Alison Stewart: This is All Of It on WNYC. I'm Alison Stewart. Fire trucks and ambulances often use lights and sirens when responding to an emergency call. The idea is to clear traffic and provide care as fast as possible. Ben Naddaf-Hafrey is a senior producer for Pushkin Industries. He lives in Brooklyn, across the street from a fire station. Ben decided to look into why sirens are loud in the first place and where they actually save time during an emergency. He reported what he discovered for a recent episode of the Revisionist History podcast and found out a whole bunch of things, including that siren usage in New York City has never been studied. The episode is called Running Hot.

Ben Naddaf-Hafrey is with me now to discuss what he found. Welcome back to the show for a second time.

Ben Naddaf-Hafrey: This is maybe technically the third time after last week.

Alison Stewart: Possibly. For those of you who missed it last week, Ben was on our show when the news dropped Pope Leo was elected during the conclave, so we had to dip into NPR special coverage for the first American Pope. We got about 10 minutes into the conversation, and the phone lines were crazy, so we decided, what the heck, we'll have him back on the show. We'll start with some of the questions, and then we'll get into more.

Ben Naddaf-Hafrey: I thought it was weird when you said, habemus, pop him in the middle of the interview.

Alison Stewart: It's like, "Hold on, Ben." All right, we're going to talk sirens. When did you first become aware of the prevalence of sirens when you were living in your house?

Ben Naddaf-Hafrey: It was pretty immediate. They work every day of the year, the fire station across the street from us. When we moved in, my wife and I were like, "Will this be a problem?" "No." Then, of course, it was a thing that became part of the fabric of our lives is just hearing the fire truck. Then it's a route that a lot of ambulances take to get to a nearby hospital, so I was like, "There's really a lot of sirens here." At really all times of the day.

Alison Stewart: In the episode, you use the neighbor's dog as a way in. Explain the neighbor's dog to us.

Ben Naddaf-Hafrey: I think it was these late-night sirens. It would be like 3:00 AM, I'd be lying in bed, and I'd hear a siren and be like, "Man, that's just really loud. Is that necessary? Does it need to be that loud, especially this late at night?" Then there was also a dog who was living somewhere in our vicinity, who, whenever this iron would go off, would howl really loudly, which I found quite charming and also interesting. I was like, "Is he also bothered by the siren?" So I set out to find this dog.

Alison Stewart: Let's listen to the dog.

[dog howling]

[sirens]

Alison Stewart: His little voice. Oh, the poor guy.

Ben Naddaf-Hafrey: Little voice. He sounds like a werewolf. [laughs] It's bellowing.

Alison Stewart: I'm like, "Poor little guy."

Ben Naddaf-Hafrey: People have been complaining about sirens in New York for basically a century, and so I was like, "Adding one more flustered writer to the chorus isn't really going to change things, but maybe if I can find this dog, he could help unlock the problem for me."

Alison Stewart: Then you guys made a spreadsheet. Explain the spreadsheet to us.

Ben Naddaf-Hafrey: My wife is a data scientist, so there's a lot of spreadsheets flying around the home.

[laughter]

Ben Naddaf-Hafrey: I thought that maybe the best way to figure out where exactly this dog was located was. Would be to keep track of all the times we heard the siren over the course of a day, and if we heard it from the front of the house, the back of the house, if the dog was howling along or not. Our apartment is small enough that front, back, really not a big difference. You hear it all over the place. This was not particularly useful, but eventually, I was just walking down the street one day, and a siren was coming by, and I saw this yellow lab retriever mix stiffen in front of me and begin to bellow, and I was like, "There he is."

Alison Stewart: There he is. Listeners, let's get you in on this conversation. Maybe you've worked as a first responder. When did you get to use the emergency call? How often are you running hot? Do you think using the siren makes your response faster or more effective? 212-433-WNYC 212-433-9692. Is there a future in New York where sirens could be used more strategically? We'd like to know what you think. 212-433-9692, or do you live near a fire station, a hospital, or police precinct and hear the sirens?

How does the loud siren affect you if it passes you in the street, if it passes you in your house? We want to hear your calls. 212-433-WNYC. 212-433-9692. You point out in your episode that much of our EMS system today relies on the same principles when EMS was launched in the '70s. That's amazing. What did you learn about the history and the circumstances of EMS when it was first deployed in the US?

Ben Naddaf-Hafrey: This was a thing. I shifted focus pretty early in my research process from looking into the loudness and the noise of a siren, into looking at this question that many paramedics and EMS medical directors have studied, which is, are sirens actually a useful intervention? How often do they save a critical amount of time? Which we can get into later. Part of what I learned is that the emergency medical services in the United States are really a relatively recent phenomenon.

It takes off around the same time as 911 in 1968. This is two years after a very influential report called, I believe, Accidental Death and Disability, which was by the National Academy of Sciences about traffic accidents, which was this new epidemic, people getting really hurt far from their home. They wanted to have a centralized place people could call to summon an ambulance, a first responder to treat someone who was injured, and maybe didn't have the time needed to get to the hospital.

There's this big push in the late '60s, early '70s to change how we did emergency medicine around the same time that we're innovating a lot in emergency rooms themselves. It really takes off in the early '70s, around the same time as there's a influential TV show promoting this new intervention too.

Alison Stewart: This is so funny. The TV show Emergency. I remember Emergency.

Ben Naddaf-Hafrey: Really? Oh, wow.

Alison Stewart: I truly remember Emergency.

Ben Naddaf-Hafrey: Were you a viewer?

Alison Stewart: Randolph Mantooth, remember that? That was the best. Play the theme.

[MUSIC- Nelson Riddle: Emergency]

Alison Stewart: Ringer's lactate. Remember, come on. Remember that? [laughs]

Ben Naddaf-Hafrey: I love how many ways the siren is featured in the theme song. It's like, it's in the music. It's layered on top of the music.

Alison Stewart: I was watching my son, he was watching 91 1. I was like, "Hey, have you heard of Emergency?"

Ben Naddaf-Hafrey: What did he say?

Alison Stewart: He was like, "No, mom, no." How did a TV show play into the role?

Ben Naddaf-Hafrey: There was this whole thing where you needed to-- a lot of the hangover of this era is that we really needed to sell people on the idea of using 911 and what the emergency services did. Of course, people were familiar with fire departments and police departments, but they weren't really used to calling for service in the way we are now. In 1971, the team behind Dragnet was looking for a new television show, and I think they were exploring a few different kinds of emergency response scenarios, and they got interested in the LA paramedic unit, which was 2 of 12 paramedic units in the entire country in 1971.

It seemed like a rich terrain for a new show. They began to make this show. The pilot episodes are really all about the legal battle to make legal paramedicine because in many places it was illegal to administer unauthorized medical care if you weren't a doctor, if you weren't in a hospital. It was a real patchwork of laws that had to change all over the country in order to make it so that we could use paramedics and ambulances the way we do now. What the show was doing is really dramatizing this classic scenario of someone is hurt, there's not enough time to get them to the hospital. We need to get there as quickly as possible to administer on-the-scene medical care.

In the time that the show was on, the seven years, EMS became a nationwide phenomenon. It went from those 12 programs to being something that was really everywhere.

Alison Stewart: When did you become interested in why the sirens are so loud? Because you need EMS services.

Ben Naddaf-Hafrey: You do. You absolutely need EMS services. I am not even arguing that we shouldn't have sirens at all. Part of what was interesting to me is, if EMS is really a thing that happened in the '60s and '70s, the siren is comparatively an ancient technology. It comes up at the end of the 18th century. It's first used as warning signals in the 1850s on steam trains. Then, when it becomes electronic in the 1880s, that's when you start to see it heading towards the siren we know now on emergency vehicles.

I think that we have not significantly updated or re-examined the way we use sirens on emergency vehicles since that's happened. Part of what was fascinating to me is learning about all these paramedics and EMS medical directors who were asking these basic questions, because I think it boils down to we don't think of sirens as risky, but they are. We think of every 911 call as super time-sensitive and urgent, but they're not. I think these things are bound up in how we learned about EMS and paramedicine in the first place through shows like Emergency.

Alison Stewart: Let's take a couple of calls. Bob is calling from the Upper West Side. Hi Bob, thank you for taking the time to call All Of It.

Bob: Hi, thank you for what you do. Actually, the thing that made me reach for the phone is when you said this has never been studied. Where I live on the Upper West Side in the '90s, it is an ever-present ambulances going to the hospital. My contribution is that as a young man I was in the rescue squad in my hometown in New England. I was a volunteer fire department. I can tell you, people really love turning on sirens and being in a vehicle where other vehicles get out of your way. It's a very exciting thing to do, and I'm sure that contributes to it, especially since it's never actually been studied.

In London, they have much less sirens. I've been in London, they have many fewer sirens and fewer lights on their emergency vehicles. Anyway, that's my contribution.

Alison Stewart: Thanks, Bob. Appreciate you calling. Let's talk to Lars from Brooklyn. Hi Lars, thanks for calling All Of It.

Lars: Hi, thanks for having me. By the way, I was a childhood fan of Emergency myself, so I love fire trucks and all that. [chuckles] I understand the need for emergency vehicles. I get it. I've lived in New York since 1990 and I used to live right off of First Avenue in the East Village, and you hear the sirens wailing up First Avenue to all those hospitals in the '20s and '30s. I remember late at night they would actually only do the whoop, whoop thing. Late at night, they would go through mostly empty First Avenue. As they approach the intersections, they slow down and go whoop whoop. They always have their lights on.

There was a distinctive difference between how they used the sirens during the day and how they used it in the middle of the night. I don't know what the connection is, but the correlation in my mind is that after 9/11, the emergency vehicles started wailing at all times of day or night. I don't know if that's a connection, but I know now that where I live in Brooklyn now I'm in front of a straightaway of one parkway connecting to another with no intersections in between it. In the middle of the night, they'll just be wailing their sirens, and there's not only no one on the street, but there's no possibility of anybody. There's no sidewalk along it. There's no intersection of traffic coming.

There's no reason to be wailing that siren at 3:00 in the morning. I feel like at one point, there must have been a directive that's saying late at night, just minimize the noise you make except for at intersections, and somewhere along the way, that got lost. I was just wondering in your research for this, have you come across any kind of directive that used to tell them to keep the noise down a little bit at night?

Ben Naddaf-Hafrey: It's a really interesting question. It is a kind of patchwork history. I think part of the context for what's happening in New York right now is that there's a lot of concern about response times. Response times have been going up to 911 life-threatening medical emergencies. They're at 11 minutes 21 seconds at the start of 2025. That is really a function of having an under-resourced paramedic EMS service in the city. There's a lot of concern about pay, recruiting, retention, and when you have fewer ambulances on the street, then it's harder to get to the places you need to get in the time that you want to get there.

I think that part of this, I've not actually been able to confirm this with FDNY, but I would imagine that in trying to keep response times down when you feel stretched like this, there's a tendency to use the siren more. Especially because you know that a lot of citizens are concerned about response times, too. This actually goes back to Bob's comment from earlier. I, in speaking to the paramedics and EMTs that I did working on this story, I actually found that none of them really felt that it was just a blast to use the siren, but they did feel like there was an expectation from a community that they use it.

I talked to one EMS medical director in Berrien County, Michigan who read some of the research that I've been alluding to and can explain about later that made a case against using sirens because they really significantly increase the risk of accidents for ambulances and they don't usually save a clinically relevant amount of time for the vast majority of cases, mass vast majority of calls. He halved the number of lights and sirens that he was using in his ambulance service.

What he found was that there was this huge outcry from the people in his community who were like, "You're killing us. You don't care. You're not going to get here on time. I'm going to have a heart attack, and I'm not going to be resuscitated in time because you're not using your lights and sirens." It is an amorphous and ubiquitous problem that has to do as much with our expectations of what emergencies look like, what 911 calls look like, as it does with first responders' guidelines. There are guidelines in the operating manual for which call segments.

Every 911 call is coded in a different way. When it comes from the dispatcher, codes one through three tend to be the most critical, time-sensitive ones. In things like that, you'll almost always see someone using their lights and sirens, but then we most likely are using our lights and sirens for a large segment of calls that are not critical or time sensitive in the same way. That I think changed in 2017. There was a reorganization of what was coded as life-threatening that I think affected this, too.

Alison Stewart: We'll have more on this. Ben Naddaf-Hafrey is my guest. He's a senior producer for Pushkin Industries. We're talking about a new episode Ben reported for the podcast Revisionist History. It's called Running Hot. Listeners, how do sirens affect you when you pass one on the street? Maybe you work as a of first responders. How often are you running hot when responding to an emergency? Our number is 212-433-9692, 212-433-WNYC. We'll have more after a quick break.

[music]

This is All Of It on WNYC. I'm Alison Stewart. My guest in studio is Ben Naddaf-Hafrey, a senior producer for Pushkin Industries. We're speaking about a new episode Ben reported for the podcast, Revisionist History. It's called Running Hot. Ben looked into why emergency vehicle sirens are so loud and whether or not the noise is actually effective in a faster response time. Let's talk about how loud they are. Medically, what do we know about how sirens can damage your hearing?

Ben Naddaf-Hafrey: There's a lot of different sirens in use in the city. I think 118 decibels to 120 decibels is probably the range I've seen cited most often. Sound, that's 120 decibels loud, can damage your hearing immediately. It's just quite a dangerous thing to be in close proximity to that without hearing protection. This is a thing that first responders suffer from as well. There's actually thousands of firemen sued the makers of the famous fire siren, which is called the federal Q2B, because they have experienced a lot of hearing loss.

There's a couple ways that noise is dangerous for people. The first is obviously, it keeps you up, it distracts you. There's studies showing there's learning loss in kids when they're exposed to a lot of noise in the classroom. Other studies show that a 5 decibel reduction in overall noise can cause a pretty significant reduction in hypertension and heart health rates or heart disease rates in the neighborhood. It's tied to our physical health in all these ways. Just losing your hearing, especially when you're an older person who's lost their hearing, it means it causes brain atrophy.

It can lead to earlier onset dementia, partially because you withdraw from social settings and are just disconnected from your life, because you've lost this really important sense.

Alison Stewart: New York is very loud.

Ben Naddaf-Hafrey: It is one of the 10 loudest cities in the world.

Alison Stewart: Is that because of sirens or sirens loud because New York's loud?

Ben Naddaf-Hafrey: [chuckles] It's really a chicken or egg situation, but it's little column A, little column B. That is one of the things people say about why sirens need to be as loud as they are is that cars have gotten better insulated, and so you need to have sirens be extra piercing and loud to get through them. Cars are also getting quieter, though, so traffic noise is reducing, so both things can be true. This is one of the reasons that I've been most inclined towards this idea about, when are sirens useful? How often do we need to use them, whether or not we change the sound?

Alison Stewart: Let's talk to Gary from Manhattan. Hi, Gary. Thank you so much for calling, All Of It. You're on the air.

Gary: Thank you, Allison. I live on the corner of 6th Avenue and 14th Street, and sirens are the bane of my existence. They're heart-stopping. They're just dreadful. I also spend a lot of time in European cities, London and Paris, and Berlin. One thing I know is they have just as many emergencies as New York, yet they use the oscillating sirens and the lights. Why can't New York City adopt the oscillating sirens? They can be heard inside of cars. I've been in cars where they've been in use. The lights, of course, help to identify that there's an emergency vehicle in your view, but why can't we have them?

Alison Stewart: Yes, Ben, why not? Why can't we have them?

[laughter]

Ben Naddaf-Hafrey: I'm trying. I'm trying. I thought of this as well when I was reporting this, and it turns out that this has been proposed a number of times in the New York City Council. Helen K. Rosenthal proposed it in 2019, and then I believe it was Carlina Rivera who proposed it in 2023. It has gone nowhere both times. There was a hearing most recently on the most recent bill. I think people are really sensitive about making changes to this particular thing because it feels so important, and no one likes imagining that you would change the sound, and all of a sudden someone's going to need help and not get it in time, which I think we have an overblown sense of these are extremely important jobs.

We tend to imagine everything as if it's the television show emergency, and it's not. I think that there's really good evidence from Europe that that siren is just as effective as ours. It's not, in fact, always quieter. Some of them are. But it is less shrill and so less irritating. One piece of hearsay I heard about this that I was unable to fact-check is that Holocaust survivors didn't want to hear European sirens because it reminded them of Europe, the émigrés in the United States. This seems to me like a fact that's too good to check and is surely apocryphal. That is something that a first responder who's been in the service since the '80s told me.

Alison Stewart: Let's talk to Richard, who's calling from West 77th Street. Hi, Richard, thank you for calling All Of It.

Richard: Hi, Alison, thanks for having this particular episode. I'm a physician here in New York, and I actually testified at the hearings that Gail Brewer was part of at the City Council, talking about the same problem. The fact remains that not only are the sirens in New York one of the major contributors to hearing loss, which is like the biggest public health threat most people don't know about, but other than that, as far as the noise is concerned, it's actually outrageous. One of the main problems we face, and other cities have done experiments with, is to have criteria part of the ambulance driver's knowledge, and they can put it up in their cabin.

There are certain categories of people that should probably have sirens accompanying their trip in New York. As a matter of fact, when those criteria are applied, it was in one city, 92% of patients were transported without lights and sirens, and the other 8% had them because these criteria were put in place. The differences of response times, I should say differences in arrival times and going to the hospital times has lso been compared without sirens and then with same time of day, same routes, et cetera. The difference between sirens and non-sirens ranges from 42 seconds to about three minutes.

None of that was considered significant as it related to the patient's conditions by the physicians who were in the ER receiving them.

Alison Stewart: I'm going to dive in here because, Ben, you did some reporting on this.

Ben Naddaf-Hafrey: Yes. I'm really happy that you brought this up. This is the thing that really blew my mind as well. I think those numbers come from a 2017 white paper by a EMS medical director named Douglas Kupas, who's really the leading researcher on this question. He found from a number of studies going back several decades that the range is 42 seconds to 3 minutes and 48 seconds of time saved. Another study found it was 1½ minutes on average in urban settings, 3½ minutes in the countryside. That's like sirens save time. Is that a clinically relevant amount of time? For most 911 calls, no.

There's another great study by a chief medical officer in Fort Worth named Jeff Jarvis, who, using a data set of over five million 911 calls that happened in 2018, was able to look at how often were we using our sirens. The answer was about 86% of the time. Then he said, "How often were paramedics making even vaguely potentially lifesaving interventions?" The answer was less than 7% of the time. There's a delta of 80% about there between how often we really need to make sure we're on the scene right away and how often we're acting as if with the siren. That's not to say the other calls don't matter. They absolutely do.

Given that using lights and sirens increases the risk of an accident in an ambulance by over 50%, you have to think of it, another person told me, as a medical intervention. The risks have to be outweighed by the benefits in order to be using lights and sirens.

Alison Stewart: In our last minute, what is your hope for how New York will consider sirens in a wider EMS system?

Ben Naddaf-Hafrey: We have this big concern about response time right now. What I am most worried about is that we'll make the same mistake twice, that we will say the only thing that matters is getting our response times down, and therefore the siren has to be sounding all the time. I think that this is an opportunity to look at the other things, the other indications that the system is working, and take care of other factors in how our EMS service is working, like how paramedics and EMTs are treated, how many ambulances are on the street.

I want that, but I also want us to look specifically at these questions that these researchers have looked at in other cities and towns, like how much time are the sirens saving us here, and to what percentage of calls do we need to be saving that amount of time? I think that we can change the criteria around how often we're running hot, and it'll just serve everyone better.

Alison Stewart: The name of the podcast is Revisionist History. The episode is called Running Hot. Ben Naddaf-Hafrey, thank you for joining us.

Ben Naddaf-Hafrey: Thank you for having me back.

Alison Stewart: We didn't have any news break.

Ben Naddaf-Hafrey: I know. Thank God.

Alison Stewart: Thanks, Ben. I'm Allison Stewart. I appreciate you listening, and I appreciate you. I will meet you back here next time.