking on behalf of the Barian County
Speaker 4: Health Department.
Speaker 1: Buyer was a boy scout, scrupulous. The reason he was
Speaker 1: speaking to me is because, in his capacity as the
Speaker 1: EMS medical director of the Baryon County Medical Control Authority,
Speaker 1: he is responsible for the ambulances of Barrion County, and
Speaker 1: that means he's thought a lot about the noises that
Speaker 1: those ambulances make and he's arrived at a very controversial position.
Speaker 4: There is no evidence that lights and sirens helps anybody.
Speaker 4: There's plenty of evidence that it hurts people.
Speaker 1: No evidence that lights and sirens helps anybody. This, even
Speaker 1: to me an inveterate complainer about sirens, was a huge surprise.
Speaker 4: I started life as a paramedic before I got demoted
Speaker 4: to doctor. I was a paramedic for eleven years. And
Speaker 4: when I was a paramedic in the Philadelphia area, we
Speaker 4: responded lights and sirens for everything. Like you called nine
Speaker 4: to one, we just let you know, there we go.
Speaker 4: When I got here to Michigan, they had two sets
Speaker 4: of priorities, Priority one in Priority two.
Speaker 1: A lot of ems across the country has a similar
Speaker 1: kind of tiered into system, a way to rank every
Speaker 1: incoming nine to one one call based not on its
Speaker 1: importance but on its time sensitivity. In Barryon County, they
Speaker 1: would tag a call with priority one or two, depending
Speaker 1: on what the issue was.
Speaker 4: There are more calls for service than there are ambulances,
Speaker 4: so we have to find some way to prioritize them.
Speaker 1: Except the system wasn't really working.
Speaker 4: And a lot of these triggers for things were like,
Speaker 4: if you ever complained of shortness of breath in any way,
Speaker 4: shape or form, it made it a Priority one. The
Speaker 4: problem is shortness of breath or do you feel like
Speaker 4: you're having trouble breathing? An incredibly subjective question, and so
Speaker 4: the medics were coming to me complaining. It's like, why
Speaker 4: are we getting Priority one dental pain because the person's like,
Speaker 4: I have a toothpain. Oh yeah, it's making hard to break.
Speaker 4: We were about fifty to fifty for Priority ones, which
Speaker 4: were lights and sirens, and Priority twos, which were not
Speaker 4: lights and siren. Speed of traffic.
Speaker 1: So you only have a certain number of ambulances, but
Speaker 1: if a full half of your calls are coming in
Speaker 1: as urgent, how do you fix the problem? How do
Speaker 1: you get all those ambulances where they need to be. Well,
Speaker 1: an easy way is to get more places faster, which
Speaker 1: theoretically you can do very easily if you're exempt from
Speaker 1: all typical traffic laws, precisely why we have sirens. But
Speaker 1: it's a little more complicated than that.
Speaker 4: So when you drive your car, you're used to things
Speaker 4: like red lights. Everyone's going to stop. Once something interferes
Speaker 4: with that, the chances of an accident increase.
Speaker 1: Specifically, it increases your chance of an accident by over
Speaker 1: fifty percent, which is crazy. This is according to a
Speaker 1: peer reviewed twenty nineteen study published in the Annals of
Speaker 1: Emergency Medicine. The risk is even higher when transporting a
Speaker 1: patient than when initially responding. But either way, the chance
Speaker 1: of an accident is a lot higher when you're using
Speaker 1: lights and sirens than if you're not. Also, these are
Speaker 1: very often bad accidents. Ambulances are heavy, not a risk
Speaker 1: worth taking if you're just responding to a toothache.
Speaker 4: I started going, why are we responding to dental pain
Speaker 4: priority one? So myself and I have a residency program here,
Speaker 4: and I had a couple of my high performing medics
Speaker 4: and another EMS position and myself. We spent a couple
Speaker 4: of weeks going through hundreds of these determined codes, going
Speaker 4: does that really need priority one?
Speaker 1: So there's the accident's risk. But also, and this is
Speaker 1: really surprising, using lights and sirens doesn't actually save that
Speaker 1: much time on your route to the patient. For decades now,
Speaker 1: studies have shown that lights and sirens seem to save
Speaker 1: on average between forty two seconds and three minutes and
Speaker 1: forty eight seconds. It's about one and a half minutes
Speaker 1: of savings if you're in a city, and a little
Speaker 1: over three and a half minutes if you're in the country.
Speaker 4: On average, yes, it's about forty five seconds or three minutes.
Speaker 1: And there are that's not a critical that's not a
Speaker 1: critical interval most of the time for.
Speaker 4: Most disease process. Cardiac arrest is one that I would
Speaker 4: put in the that's the time makes sense because in
Speaker 4: cardiac arrest, for every every minute that you go without
Speaker 4: CPR being done, there's about a ten percent increase in
Speaker 4: mortality and decrease in survivable brain function coming.
Speaker 1: That's huge. Yeah, serta's huge. But heart attacks are actually
Speaker 1: one of the few exceptions, not the rule, and yet
Speaker 1: they are the exception on which the rule is largely based.
Speaker 1: So all of these factors led Buyer to do something big.
Speaker 1: He restructured the tears.
Speaker 4: I tell the medics, and this is how I presented
Speaker 4: it is consider lights and sirens a medical therapy. Right,
Speaker 4: there's for every medicine that you give, there is an
Speaker 4: indication and there's a contraindication.
Speaker 1: Right.
Speaker 4: If I were going to say I'm going to give
Speaker 4: you up an effort, well, why would I give you
Speaker 4: epin effort and the benefits have to outweigh the risks.
Speaker 4: So I wanted to think of lights and sirens that way.
Speaker 4: It is a high risk procedure. When are we going
Speaker 4: to do it when the risks are outweighed by the benefits.
Speaker 1: They ran through their data on all the calls that
Speaker 1: they had responded to Priority one lights and sirens, and
Speaker 1: they reassessed whether those really needed to be lights and sirens.
Speaker 4: So cardiac arrest, people choking, respiratory arrest, things where seconds
Speaker 4: could make a difference, yep, that is worth the risk
Speaker 4: to try to get someone there quicker. But other things
Speaker 4: like well she fell and broke her hip, Okay, that's
Speaker 4: an emergency and that person needs to get to a hospital.
Speaker 4: I don't doubt that is the three minutes going to
Speaker 4: make a difference in that person's outcome.
Speaker 1: No, So with all this data, Buyer and his team
Speaker 1: changed how the calls were coded.
Speaker 4: I wiped out about fifty percent of the Priority one
Speaker 4: calls in burying down.
Speaker 1: Let that sink in ambulance lights and sirens and Barrion
Speaker 1: County were sounding half as often as they had before.
Speaker 1: Now even I was wondering, could you really know that
Speaker 1: this switch was putting anyone at risk? Well, eventually they
Speaker 1: followed up on the people the ambulances had picked up
Speaker 1: in the field to see how the hospital coded the
Speaker 1: patients as they came in. So if you went to
Speaker 1: someone as a priority too not that urgent, and they
Speaker 1: showed up to the hospital as a priority one, that
Speaker 1: would mean that you'd made a mistake. How much more
Speaker 1: often was that happening under the new coding system than
Speaker 1: the old It was the same number. Wow, there was
Speaker 1: basically no difference, as in, he had the number of
Speaker 1: lights and sirens responses in Barrion County. He reduced the
Speaker 1: risk of accidents as a result, and it cost the
Speaker 1: people of Barrion County nothing.
Speaker 4: When I instituted the change, I didn't really have much
Speaker 4: of a problem. Nine to one one didn't have a
Speaker 4: problem with this because it just was a difference in
Speaker 4: coding for them.
Speaker 1: It didn't affect them.
Speaker 4: The medics themselves really liked it because the medics were like, yep,
Speaker 4: most of these things we were going on are not
Speaker 4: priority on board.
Speaker 1: The paramedics are on board. Smooth sailing, except what ended.
Speaker 4: Up happening and I'm not exactly sure how this got out.
Speaker 4: It went through all the proper channels on my side,
Speaker 4: like medical control in the hospital in the county, so
Speaker 4: that was okay, But it started getting publicized, and I
Speaker 4: don't exactly know how, but it started showing up on
Speaker 4: the hospital Facebook page about Burian County medical Control is
Speaker 4: killing people with slow responses, and oh boy.
Speaker 1: Unbeknownst to Bayer, word had gotten out to the people
Speaker 1: who call ambulances big problem.
Speaker 6: Hey, if you're drive in Barrian County, you won't see
Speaker 6: as many lights and sirens as you're driving. Ambulances will
Speaker 6: be using them only for time sensitive cases like a
Speaker 6: heart attack.
Speaker 1: The local news began doing man on the street interviews.
Speaker 4: Literally, they were out on the bluff overlooking Lake Michigan,
Speaker 4: just interviewing people walking by, going what do you think
Speaker 4: about ambulances coming to your house slower?
Speaker 1: And of course people explode over what did they say?
Speaker 4: It's like, I can't believe this, and you know that
Speaker 4: this is terrible. Of course I won't ambulance there fast.
Speaker 4: And the hospital started getting a lot of flack, some
Speaker 4: of it was very nasty. So people started on Facebook
Speaker 4: attacking the hospital. Oh this is Lakeland just killing patients again?
Speaker 4: You know, just very bad vitriol.
Speaker 1: At the time, though Bayer was blissfully unaware any of
Speaker 1: this was happening. Other jobs were keeping him very busy.
Speaker 1: But then one morning he got a call.
Speaker 4: I'd done a six p to two am shift and
Speaker 4: at eight am I got a call from the administrative
Speaker 4: assistant to the CEO of the hospital. Hi there, doctor Buyer,
Speaker 4: It's eight am. What are you doing at eight thirty?
Speaker 4: I'm like, and I'm still swaking up because again I've
Speaker 4: had four hours of sleep, and she's like, doctor Hamill.
Speaker 4: At that point, the CEO of the hospital would like
Speaker 4: to speak to you.
Speaker 1: Buyer gets dressed in hurries to doctor Hamill's office.
Speaker 4: And I'm met by them in the hospital attorney and
Speaker 4: being shown this Facebook page and they're like, what did
Speaker 4: you do? This is terrible?
Speaker 1: Buyers stunned, and then he begins to lay out the
Speaker 1: case against Sirens in a very doctor buyer way.
Speaker 4: I try to explain what I had done. Is have
Speaker 4: you ever taken physics?
Speaker 1: Buyer explained his move, maybe a little inefficiently, by using
Speaker 1: the equation for velocity distance divided by time changed to
Speaker 1: solve for time or Tea. It amounted to this, If
Speaker 1: you're trying to get time down and you can't reduce
Speaker 1: the distance between you and a patient by putting more
Speaker 1: ambulances on the street, because it's expensive, the easiest way
Speaker 1: to get it done is to increase your velocity, which
Speaker 1: means running your lights and sirens. But the problem is,
Speaker 1: we now know that running lights and sirens significantly increases
Speaker 1: the risk of an accident, So maybe you don't want
Speaker 1: to do that either. Then the thing to do is
Speaker 1: to take a second look at tea. Does time really
Speaker 1: need to come down by the small increment that we
Speaker 1: now know lights and sirens is going to reduce it?
Speaker 1: Not for most things.
Speaker 4: I showed him some of the studies. He's like, your
Speaker 4: science is sound. You may you go next time, do
Speaker 4: a press conference. Oh I had a press conference, which
Speaker 4: is what you saw.
Speaker 1: Online Buyer confronted the outrage masses.
Speaker 4: And once that went out, all complaints disappeared in six
Speaker 4: weeks and I've heard not a thing since then. In fact,
Speaker 4: now we are considered we right now are the leader
Speaker 4: in Michigan for the lowest rates of lights and sirens
Speaker 4: use in the state of Michigan.
Speaker 1: For ems. Things worked out for buyer in the end.
Speaker 1: But I'm interested in that initial freak out because it
Speaker 1: reveals a basic assumption people make, myself included. Everything is urgent,
Speaker 1: so we accept this social loophole where you can break
Speaker 1: all known traffic laws provided you possess a device that
Speaker 1: emits the loudest, shrillest sound imaginable. What kind of world
Speaker 1: does this? I'm not arguing that we shouldn't have sirens
Speaker 1: at all, but it seems to me that they're not
Speaker 1: only too loud and crazy sounding, but like we use
Speaker 1: them way more often than is necessary because we're unwilling
Speaker 1: to let go of them. But of course, Barrion County
Speaker 1: is just one place. Approximately twenty thousand the MS calls
Speaker 1: a year, and paramedics are just one branch of the
Speaker 1: emergency service. I shouldn't get ahead of myself. I was
Speaker 1: left with two big questions to answer. Next, where did
Speaker 1: we get the idea that sirens are so necessary? And
Speaker 1: exactly how unnecessary are they? A good place to look
Speaker 1: is the same place we fell in love with the
Speaker 1: MS once upon a time. We'll be right back.
Speaker 8: If you would have asked eighteen year old Jeff when
Speaker 8: I first drove lights and sirens. I would have said
Speaker 8: that they are always life saving and we absolutely need
Speaker 8: to use it. But I'm not eighteen anymore.
Speaker 1: Jeff Jarvis the chief Medical Officer for the Metropolitan Area
Speaker 1: EMS Authority in Fort Worth, Texas, an emergency medical service
Speaker 1: that serves over a million people in Fort Worth and
Speaker 1: fourteen surrounding cities. He's been a paramedic since the nineteen eighties.
Speaker 1: He served around New York City in Austin. So eighteen
Speaker 1: year old Jeff who's made his decision to begin to
Speaker 1: be a paramedic. So let me ask you. Let me
Speaker 1: ask you a question. In the nineteen seventies, did you
Speaker 1: ever watch the television show Emergency?
Speaker 8: Oh?
Speaker 1: Of course? And did that have an effect on your
Speaker 1: becoming a paramedic?
Speaker 8: It did. I thought it was the coolest thing ever.
Speaker 1: In nineteen seventy two, NBC began airing a television show
Speaker 1: called Emergency. That's got an exclamation point at the end.
Speaker 1: By the way, the theme song is the music they'd
Speaker 1: play in my version of Hell. The show is about
Speaker 1: Johnny and Roy, two young paramedics working out of fire
Speaker 1: Station fifty one in Los Angeles, except they're not paramedics
Speaker 1: in the beginning that.
Speaker 9: Special training program.
Speaker 8: Remember we were talking about it a couple of days ago.
Speaker 1: Yes, sir, the para something or other paramedics. The series
Speaker 1: begins in a world where there basically aren't any paramedics,
Speaker 1: which was our world fifty three years ago. Fifty three
Speaker 1: years in nineteen seventy one, there were a slim twelve
Speaker 1: paramedic units in the entire country and it was kind
Speaker 1: of a Wild West situation. Details varied from place to place,
Speaker 1: but in some areas it was illegal to give someone
Speaker 1: medical care if you weren't a doctor or a nurse.
Speaker 1: So about fifty percent of ambulances were just hearses driven
Speaker 1: out of funeral homes by morticians whose sole purpose was
Speaker 1: to get patients to doctors as quickly as possible. In
Speaker 1: that failed back to the funeral home, you go. This
Speaker 1: is actually how it worked. Emergency was a show dreamed
Speaker 1: up in partnership with the father of modern ms, a
Speaker 1: guy named James Page who worked at one of the
Speaker 1: first firehouses with a paramedic unit in Los Angeles, and
Speaker 1: the show was literally meant to make the case for paramedics.
Speaker 1: Every Saturday night nationwide on NBC thirty million viewers at
Speaker 1: a time, not a few of whom became paramedics.
Speaker 9: People at dying at the scene, people who could stay
Speaker 9: alive if there was somebody on the spot who knew
Speaker 9: what to do.
Speaker 1: Look, if that.
Speaker 9: Bill passed the legislature today, do you know how many
Speaker 9: people we'd have ready for the job?
Speaker 8: Six men for six and a half million people.
Speaker 1: I learned about emergency in a brilliant essay by UCLA
Speaker 1: emeritis law professor Paul Bergman, where he traces the profound
Speaker 1: influence the show had not just on par metics, but
Speaker 1: on lawmakers too, by dramatizing just how urgent every single
Speaker 1: nine to one call is.
Speaker 8: We almost head him back.
Speaker 9: Damn it, we almost head him back.
Speaker 1: If you could have been defibrillated the moment they pulled
Speaker 1: him off the wire. This is from the first episode,
Speaker 1: right after a maintenance man gets electrocuted and eventually dies.
Speaker 1: The doctor and nurse, who by the way, are of
Speaker 1: course romantically involved, are talking.
Speaker 9: Somebody should have been there with a machine in their bucket,
Speaker 9: not somebody The paramedics again.
Speaker 1: Call him paramedics a rescue team. That doesn't matter.
Speaker 9: Cal if somebody with the right equipment and trained to
Speaker 9: use it.
Speaker 8: Had gotten to this man in time, he'd be alive.
Speaker 9: Now, I won't use this situation that justify setting amaters
Speaker 9: out to practice medicine on the street, trained amaters trained
Speaker 9: by you, and doctors like you, amateurs, Dixie. I spent
Speaker 9: twelve years in school and residency and I'm still learning
Speaker 9: my trade.
Speaker 1: It's a doubleheader pilot, and both episodes are full of
Speaker 1: these situations that dramatized the resistance to paramedics, which was
Speaker 1: very real. But the show argues that we need paramedics
Speaker 1: and why do we need them because there are so
Speaker 1: many accidents where if only someone had been there in time,
Speaker 1: we could have saved.
Speaker 5: Them, including myself, and thought it could possibly be a success.
Speaker 9: Well, or arm may not function as well as it
Speaker 9: used to, but at least it'll be your own.
Speaker 1: You're getting out here as fast as you did. Made
Speaker 1: the difference, Randy, to have around, doc, you gotta give.
Speaker 8: Us a try.
Speaker 1: Bergmann, the law professor, talked to the legends of ems
Speaker 1: and he heard all these emergency references. Dug through California
Speaker 1: hearings on the Paramedic Act, and he found emergency references
Speaker 1: letters from senators emergency references. In the early years of
Speaker 1: the show, forty six states legalized paramedicine. To be clear,
Speaker 1: this was a movement that was already in process, but
Speaker 1: emergency was a big part of establishing the cultural expectations
Speaker 1: for what those units would look like. And it looked
Speaker 1: like lights and sirens to every call, because every call
Speaker 1: was all about time.
Speaker 9: But you can't ask someone not to die while you're
Speaker 9: trying to find out what's wrong with him. And they
Speaker 9: do die, gentlemen, on the way from where it happens
Speaker 9: to my hospital.
Speaker 1: This is from the second part of the pilot episode,
Speaker 1: when the skeptical doctor has come around.
Speaker 9: They die by the hundreds every year, not from mortal wounds,
Speaker 9: but neglected wounds, not from incompetence or indifference, but from time,
Speaker 9: from lack of time. I'm in favor of more doctors,
Speaker 9: more hospitals, and better equipment. And I'm also in favor
Speaker 9: of this bill until those other things come along, because
Speaker 9: it will save lives, maybe a dozen lives, maybe a thousand,
Speaker 9: maybe just one.
Speaker 1: He's looking directly into the camera, those thirty million viewers,
Speaker 1: and who knows which one time, time time, And if
Speaker 1: you succeed at convincing people that every situation is urgent.
Speaker 1: They're going to come to expect lights and sirens every
Speaker 1: time they call nine one one, And how many of
Speaker 1: the calls in emergency do they respond to with lights
Speaker 1: and si.
Speaker 8: Absolutely, so think about it this way. On Emergency, every
Speaker 8: call was a life threatening emergency. Now I say that
Speaker 8: knowing the first call they went on was not but
Speaker 8: in the team the first episode of the pilot, but
Speaker 8: the vast majority were life threatening emergencies. So sure people
Speaker 8: got that that notion and expectation that that's what would happen.
Speaker 8: There are a lot of paramedics who joined up for
Speaker 8: those life threatening emergencies only to find out that eighty
Speaker 8: five percent of the calls is holding somebody's hand.
Speaker 1: Sirens are all over the show. You may recall that
Speaker 1: the literal theme song of Emergency features sirens, and I
Speaker 1: think a lot of this time sireen obsession is due
Speaker 1: to the fact that early ems departments were part of
Speaker 1: fire departments, and a fire is a very specific kind
Speaker 1: of emergency. If you don't contain it, it spreads. So
Speaker 1: every fire is an urgent situation, and according to FEMA, anecdotally,
Speaker 1: firefighters use their sirens way more often than the police.
Speaker 1: But these days even the fire service in most places
Speaker 1: seems to be based on an outdated sense of its mission.
Speaker 1: As of twenty twenty three, less than four percent of
Speaker 1: all nine one one calls firefighters responded to or for fires,
Speaker 1: most or for ems and rescue. So then it looks
Speaker 1: like the argument about siren reform broadly applies to firefighters too.
Speaker 1: The US Fire Administration actually cited a bunch of studies
Speaker 1: about reducing siren u usage just last year. Sirens are dangerous,
Speaker 1: they save time, but not that much, and things are
Speaker 1: often less urgent than they appear.
Speaker 8: Sometimes that three or four minutes is clinically valuable. Most
Speaker 8: of the time it's not.
Speaker 1: Jeff Jarvis did a massive study on lights and sirens
Speaker 1: using something called the ESO data set, a national collection
Speaker 1: of emergency calls with unbelievably granular data attached.
Speaker 8: Seven and a half million records. Five point nine million
Speaker 8: of those were non Wollown responses. We analyzed every one
Speaker 8: of those and calculated the proportion that used lights and sirens,
Speaker 8: and eighty five point eight eighty six percent of them
Speaker 8: responded to the scene with lights and sirens.
Speaker 1: Oh my, God.
Speaker 8: The fundamental question we ask is of those responses where
Speaker 8: you use lightcense sirens, how many of them did we
Speaker 8: do something potentially life saving? And what we ended up
Speaker 8: finding is six point nine of those nine one one
Speaker 8: lights and sirens responses, did we do something even vaguely
Speaker 8: potentially life saving? And we were rather generous with our
Speaker 8: description of what potentially life saving is.
Speaker 1: So this is crucial. Paramedics are responding with lights and
Speaker 1: sirens to around eighty six percent of calls when only
Speaker 1: seven percent of them are resulting in a vaguely potentially
Speaker 1: life saving intervention, So why were they urgent? That means
Speaker 1: that in the United States, we're using lights and sirens
Speaker 1: somewhere between eighty percent and ninety percent more often than
Speaker 1: we need to. The question I have that I can
Speaker 1: imagine people who are skeptical might ask, is, well, how
Speaker 1: much do you really know from the call? Can you tell?
Speaker 8: Most folks are using some type of emergency medical dispatch
Speaker 8: where there are scripted questions, and they will give each type.
Speaker 1: Of call.
Speaker 8: A number and a letter, and the letter is called
Speaker 8: the determinant and it goes from your echo level calls
Speaker 8: which are most likely to be life threatening down to
Speaker 8: Omega level calls which are not very likely at all
Speaker 8: to be life threatening. And those criteria have been evaluated
Speaker 8: multiple times with multiple data sets. Again, they're not perfect,
Speaker 8: but they are pretty accurate. For example, there is a
Speaker 8: call nature called eye problem. Zero point sixty seven percent
Speaker 8: of those calls resulted in a potentially life saving intervention.
Speaker 1: And how many do people run hot to all of them?
Speaker 8: It's just dangerous, and it's dangerous, and it's not really
Speaker 8: doing what we think it is. So it seems like
Speaker 8: it is an intervention whose time has come and gone.
Speaker 1: So I want to play for you again a very
Speaker 1: specific moment from the pilot episode of Emergency and the
Speaker 1: speech that doctor gave to the legislature about why we
Speaker 1: need ems.
Speaker 9: I'm in favor of more doctors, more hospitals, and better equipment,
Speaker 9: and I'm also in favor of this bill until those
Speaker 9: other things come along.
Speaker 1: But those other things have come along. More doctors, advances
Speaker 1: in the ways we take nine to one one calls,
Speaker 1: better in more emergency rooms, better in more emergency medicine, better,
Speaker 1: and more paramedics to use Buyer's formula. We have reduced distance.
Speaker 1: Paramedic units are all over the place now in a
Speaker 1: way they just weren't in the world of emergency. But
Speaker 1: it seems to me like in our minds and on TV,
Speaker 1: it's as if nothing has changed since the nineteen seventies.
Speaker 1: Emergency was the most significant early example of an entire
Speaker 1: genre of TV show that dramatized the emergency services. Before
Speaker 1: there was Cops or Rescue nine one one, there was emergency.
Speaker 1: And here's the trick. All of those TV shows are
Speaker 1: based on the narrative conventions that emergency pioneer, a world
Speaker 1: in which the TV show had not yet done its work,
Speaker 1: and help was always too far away and always came
Speaker 1: with lights and sirens blaring, because that's what firefighters did.
Speaker 1: And these shows are everywhere. Rescue Me, sky Mett, Live Rescue,
Speaker 1: Helicopter Heroes, Island Medics, Air Ambulance Er, a show that
Speaker 1: was literally called Sirens, which is what they'll play on
Speaker 1: TV in Hell for me. They even make this stuff
Speaker 1: for kids. This is what Paw Patrol is, start them young.
Speaker 8: There is in emergency departments everywhere I see as there's
Speaker 8: this concept called alarm fatigue, where when everything is an alarm,
Speaker 8: nothing is an alarm. To paraphrase, The Incredibles, the Car
Speaker 8: Chain movie. So you just get immune to these sirens
Speaker 8: that are not doing the job.
Speaker 1: So Jarvis, like Buyer, reduce the use of lights and sirens.
Speaker 1: He cut them by about a third. Did their response
Speaker 1: time increase, Yes, by a median of six seconds, and
Speaker 1: in the vast majority of cases by less.
Speaker 8: So it's turning out it's not making that much of
Speaker 8: a difference in we're being much safer.
Speaker 1: And this I realized this is purely in the realm
Speaker 1: of hypothesis, but it seems to me common sensical that
Speaker 1: were lights and sirens reserved for truly emergency use, you
Speaker 1: would see a more potent reaction to them, and likely
Speaker 1: then it would it could it could possibly decrease response times.
Speaker 8: So I'll put my scientist hat on and say that's
Speaker 8: an interesting hypothesis that needs to be tested. I will
Speaker 8: put my realist in my pragmatic public health hat on
Speaker 8: and say, absolutely, giddy up. I absolutely think you'll see that.
Speaker 1: I like that hat. That's a very stylish hat. You're
Speaker 1: all right, So here it is. Lights and sirens are
Speaker 1: a tool that currently seem to be way overused, and
Speaker 1: that overuse has real consequences. Most of all, for our
Speaker 1: burnt out, overstretched first responders who go to work to
Speaker 1: save lives and wind up responding to everything as if
Speaker 1: it's a crisis, wearing themselves out and losing their hearing
Speaker 1: in the process. In twenty fifteen, fifteen hundred firemen sued
Speaker 1: that company Federal Signal, the one that makes the iconic
Speaker 1: fire siren, for causing mass loss of hearing. A lawyer
Speaker 1: opposing them said, and I, quote, what's their solution. If
Speaker 1: you don't have sirens, people would get mowed down in
Speaker 1: the streets. The siren works exactly the way it should
Speaker 1: end quote. I could not disagree more. And you know
Speaker 1: who else disagrees that's right? I found him. Okay, I
Speaker 1: am approaching Davy's house, which is coincidentally directly behind my house.
Speaker 1: I was just walking down my street one day when
Speaker 1: an ambulance rushed by and I saw this dopey yellow
Speaker 1: lab stiffening owl. I'd know that owl anywhere. I rushed
Speaker 1: over it and I was like, hey, I've got a
Speaker 1: question about your dog, and his owner was very obliging.
Speaker 1: His name is Joe. The dog's name Davy, And a
Speaker 1: while later I came by their house for an interview
Speaker 1: that was a very that was very satisfied. Sniff said,
Speaker 1: I got Jen and Joe live one street over from
Speaker 1: me and Julia, a beautiful brownstone, two kids, and a
Speaker 1: noisy dog. We sat down at their kitchen table. I
Speaker 1: am curious if you could tell me about when you
Speaker 1: realize that you had a sort of eccentric dog. Well,
Speaker 1: I guess it.
Speaker 6: Was like the first time we heard him howling at sirens,
Speaker 6: because he didn't seem particularly distressed by it. Like a
Speaker 6: lot of times his tail wags and he does get
Speaker 6: quite a reaction from like the neighbors, like the neighborhood,
Speaker 6: Like everyone usually turns around and stops and like laughs
Speaker 6: and was there, like I've never heard that before.
Speaker 1: It turns out Davy is starting a movement.
Speaker 6: His dog walker always like posts like sends us emails
Speaker 6: like describing their walk. So you know, sometimes Davy has
Speaker 6: gotten his his co his co partners in walking the
Speaker 6: other dogs to start to howl with him.
Speaker 1: But he's always the first towler.
Speaker 6: It's definitely always the first howlur. But I think he
Speaker 6: has taught some of the other dogs like how to
Speaker 6: maybe start doing this, so.
Speaker 1: Their owners must be thrilled. Jen is a psychologist, Joe
Speaker 1: is a composer for film and television, so together they're
Speaker 1: experts on mammalian behavior and sound. So I'm inclined to
Speaker 1: believe their analysis of Davy's views on the sirens subject.
Speaker 1: He's not in distress, which means he's not going to
Speaker 1: be the poster child for my anti siren campaign. But
Speaker 1: I hadn't given up yet. Do you share this view
Speaker 1: of Davy's howl origins or what? So?
Speaker 5: There's there's another theory, which this is the one I
Speaker 5: think I if I had to choose one that I
Speaker 5: would like to believe the most, it is. It is
Speaker 5: that the sirens harken back to a lost dog who
Speaker 5: has been separated from the group, and they are howling
Speaker 5: to reconnect with the pack like a like a call
Speaker 5: and answer from a lost dog. That's one of the series,
Speaker 5: And that Davy is saying, we're over here. Come on,
Speaker 5: lost buddy, this is where we are.
Speaker 6: He is a very nigh early dog.
Speaker 5: It loves to hang.
Speaker 1: Jen and Joe are very neighborly people. I'm glad to
Speaker 1: know them now, even if their dog is a huge disappointment.
Speaker 1: My anti Siren cusade, seeing as he really love sirens.
Speaker 1: But it makes sense. It goes back to that evolutionary
Speaker 1: theory Malcolm was talking about at the top of the episode,
Speaker 1: the idea of the spandrel and the things in our
Speaker 1: bodies and our worlds that we think we're selected for
Speaker 1: but actually are just there and maybe not doing us
Speaker 1: a whole lot of good. Davy's howl isn't quite a spandrel,
Speaker 1: if we're being banantic. It's more like a vestige. He
Speaker 1: thinks he's living with a pack of dogs in the wild,
Speaker 1: but he's not. He's a house dog who lives in Brooklyn,
Speaker 1: a block away from a busy grocery store or a playground,
Speaker 1: a frustrated podcaster, a New York City government employee and
Speaker 1: a fire station, a celebrity ignorant of his own fame,
Speaker 1: and a howler who howls just because that's what he's
Speaker 1: always done. Revisionist History is produced by me Ben matt
Speaker 1: of Haffrey, Nina Bird Lawrence, and Lucy Sullivan. Our editor
Speaker 1: is Karen Chakerji. Original scoring and theme by Louis Garra,
Speaker 1: Additional scoring by Jake Gorski. Jacob Smith is our executive
Speaker 1: producer engineering by Marcelo d Olivera. I relied on quite
Speaker 1: a few studies in researching this and put a link
Speaker 1: to the bibliography in the show notes should you want
Speaker 1: any references for starting your own local movement. Special things
Speaker 1: also to Douglas Koupas, whose work helped launch the field
Speaker 1: of sign reform studies, Mike Tageman, Helen k Rosenthal, Stephen Solomon,
Speaker 1: and Paul Bergman. I'm Ben Mattahaffrey. The really Alarming music
Speaker 1: You're hearing right Now was composed by davi's owner Joe
Speaker 1: Saba for the trailer of the Michael Bay film Ambulance.
Speaker 2: Get add free episodes of Revision's history by subscribing to
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