Speaker 1: Pushkin. Hey, last Archive listeners, it's Ben. I've been hard
Speaker 1: at work on another show at Pushkin called Revisionist History,
Speaker 1: and I've done four episodes for this most recent season
Speaker 1: that I wanted to share with you too. They run
Speaker 1: the gamut from an argument about why we don't need
Speaker 1: emergency vehicle sirens as much as we think we do,
Speaker 1: to a history of psychology involving some mischievous raccoons, and
Speaker 1: a two part blowout about a big trade secrecy case
Speaker 1: that turns on the top secret recipe for Thomas's English muffins.
Speaker 1: We're going to be releasing one a week over in
Speaker 1: this feed, and we're starting today with the episode about sirens.
Speaker 1: You can find more episodes of Revisionist History wherever you
Speaker 1: get your podcasts. Thanks for listening and enjoy.
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 Benadaph Haffray. Ben is the guy
Speaker 2: when you're hiking through the wilderness who says let's go
Speaker 2: 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 the 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 Ben the daf Haffrey investigates a spandrel. You don't
Speaker 2: even realize you've been living with something that none of
Speaker 2: us would ever think to question because it's such a
Speaker 2: bedrock part of our world, we all just assume it
Speaker 2: has 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: rippers 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 basel. 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: in 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 mean this. I could get enough of this
Speaker 1: in my job. I don't hear from you. I will
Speaker 1: confess that the spreadsheet, consisting of mauv baby blue, puke green,
Speaker 1: a cheery yellow, and several pleasingly varied shades of red
Speaker 1: isn't even complete because it does not count the times
Speaker 1: we heard the siren in the middle of the night
Speaker 1: when there is no one on the road. Maybe you
Speaker 1: didn't realize this, but emergency vehicles will sometimes run their
Speaker 1: lights and sirens even if there's seemingly no one around.
Speaker 1: Sirens can run anywhere from one hundred and ten decibels
Speaker 1: to over one hundred and thirty. That is ear damagingly loud.
Speaker 1: The classic fire sirens sound like what you hear in
Speaker 1: your head. If you imagine a fire truck right now,
Speaker 1: is called the Federal Q TWOV and it's a whopping
Speaker 1: one hundred and twenty three decibels at one hundred feet away.
Speaker 1: There's an actual corporation that makes the siren. Federal Signal
Speaker 1: Fans post videos about the siren online. Here's what it
Speaker 1: sounds like. Maybe turn your volume down.
Speaker 4: As we say, it's not a fire truck unless it's got.
Speaker 1: A key siren. According to a helpful chart from Yale University,
Speaker 1: one hundred and twenty three decibels is just two decibels
Speaker 1: lower than the point at which quote pain begins. This
Speaker 1: would all be fine, except I kind of need my
Speaker 1: ears for my job, and this is why I began
Speaker 1: the log. 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 lodged for front
Speaker 3: and back, so that's when you know it's a really
Speaker 3: big sire.
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 1: They're they're dedicated to their.
Speaker 5: Howling.
Speaker 4: I think I feel like my wife has heard the dog.
Speaker 6: But does a guy Kevin that lives after that garage
Speaker 6: right there.
Speaker 1: And he does so, he's talked about this dog heare Yeah,
Speaker 1: what does he say?
Speaker 7: Oh, he's ready to do.
Speaker 1: Something about it.
Speaker 3: It starts really low and guttural.
Speaker 1: I thought it was like a wearwolf or something. I
Speaker 1: decided to take a too pronged approach to my siren
Speaker 1: problem planet. I had to see if I could prove
Speaker 1: that the sirens in my neighborhood were dangerously unnecessarily loud
Speaker 1: and plan B. I needed a sympathetic face for my cause.
Speaker 1: Nobody really cares about podcasters, but everybody cares about dogs,
Speaker 1: and I had to assume that that dog was howling
Speaker 1: along with the siren because he was, like me, in
Speaker 1: serious pain. So find the dog, stop the siren. It'd
Speaker 1: be that simple, except the dog was not immediately forthcoming.
Speaker 1: So I pushed ahead with plan a noise research, which
Speaker 1: led me straight to doctor Arlene Bronze Aft.
Speaker 8: We're going to take you into the noise room.
Speaker 1: What's the noise room?
Speaker 9: Oh?
Speaker 8: Okay, no, see when you get there, sir.
Speaker 1: Doctor Bronze Aft is an eighty nine year old environmental
Speaker 1: psychologist who has been called the noise Queen of New
Speaker 1: York City. She's done major noise studies, worked for five mayors.
Speaker 1: She grew up in Brooklyn and lives in a lovely
Speaker 1: tidy apartment on the Upper East Side. Someone was jackhammering
Speaker 1: the street outside the building, and yet you couldn't hear
Speaker 1: a thing. Double glazed windows. Of course, she took me
Speaker 1: to her noise room. The noise room sounds possibly like
Speaker 1: the opposite of what I mean.
Speaker 8: Let me tell you it is a very quiet room.
Speaker 4: This is quiet.
Speaker 1: Wow. How did you get it so quiet? Oh?
Speaker 8: Did I help make it quiet? The answer, yes, I
Speaker 8: did have a role and making it quieter than it
Speaker 8: would have been. Can you see the cooling units? Are
Speaker 8: they all closed?
Speaker 1: Yep?
Speaker 8: Who anything 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: Early work demonstrated that noise isn't just annoying, They can
Speaker 1: get in the way of kids learning in school, and
Speaker 1: she just kept going from there. When the city updated
Speaker 1: its noise code in two thousand and seven.
Speaker 8: In fact, it was my suggestion that they updated, it
Speaker 8: carried quite a bit of weight. However, the literature that
Speaker 8: they were depending upon was it was older. So today
Speaker 8: we have much more solid literature on the link between
Speaker 8: noise and health critical and that includes mental health as
Speaker 8: well in learning.
Speaker 1: That all checked out for me, of course, the sirens
Speaker 1: are too loud, but it can take a while for
Speaker 1: the research to make its way into policy. Now we
Speaker 1: have research linking even small changes and overall noise to
Speaker 1: significantly increased risk of heart disease, to say nothing of stress,
Speaker 1: poor sleep and its associated ailments, and crucially the effective
Speaker 1: noise on exasperated podcasters.
Speaker 8: Now you mentioned sirens all right, That deals with safety
Speaker 8: that deals with getting someone to the hospital on time. However,
Speaker 8: the sirens in Europe are less offensive, are less intrusive.
Speaker 8: European people aren't dying, aren't they. The point is, if
Speaker 8: Europe could have quiet at once, you could come up
Speaker 8: with a method of quieting the sirens and still be
Speaker 8: as effective. I have not seen a st I had
Speaker 8: shown that if you have a less offensive intrusive siren
Speaker 8: that more people will die.
Speaker 4: Have you no so here I am.
Speaker 8: 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 Burrian 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 Barrion 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 Barrion 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: respotted lights and sirens to 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 intake 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.
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. Well,
Speaker 4: the problem is shortness of breath or do you feel
Speaker 4: like you're having trouble breathing? An incredibly subjective question, and
Speaker 4: so the medics were coming to me complaining It's like,
Speaker 4: why are we getting priority one dental pain because the
Speaker 4: person's like, I have a tooth pain. Oh yeah, it's
Speaker 4: making hard to breathe. We were about fifty to fifty
Speaker 4: for Priority ones, which were lights and sirens, and Priority twos,
Speaker 4: which were not lights and sirens. 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 physician 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 processes. 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 fusction come in.
Speaker 1: That's huge. Yeah, so that's huge. 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. Right If I were going
Speaker 4: to say I'm going to give you upin effort, well,
Speaker 4: why would I give you epin effort? And the benefits
Speaker 4: have to outweigh the risks. So I wanted to think
Speaker 4: of lights and sirens that way. It is a high
Speaker 4: risk procedure. When are we going to do it when
Speaker 4: 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.
Speaker 4: Sirens, so cardiac arrest, people, choking, respiratory arrest, things where
Speaker 4: seconds could make a difference. Yep, that is worth the
Speaker 4: risk to try to get someone there quicker. But other
Speaker 4: things like well she fell and broke her hip, Okay,
Speaker 4: that's an emergency and that person needs to get to
Speaker 4: a hospital. I don't doubt that is the three minutes
Speaker 4: going to 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 ount.
Speaker 1: Let that sink in ambulance lights and sirrons in 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 wasn't 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 halved 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. It didn't affect them. The medics themselves
Speaker 4: really liked it because the medics were like, yep, most
Speaker 4: of these things we were going on are not.
Speaker 1: Priority buyers on board, the paramedics are on board. Smooth sailing,
Speaker 1: except what ended up happening.
Speaker 4: And I'm not exactly sure how this got out. It
Speaker 4: went through all the proper channels on my side, like
Speaker 4: medical control in the hospital in the county, So that
Speaker 4: was okay, But it started getting publicized and I don't
Speaker 4: exactly know how, but it started showing up on the
Speaker 4: hospital facebook page about Burying County medical control is killing
Speaker 4: people with slow responses, and oh.
Speaker 1: Boy, unbeknownst to Bayer, word had gotten out to the
Speaker 1: people who call ambulances big problem.
Speaker 10: If you're drive in Barrian County, you won't see as
Speaker 10: many lights and sirens as you're driving. Ambulances will be
Speaker 10: using them only for time sensitive cases like a 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? And of course people.
Speaker 1: 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 weren't an ambulance there
Speaker 4: fast and the hospital started getting a lot of flak.
Speaker 4: Some of it was very nasty. So people started on
Speaker 4: Facebook attacking the hospital. Oh this is Lakeland just killing
Speaker 4: patients again, you know, just very bad vitriol.
Speaker 1: At the time, though Byer 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 had done a six p to two am shift
Speaker 4: and at eight am I got a call from the
Speaker 4: administrative assistant to the CEO of the hospital. Hi, there,
Speaker 4: doctor Buyer, it's eight am. What are you doing at
Speaker 4: eight thirty? I'm like, and I'm still swaking up because
Speaker 4: again I've had four hours of sleep, And she's like,
Speaker 4: doctor Hamill. At that point, the CEO of the hospital
Speaker 4: would like 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: Buyer stunned, and then he begins to lay out the
Speaker 1: case against sirens in a very doctor buyer way.
Speaker 4: I tried 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 online.
Speaker 1: 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 for ems.
Speaker 1: Things worked out for Buyer in the end, But I'm
Speaker 1: interested in that initial freak out because it reveals a
Speaker 1: basic assumption people make, myself included. Everything is urgent. So
Speaker 1: we accept this social loophole where you can break all
Speaker 1: known traffic laws provided you possess a device that emits
Speaker 1: the loudest, shrillest sound imaginable. What kind of world does
Speaker 1: this I'm not arguing that we shouldn't have sirens at all,
Speaker 1: but it seems to me that they're not only too
Speaker 1: loud and crazy sounding, but like we use them way
Speaker 1: more often than is necessary because we're unwilling to let
Speaker 1: go of them. But of course, Barrion County is just
Speaker 1: one place, approximately twenty thousand MS calls a year, and
Speaker 1: paramedics are just one branch of the emergency service. I
Speaker 1: shouldn't get ahead of myself. I was left with two
Speaker 1: big questions to answer. Next, where did we get the
Speaker 1: idea that sirens are so necessary? And exactly how unnecessary
Speaker 1: are they? A good place to look is the same
Speaker 1: place we fell in love with EMS once upon a time.
Speaker 1: We'll be right back.
Speaker 11: If you would have asked eighteen year old Jeff when
Speaker 11: I first drove lights and sirens, I would have said
Speaker 11: that they are always life saving and we absolutely need
Speaker 11: 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 param 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 6: Oh?
Speaker 1: Of course, and did that have an effect on your
Speaker 1: becoming a paramedic?
Speaker 7: It did.
Speaker 11: 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 special training program.
Speaker 12: Remember we were talking about it a couple of days ago.
Speaker 9: Answer the or something or other paramedics.
Speaker 1: The series begins in a world where there basically aren't
Speaker 1: any paramedics, which was our world fifty three years ago.
Speaker 1: Fifty three years in nineteen seventy one, there were a
Speaker 1: slim twelve paramedic units in the entire country, and It
Speaker 1: was kind of a Wild West situation. Details varied from
Speaker 1: place to place, but in some areas it was illegal
Speaker 1: to give someone medical care if you weren't a doctor
Speaker 1: or a nurse. So about fifty percent of ambulances were
Speaker 1: just purses driven out of funeral homes by morticians whose
Speaker 1: sole purpose was to get patients to doctors as quickly
Speaker 1: as possible, and if that failed, back to the funeral
Speaker 1: home you go. This is actually how it worked. Emergency
Speaker 1: was a show dreamed up in partnership with the father
Speaker 1: of modern ms, a guy named James Page who worked
Speaker 1: at one of the first firehouses with a paramedic unit
Speaker 1: in Los Angeles, and the show was literally meant to
Speaker 1: make the case for paramedics. Every Saturday night nationwide on
Speaker 1: NBC thirty million viewers at a time, not a few
Speaker 1: of whom became paramedics.
Speaker 12: People are dying at the scene, people who could stay
Speaker 12: alive if there was somebody on the spot who knew
Speaker 12: what to do.
Speaker 9: Look, if that bill passed the legislature today, do you
Speaker 9: know how many people we'd have ready for the job?
Speaker 11: Six men for six and a half million people.
Speaker 1: I learned about Emergency in a brilliant essay by UCLA
Speaker 1: emeritus law professor Paul Bergman, where he traces the profound
Speaker 1: influence the show had not just on paramedics, but on
Speaker 1: lawmakers too, by dramatizing just how urgent every single nine
Speaker 1: to one one call is.
Speaker 12: We almost head him back. Damn it, we almost head
Speaker 12: him back if you.
Speaker 9: Could have been to fibrillated the moment they pulled him
Speaker 9: off the wire.
Speaker 1: This is from the first episode, right after a maintenance
Speaker 1: man gets electrocuted and eventually dies. The doctor and nurse,
Speaker 1: who by the way, are of course romantically involved, are talking.
Speaker 12: Somebody should have been there with a machine in their bucket,
Speaker 12: not somebody the paramedics again.
Speaker 9: Paul, and paramedics a rescue team. That doesn't matter. Cal
Speaker 9: If somebody with the right equipment and trained to use
Speaker 9: it had gotten to this man in time, he'd be alive.
Speaker 12: Now, I won't use this situation that justifies sending amaters
Speaker 12: out the practice medicine on the street.
Speaker 9: Trained amaters, trained by you, and doctors.
Speaker 12: Like you, amateurs, Dixie. I spent twelve years in school
Speaker 12: and residency, and I'm still learning my trade.
Speaker 1: It's a doubleheader pilot and both episodes are full of
Speaker 1: these situations that dramatize 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 them, including myself. I thought it
Speaker 1: could possibly be a success.
Speaker 12: Well or or may not function as well as it
Speaker 12: used to. At least it'll be your own You're getting
Speaker 12: out here as fast as you did.
Speaker 1: Made the difference Brandy to have her own doc. Gotta
Speaker 1: give us a try. Bergmann, the law professor, talked to
Speaker 1: the legends of ems, and he heard all these emergency references.
Speaker 1: Dug through California hearings on the Paramedic Act and he
Speaker 1: found emergency references, letters from senators, emergency references. In the
Speaker 1: early years of the show, forty six states legalized paramedicine.
Speaker 1: To be clear, this was a movement that was already
Speaker 1: in process, but emergency was a big part of establishing
Speaker 1: the cultural expectations for what those units would look like.
Speaker 1: And it looked like lights and sirens to every call
Speaker 1: because every call was all about time.
Speaker 12: But you can't ask someone not to die while you're
Speaker 12: trying to find out what's wrong with him. And they
Speaker 12: do die, gentlemen, on the way from where it happens
Speaker 12: 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 12: They die by the hundreds every year, not from mortal wounds,
Speaker 12: but neglected wounds, not from incompetence or indifference, but from time.
Speaker 11: From lack of time.
Speaker 12: I'm in favor of more doctors, more hospitals, and better equipment.
Speaker 12: And I'm also in favor of this bill until those
Speaker 12: other things come along, because it will save lives, maybe
Speaker 12: a dozen lives, maybe a thousand, maybe just one.
Speaker 1: He's looking directly into the camera right at those thirty
Speaker 1: million viewers, and who knows which one time time time.
Speaker 1: And if you succeed at convincing people that every situation
Speaker 1: is urgent, they're going to come to expect lights and
Speaker 1: sirens every time they call nine one one. And how
Speaker 1: many of the calls in emergency do they respond to
Speaker 1: with lights since.
Speaker 11: So think about it this way. On emergency, every call
Speaker 11: was a life threatening emergency. Now I say that knowing
Speaker 11: the first call they went on was not. But in
Speaker 11: the team of the first episode of the pilot, but
Speaker 11: the vast majority were life threatening emergencies, so sure people
Speaker 11: got that that notion and expectation that that's what would happen.
Speaker 11: There are a lot of paramedics who joined up for
Speaker 11: those life threatening emergencies only to find out that eighty
Speaker 11: 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 sire and obsession is
Speaker 1: due to the fact that early EMS departments were part
Speaker 1: of fire departments, and a fire is a very specific
Speaker 1: kind of emergency. If you don't contain it, it spreads.
Speaker 1: So every fire is an urgent situation, and according to FEMA, anecdotally,
Speaker 1: firefighter 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 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 11: Sometimes that three to four minutes is clinically valuable. Most
Speaker 11: 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 11: Seven and a half million records. Five point nine million
Speaker 11: of those were non on known responses. We analyzed every
Speaker 11: one of those and calculated the proportion that used lights
Speaker 11: and sirens, and eighty five point eight eighty six percent
Speaker 11: of them responded to the scene with lights and sirens.
Speaker 1: Oh my god.
Speaker 11: The fundamental question we ask is of those responses where
Speaker 11: you use license sirens, how many of them did we
Speaker 11: do something potentially life saving? And what we ended up
Speaker 11: finding is six point nine percent of those nine one
Speaker 11: one lights and sirens responses did we do something even
Speaker 11: vaguely potentially life saving? And we were rather generous with
Speaker 11: our 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 any vaguely potentially life
Speaker 1: saving intervention, So why were they urgent? That means that
Speaker 1: in the United States, we're using lights and sirens somewhere
Speaker 1: between eighty percent and ninety percent more often than we
Speaker 1: need to. The question I have that I can imagine
Speaker 1: people who are skeptical might ask, is, well, how much
Speaker 1: do you really know from the call? Can you tell?
Speaker 11: Most folks are using some type of emergency medical dispatch
Speaker 11: where there are scripted questions, and they will give each
Speaker 11: type of call a number and a letter, and the
Speaker 11: letter is called the determinant and it goes from your
Speaker 11: ECO level calls, which are most likely to be life threatening,
Speaker 11: down to Omega level calls, which are not very likely
Speaker 11: at all to be life threatening. And those criteria have
Speaker 11: been evaluated multiple times with multiple data sets. Again, they're
Speaker 11: not perfect, but they are pretty accurate. For example, there
Speaker 11: is a call nature called eye problem. Zero point sixty
Speaker 11: seven percent of those calls resulted in a potentially life
Speaker 11: saving intervention.
Speaker 1: And how many people run hot to all of them?
Speaker 11: It's just dangerous, and it's dangerous, and it's not really
Speaker 11: doing what we think it is. So it seems like
Speaker 11: 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, from the
Speaker 1: speech that doctor gave to the legislature about why we
Speaker 1: need ems.
Speaker 12: I'm in favor of more doctors, more hospitals, and better equipment,
Speaker 12: and I'm also in favor of this bill until those
Speaker 12: 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, better,
Speaker 1: in more emergency rooms, better in more emergency medicine, better,
Speaker 1: and more paramedics. To you use Buyer's formula, we have
Speaker 1: reduced distance. Paramedic units are all over the place now
Speaker 1: in a way they just weren't in the world of emergency.
Speaker 1: But it seems to me like in our minds and
Speaker 1: on TV, it's as if nothing has changed since the
Speaker 1: nineteen seventies. Emergency was the most significant early example of
Speaker 1: an entire genre of TV show that dramatized the emergency services.
Speaker 1: Before there was Cops or Rescue nine one one, there
Speaker 1: was Emergency and here's the trick. All of those TV
Speaker 1: shows are based on the narrative conventions that emergency pioneered
Speaker 1: a world in which the TV show had not yet
Speaker 1: done its work, and help was always too far away
Speaker 1: and always came with lights and sirens blaring, because that's
Speaker 1: what firefighters did. And these shows are everywhere. Rescue Me,
Speaker 1: sky Met Live Rescue, Helicopter Heroes, Island Medics, Air Ambulance Er,
Speaker 1: a show that was literally called Sirens, which is what
Speaker 1: they'll play on TV in Hell for me. They even
Speaker 1: make this stuff for kids. This is what paw Patrol is.
Speaker 1: Start them young.
Speaker 11: There is in emergency departments everywhere I see as there's
Speaker 11: this concept called the alarm fatigue, where when everything is
Speaker 11: an alarm, nothing is an alarm, to paraphrase The Incredibles,
Speaker 11: the cartoon movie. So you just get immune to the sirens.
Speaker 11: They're not doing the job.
Speaker 1: So Jarvis, like Buyer, reduced 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 11: So it's turning out it's not making that much of
Speaker 11: a difference in we're being much safer.
Speaker 1: And this I realize 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 11: So I'll put my scientist hat on and say that's
Speaker 11: an interesting hypothesis that needs to be tested. I will
Speaker 11: put my realist in my pragmatic public health hat on
Speaker 11: and say, absolutely, gid up. I absolutely think you'll see that.
Speaker 1: I like that hat. That's a very stylish hat. You're right,
Speaker 1: so here it is. Lights and sirens are a tool
Speaker 1: that currently seem to be way overused, and that overuse
Speaker 1: has real consequences, most of all for our burnt out,
Speaker 1: overstretched first responders who go to work to save lives
Speaker 1: and wind up responding to everything as if it's a crisis,
Speaker 1: wearing themselves out and losing their hearing in the process.
Speaker 1: In twenty fifteen, fifteen one hundred firemen sued that company
Speaker 1: Federal Signal, the one that makes the iconic fire siren,
Speaker 1: for causing mass loss of hearing a lawyer opposing them said,
Speaker 1: and I quote, what's their solution. If you don't have sirens,
Speaker 1: people would get mowed down in the streets. The siren
Speaker 1: works exactly the way it should end quote. I could
Speaker 1: not disagree more. And you know who else disagrees.
Speaker 7: That's right, I found out.
Speaker 1: Okay, I am approaching Davy's house, which is coincidentally directly
Speaker 1: behind my us. I was just walking down my street
Speaker 1: one day when an ambulance rushed by and I saw
Speaker 1: this dopey yellow lab stiffening owl. I'd know that owl anywhere.
Speaker 1: I rushed over and I was like, hey, I've got
Speaker 1: a 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.
Speaker 6: Interview that was very satisfied, said, I got.
Speaker 1: Jen and Joe live one street over from me and Julia,
Speaker 1: a beautiful brownstone, two kids, and a noisy dog. We
Speaker 1: sat down at their kitchen table. I am curious if
Speaker 1: you could tell me about when you realize that you
Speaker 1: had a sort of eccentric dog.
Speaker 10: Well, yes, it was like the first time we heard
Speaker 10: him howling at sirens because he didn't seem particularly distressed
Speaker 10: by it. Like a lot of times his tail wags
Speaker 10: and he does get quite a reaction from like the neighbors,
Speaker 10: like the neighborhood, like everyone usually turns around and stops
Speaker 10: and like laughs and was there, Like I've never heard
Speaker 10: that before.
Speaker 1: It turns out Davey is starting a movement.
Speaker 10: His dog walker always like posts like sends us emails
Speaker 10: like describing their walk. So you know, sometimes Davey has
Speaker 10: gotten his his co his co partners in walking to
Speaker 10: the other dogs to start to howl with him.
Speaker 1: But he's always the first howler.
Speaker 10: It's definitely always the first towler. But I think he
Speaker 10: has taught some of the other dogs like how to
Speaker 10: maybe start doing this, so.
Speaker 1: Must be thrilled. Jen is a psychologist, Joe is a
Speaker 1: composer for film and television, so together they're experts on
Speaker 1: mammalian behavior and sound. So I'm inclined to believe their
Speaker 1: analysis of Davy's views on the siren subject. He's not
Speaker 1: in distress, which means he's not going to be the
Speaker 1: poster child for my anti siren campaign. But I hadn't
Speaker 1: given up yet. Do you share this view of Davy's
Speaker 1: howel origins or what.
Speaker 5: So, there's there's another theory, which this is the one
Speaker 5: I think I if I had to choose one, that
Speaker 5: I would like to believe the most, it is. It
Speaker 5: is that the sirens hearken back to a lost dog
Speaker 5: who has been separated from the group, and they are
Speaker 5: howling to reconnect with the pack like a like a
Speaker 5: calling answer from a lost dog. That's another one of
Speaker 5: the series. And that Davy is saying, we're over here.
Speaker 5: Come on, lost buddy, this is where we are.
Speaker 10: He is a very name early dog and loves to hang.
Speaker 1: Jen and Joe are very name rely people. I'm glad
Speaker 1: to know them now, even if their dog is a
Speaker 1: huge disappointment. My anti siren Crusade saying, as he really
Speaker 1: love sirens. But it makes sense. It goes back to
Speaker 1: that evolutionary theory Malcolm was talking about at the top
Speaker 1: of the episode, the idea of the spandrel and the
Speaker 1: things in our bodies and our worlds that we think
Speaker 1: we're selected for but actually are just there and maybe
Speaker 1: not doing us a whole lot of good. Davy's howl
Speaker 1: isn't quite a spandrel if we're being banantic. It's more
Speaker 1: like a vestige. He thinks he's living with a pack
Speaker 1: of dogs in the wild, but he's not. He's a
Speaker 1: house dog who lives in Brooklyn, a block away from
Speaker 1: a busy grocery store, a playground, a frustrated podcaster, a
Speaker 1: New York City government employee, and a fire station. A
Speaker 1: celebrity ignorant of his own fame, and a howler.
Speaker 13: Who howls just because that's what he's always done.
Speaker 1: Revisionist History is produced by me Ben Mattah Haffrey, Nino Bird, Lawrence,
Speaker 1: and Lucy Sullivan. Our editor is Karen Chakerji. Original scoring
Speaker 1: and team by Louis Gara. Additional scoring by Jake Gorski.
Speaker 1: Jacob Smith is our executive producer. Engineering by Marcelo di Olavera.
Speaker 1: I relied on quite a few studies in researching this.
Speaker 1: You put a link to the bibliography in the show
Speaker 1: notes should you want any references for starting your own
Speaker 1: local movement. Special things also to Douglas Koupas, whose work
Speaker 1: helped launch the field of sign and reform studies, Mike Tageman,
Speaker 1: Helen k Rosenthal, Steven Solomon, and Paul Bergman. I'm Ben
Speaker 1: Mattah Haffrey, The really alarming music you're hearing right now
Speaker 1: was composed by Davy's owner Joe Saba for the trailer
Speaker 1: of the Michael Bay film Ambulance