Running Hot

Summary

Revisionist History: "Running Hot" — A Detailed Summary

Revisionist History hosted by Malcolm Gladwell delves into the often-overlooked and misunderstood aspects of our world. In the episode titled "Running Hot," released on April 10, 2025, Gladwell explores the pervasive use of sirens in emergency services, questioning their necessity and impact on both society and individuals. This comprehensive summary captures the episode's key discussions, insights, and conclusions, enriched with notable quotes and organized into clear sections for easy comprehension.

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1. The Siren Dilemma: A Personal Quest

Malcolm Gladwell begins by introducing his personal struggle with incessant sirens in his Brooklyn neighborhood. Living opposite a bustling grocery store, a noisy playground, and an active fire station, Gladwell finds the frequent sirens disruptive, especially as a light sleeper and a content creator reliant on a peaceful environment.

Malcolm Gladwell [03:06]: "Julia and I live opposite this grocery store that's all local, small batch whatnot. So instead of getting just one delivery a day, they get like 15, sometimes from trucks bearing, I assume, one sprig of artisanal basil. Next door there's a noisy playground and crucially, a fire station. A really active fire station."

Determined to address the issue, Gladwell embarks on a data-driven investigation, meticulously logging 24 siren occurrences in a single day—a figure validated by his data scientist wife, Julia Conrad.

Malcolm Gladwell [04:17]: "I don't need this. I could get enough of this at my job. I don't need it from you."

2. The Noise Control Expert: Dr. Arlene Bronzaft

Gladwell consults with Dr. Arlene Bronzaft, an esteemed 89-year-old environmental psychologist renowned as New York City's "noise queen." Dr. Bronzaft elucidates the detrimental effects of excessive noise, linking it to various health issues such as heart disease, stress, and poor sleep.

Dr. Arlene Bronzaft [09:05]: "Are they all enclosed?"

She challenges the necessity of loud sirens, particularly in regions like Europe, where sirens are quieter yet effective. This encounter reinforces Gladwell's conviction that current siren practices may be excessively loud and overused without substantial benefits.

Dr. Arlene Bronzaft [10:02]: "That's critical, and that includes mental health as well and learning."

3. Emergency Medical Services Perspective

Gladwell interviews Jonathan Byer, the EMS Medical Director for Berrien County, Michigan, and Jeff Jarvis, Chief Medical Officer for the Metropolitan Area EMS Authority in Fort Worth, Texas. Their insights reveal a troubling overreliance on lights and sirens in emergency responses.

a. Jonathan Byer on Berrien County's Reforms

Byer discusses his controversial decision to restructure siren usage in Berrien County. By implementing a tiered response system, he successfully reduced siren activations by 50% without compromising patient outcomes.

Jonathan Byer [13:57]: "There is no evidence that lights and sirens helps anybody. There's plenty of evidence that it hurts people."

Despite initial public backlash and accusations of delayed emergency responses, Byer's data demonstrated no increase in patient mortality, highlighting the minimal time saved versus the heightened accident risks.

Jonathan Byer [16:08]: "Specifically, it increases your chance of an accident by over 50%, which is crazy."

b. Jeff Jarvis on National EMS Practices

Jarvis presents findings from a comprehensive study using the ESO dataset, analyzing seven and a half million emergency calls. The study revealed that a staggering 86% of responses utilized lights and sirens, yet only 7% of these were deemed potentially life-saving.

Jeff Jarvis [34:05]: "85.8% of those responses used lights and sirens."

This overuse indicates that sirens are employed 80-90% more often than necessary, posing significant safety risks without proportional benefits.

Jeff Jarvis [35:27]: "How many of them did we do something potentially life saving? And what we ended up finding is 6.9% of those 911 lights and sirens responses."

4. Cultural Influences: The Television Factor

Gladwell examines the influence of television, particularly the 1970s NBC show Emergency!, on public perception and expectations of emergency services. The show dramatized every 911 call as a life-threatening emergency, embedding the notion that sirens are essential for urgency.

Malcolm Gladwell [28:45]: "If you succeed at convincing people that every situation is urgent, they're going to come to expect lights and sirens every time they call 911."

This cultural portrayal has led to unrealistic expectations, with both the public and emergency services defaulting to siren usage even when unnecessary, perpetuating the cycle of overuse.

5. Sirens as a Vestige: Reassessing Necessity

Gladwell posits that sirens, much like a biological spandrel, may exist without serving a functional purpose in modern contexts. He challenges the entrenched belief in their necessity, advocating for data-driven reforms to mitigate their negative impacts.

Malcolm Gladwell [24:03]: "Lights and sirens are a tool that currently seem to be way overused. And that overuse has real consequences, most of all for our burnt out, overstretched first responders."

6. Personal Anecdotes and Moving Forward

The episode concludes with a lighter note as Gladwell interacts with Joe and Jen, owners of Davey, a dog who howls at sirens. Davey's behavior symbolizes the unintended consequences of siren overuse, affecting not just humans but also their pets.

Malcolm Gladwell [42:01]: "Do you share this view of Davey's howl origins or what's?"

Gladwell reflects on the broader implications of siren reform, emphasizing the need to balance emergency responsiveness with safety and community well-being. He underscores that changes implemented in places like Berrien County demonstrate that reducing siren usage can enhance safety without endangering lives.

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Conclusion

"Running Hot" serves as a critical examination of the ubiquitous sirens in emergency services, blending personal narrative with expert insights and cultural analysis. Malcolm Gladwell effectively challenges the status quo, urging listeners to reconsider the necessity and impact of siren use. Through data-driven discussions and real-world examples, the episode advocates for thoughtful reforms that prioritize both public safety and community tranquility.

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Notable Quotes:

• Malcolm Gladwell [03:06]: "Julia and I live opposite this grocery store that's all local, small batch whatnot. So instead of getting just one delivery a day, they get like 15..."

• Jonathan Byer [13:57]: "There is no evidence that lights and sirens helps anybody. There's plenty of evidence that it hurts people."

• Jeff Jarvis [34:05]: "85.8% of those responses used lights and sirens."

• Malcolm Gladwell [28:45]: "If you succeed at convincing people that every situation is urgent, they're going to come to expect lights and sirens every time they call 911."

• Jeff Jarvis [35:27]: "Most folks are using some type of emergency medical dispatch where there are scripted questions..."

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Final Notes:

Running Hot is produced by Ben Nadaff Haffrey, Ena Bird Lawrence, and Lucy Sullivan, with contributions from various experts and a thorough bibliography for further exploration. The episode highlights the complex interplay between cultural perceptions, emergency service practices, and community well-being, advocating for a reassessment of how we respond to emergencies in our modern world.

Transcript

[Malcolm Gladwell]

Foreign.

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[Ben Nadaff Haffrey]

Hello. Hello everyone. This is the first of what are going to be a couple of episodes in this mini season from my colleague Ben Nadaff Haffrey. Ben is the guy when you're hiking through the wilderness who says, let's go this way and there's no trail and you think, oh, I'm going to get eaten by bears. And then no, you find some lost civilization and large piles of glittering gold. Ben started telling me this story and I stopped him halfway through and I said, oh Ben, this is a spandrel. And what's a spandrel? One of my all time favorite concepts invented by Stephen Jay Gould, the spandrel is the thing that doesn't have a fun function, but which hangs around like a random hitchhiker because it happens to be riding along with things that do have a function. Like your earlobes. I mean, what are they there for? Doesn't it seem like they were all just along for the ride with the part of our ear that actually does useful things? Or your chin? What's up with the chin? We look at a spandrel and we assume there has to be a reason for it, and there isn't. They're just spandrels. My name is Malcolm Gladwell. This is Revisionist History, my podcast about things overlooked and misunderstood. In this episode, my colleague Ben Nadaff Haffrey investigates a spandrel. You don't even realize you've been living with something that none of us would ever think to question. Because it's such a bedrock part of our world, we all just assume it has to be there. And it doesn't. I'm talking, of course, about sirens.

[Malcolm Gladwell]

Walk me through.

[Julia Conrad]

Oh no, you really do walk me.

[Malcolm Gladwell]

Through what we're looking at here. I'm talking with my wife, Julia Conrad, who happens to share an apartment with me on quite a noisy street in Brooklyn.

[Julia Conrad]

This is a log that you created. Although I am represented in it, I think it looks like we only did it for one day of how many times we heard the siren and where we heard it. Wow, what a day.

[Malcolm Gladwell]

Julia and I live opposite this grocery store that's all local, small batch whatnot. So instead of getting just one delivery a day, they get like 15, sometimes from trucks bearing, I assume, one sprig of artisanal basil. Next door there's a noisy playground and crucially, a fire station. A really active fire station. What happens is the grocery store trucks block traffic, which means the fire trucks can't get out. And so sirens all the time. This, for me as a writer, podcaster and light sleeper, is a problem. So I decided to do some research. I made a spreadsheet. We counted from 9am till 10 at night, and we heard a siren 24 times. 24 times. And this is reliable data? Julia is a data scientist. She works for the New York City government, and she has held my spreadsheet to the highest of standards.

[Julia Conrad]

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

[Malcolm Gladwell]

I don't need this. I could get enough of this at my job. I don't need it from you. I will confess that the spreadsheet, consisting of mauve, baby blue, puke green, a cheery yellow, and several pleasingly varied shades of red, isn't even complete because it does not count the times we heard the siren in the middle of the night when there is no one on the road. Maybe you didn't realize this, but emergency vehicles will sometimes run their lights and sirens even if there's seemingly no one around. Sirens can run anywhere from 110 decibels to over 130. That is ear damagingly loud. The classic fire siren sound, like what you hear in your head. If you imagine a fire truck right now is called the Federal Q2B and it's a whopping 123 decibels at 100ft away. There's an actual corporation that makes the siren. Federal signal fans post videos about the siren online. Here's what it sounds like. Maybe turn your volume down.

[Jeff Jarvis]

As we say, it's not a fire.

[Jonathan Byer]

Truck unless it's got a Q siren.

[Malcolm Gladwell]

According to a helpful chart From Yale University, 123 decibels is just 2 decibels lower than the point at which pain begins. This would all be fine, except I kind of need my ears for my job. And this is why I began the log. The log has fields for all relevant data. Date, time, branch of emergency service, location in the house from which we have heard the siren.

[Julia Conrad]

Well, there's really just two possibilities. You're either in the front of the house or the back of the house. But actually some of these entries are logged for front and back. So that's when you know it's a really big siren.

[Malcolm Gladwell]

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

[Julia Conrad]

The final column is called Dog.

[Malcolm Gladwell]

This is the only field that matters. You see, there's a dog in my neighborhood who howls almost every time the siren goes off. And he sounds like this. A dog who by the standards of people on my blog, is practically famous. Have you heard a dog who howls every time the sirens go off?

[Unknown]

Yeah.

[Malcolm Gladwell]

You have? I have.

[Julia Conrad]

I mean, they're pretty consistent with it.

[Malcolm Gladwell]

They're.

[Julia Conrad]

They're dedicated to their howling.

[Malcolm Gladwell]

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

[Jonathan Byer]

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

[Malcolm Gladwell]

So he's talking about this dog?

[Jonathan Byer]

Yeah.

[Malcolm Gladwell]

What does he say? Oh, he's ready to do something about starts.

[Julia Conrad]

Really low and guttural. I thought it was like a werewolf or something.

[Malcolm Gladwell]

I decided to take a two pronged approach to my siren problem. Plan A, I had to see if I could prove that the sirens in my neighborhood were dangerously, unnecessarily loud. And plan B, I needed a sympathetic face for my cause. Nobody really cares about podcasters, but everybody cares about dogs. And I had to assume that that dog was howling along with the siren because he was, like me, in serious pain. So find the dog, stop the siren. It'd be that simple, except the dog was not immediately forthcoming. So I pushed ahead with plan A, noise research, which led me straight to Dr. Arlene Bronzaft.

[Dr. Arlene Bronzaft]

I'm gonna take you into the noise room.

[Malcolm Gladwell]

What's the noise room?

[Dr. Arlene Bronzaft]

Okay, you'll see when you get there, sir.

[Malcolm Gladwell]

Dr. Bronzaft is an 89 year old environmental psychologist who has been called the noise queen of New York City. She's done major noise studies, worked for five mayors. She grew up in Brooklyn and lives in a lovely, tidy apartment on the Upper east side. Someone was jackhammering the street outside the building, and yet you couldn't hear a thing. Double glazed windows, of course. She took me to her noise room. Noise room sounds possibly like the opposite of what I mean.

[Dr. Arlene Bronzaft]

Let me tell you, it is a very quiet room. This is quiet.

[Malcolm Gladwell]

Wow. How did you get it so quiet here?

[Dr. Arlene Bronzaft]

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

[Malcolm Gladwell]

Yep.

[Dr. Arlene Bronzaft]

Are they all enclosed?

[Malcolm Gladwell]

Yep.

[Dr. Arlene Bronzaft]

Who do you think made that request?

[Malcolm Gladwell]

Bronze Aft started her work during the golden age of noise control, the 1970s, when the EPA began regulating noise. Her early work demonstrated that noise isn't just annoying, it can get in the way of kids learning in school, and she just kept going from there. When the city updated its noise code in 2007, in fact, it was my.

[Dr. Arlene Bronzaft]

Suggestion that they update it. That carried quite a bit of weight. However, the literature that they were depending upon was it was older. So today we have much more solid literature on the link between noise and health. That's critical, and that includes mental health as well and learning.

[Malcolm Gladwell]

That all checked out for me. Of course, the sirens are too loud, but it can take a while for the research to make its way into policy. Now we have research linking even small changes in overall noise to significantly increased risk of heart disease, to say nothing of stress, poor sleep and its associated ailments, and, crucially, the effect of noise on exasperated podcasters.

[Dr. Arlene Bronzaft]

Now, you mentioned sirens, all right, that deals with safety, that deals with getting someone to the hospital on time. However, the sirens in Europe are less offensive, are less intrusive. European people aren't dying, are they? The point is, if Europe could have quieter ones, you could come up with with a method of quieting the sirens and still be as effective. I have not seen a study that has shown that if you have a less offensive, intrusive siren, that more people will die. Have you?

[Malcolm Gladwell]

No.

[Dr. Arlene Bronzaft]

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

[Malcolm Gladwell]

I left that meeting full of hope. There's no doubt that sirens are dangerously loud. I just need to find the data to back this up and figure out a new solution. Like Arlene said, I went straight to the library and started digging around. But the more I saw about how clear it is already that these sirens are crazy, the less I believed that that data was going to make any difference in the world. And then I found a different set of data. Not something about noise, but something that undermined the very foundation of the siren's existence. We'll be right back.

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[Malcolm Gladwell]

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

[Jonathan Byer]

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

[Malcolm Gladwell]

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

[Jonathan Byer]

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

[Malcolm Gladwell]

Meyer was a Boy Scout, scrupulous. The reason he was speaking to me is because in his capacity as the EMS medical director of the Berrien County Medical Control Authority, he is responsible for the ambulances of Berrien County. And that means he's thought a lot about the noises that those ambulances make. And he's arrived at a very controversial position.

[Jonathan Byer]

There is no evidence that lights and sirens helps anybody. There's plenty of evidence that it hurts people.

[Malcolm Gladwell]

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

[Jonathan Byer]

I started life as a paramedic before I got demoted to doctor. I was a paramedic for 11 years. And when I was a paramedic in the Philadelphia area, we responded lights and sirens to everything. Like, you called 911. We just left. You know, there we go. When I got here to Michigan, they had two sets of priorities, Priority one and priority two.

[Malcolm Gladwell]

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

[Jonathan Byer]

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

[Malcolm Gladwell]

Except the system wasn't really working.

[Jonathan Byer]

And a lot of these triggers for things were like, if you ever complained of shortness of breath in any way, shape or form it made it a priority one. The problem is shortness of breath or do you feel like you're having trouble breathing? An incredibly subjective question. And so the medics were coming to me complaining, it's like, why are we getting priority one dental pain? Because the person's like, I have a tooth pain. Oh, yeah, it's making it hard to breathe. We were about 50, 50 for priority ones, which were lights and sirens and priority twos, which were not lights and sirens. Speed of traffic.

[Malcolm Gladwell]

So you only have a certain number of ambulances. But if a full half of your calls are coming in as urgent, how do you fix the problem? How do you get all those ambulances where they need to be? Well, an easy way is to get more places faster, which theoretically you can do very easily if you're exempt from all typical traffic laws. Precisely why we have sirens. But it's a little more complicated than that.

[Jonathan Byer]

So when you drive your car, you're used to things like red lights, everyone's going to stop. Once something interferes with that, the chances of an accident increase.

[Malcolm Gladwell]

Specifically, it increases your chance of an accident by over 50%, which is crazy. This is according to A peer reviewed 2019 study published in the Annals of Emergency Medicine. The risk is even higher when transporting a patient than when initially responding. But either way, the chance of an accident is a lot higher when you're using lights and sirens than if you're not. Also, these are very often bad accidents. Ambulances are heavy. Not a risk worth taking if you're just responding to a toothache.

[Jonathan Byer]

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

[Malcolm Gladwell]

So there's the accidents risk. But also, and this is really surprising, using lights and sirens doesn't actually save that much time on your route to the patient. For decades now, studies have shown that lights and sirens seem to save on average between 42 seconds and 3 minutes and 48 seconds. It's about one and a half minutes of savings if you're in a city and a little over three and a half minutes if you're in the country.

[Jonathan Byer]

On average, yes, it's about 45 seconds and three minutes. And there are. That's not a critical, that's not a.

[Malcolm Gladwell]

Critical interval most of the time.

[Jonathan Byer]

For most disease processes, cardiac arrest is one that I Would put in the. That's the time makes sense. Because in cardiac arrest, for every minute that you go without CPR being done, there's about a 10% increase in mortality and decrease in survivable brain function. I mean, that's huge.

[Malcolm Gladwell]

Yeah, it is huge. But heart attacks are actually one of the few exceptions, not the rule. And yet they are the exception on which the rule is largely based. So all of these factors led Bayer to do something big. He restructured the tiers.

[Jonathan Byer]

I tell the medics and this is how I presented it, is consider lights and sirens a medical therapy. Right. For every medicine that you give, there is an indication and there's a contraindication. Right. If I were going to say, I'm going to give you epinephrine, well, why would I give you epinephrine? And the benefits have to outweigh the risks. So I wanted to think of lights and sirens that way. It is a high risk procedure. When are we going to do it? When the risks are outweighed by the benefits.

[Malcolm Gladwell]

They ran through their data on all the calls that they had responded to, priority one lights and sirens, and they reassessed whether those really needed to be lights and sirens.

[Jonathan Byer]

So cardiac arrest, people choking, respiratory arrest, things where seconds could make a difference. Yep, that is worth the risk to try to get someone there quicker. But other things like, well, she fell and broke her hip, okay, that's an emergency and that person needs to get to a hospital. I don't doubt that. Is the three minutes going to make a difference in that person's outcome? No.

[Malcolm Gladwell]

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

[Jonathan Byer]

I wiped out about 50% of the priority one calls in buried county.

[Malcolm Gladwell]

Let that sink in. Ambulance lights and sirens in Berrien county were sounding half as often as they had before. Now even I was wondering, could you really know that this switch wasn't putting anyone at risk? Well, eventually they followed up on the people the ambulances had picked up in the field to see how the hospital coded the patients as they came in. So if you went to someone as a priority, too, not that urgent. And they showed up to the hospital as a priority one, that would mean that you'd made a mistake. How much more often was that happening under the new coding system than the old?

[Jonathan Byer]

It was the same number. Wow.

[Malcolm Gladwell]

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

[Jonathan Byer]

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

[Malcolm Gladwell]

Not priority buyers on board. The paramedics are on board. Smooth sailing.

[Jonathan Byer]

Except what ended up happening, and I'm not exactly sure how this got out. It went through all the proper channels on my side, like medical control in the hospital in the county. So that was okay. But it started getting publicized, and I don't exactly know how, but it started showing up on the hospital Facebook page about Berrien County. Medical control is killing people with slow responses. And oh, boy.

[Malcolm Gladwell]

Unbeknownst to Bayer, word had gotten out to the people who call ambulances. Big problem. If you drive in Berrien county, you won't see as many lights and sirens as you're driving.

[Jonathan Byer]

Ambulances will be using them only for time sensitive cases like a heart attack.

[Malcolm Gladwell]

The local news began doing man on the street interviews.

[Jonathan Byer]

Literally, they were out on the bluff overlooking Lake Michigan, just interviewing people walking by, going, what do you think about ambulances coming to your house slower? And of course, people explode over them.

[Malcolm Gladwell]

What did they say?

[Jonathan Byer]

It's like, I can't believe this. And you know, this is terrible. Of course I want an ambulance there fast. And the hospital started getting a lot of flack. Some of it was very nasty. So people started on Facebook attacking the hospital. Oh, this is Lakeland just killing patients again, you know, just very bad vitriol.

[Malcolm Gladwell]

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

[Jonathan Byer]

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

[Malcolm Gladwell]

Bayer gets dressed and hurries to Dr. Hamill's office.

[Jonathan Byer]

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

[Malcolm Gladwell]

Bayer's stunned. And then he begins to lay out the case against sirens in a very.

[Jonathan Byer]

Dr. Bayer way I try to explain what I had done is. Have you ever taken physics?

[Malcolm Gladwell]

Bayer explained his move, maybe a little inefficiently, by using the equation for velocity distance divided by time changed to solve for time or T. It amounted to this. If you're trying to get time down and you can't reduce the distance between you and a patient by putting more ambulances on the street because it's expensive, the easiest way to get it done is to increase your velocity, which means running your lights and sirens. But the problem is we now know that running lights and sirens significantly increases the risk of an accident. So maybe you don't want to do that either. Then the thing to do is to take a second look at T. Does time really need to come down by the small increment that we now know lights and sirens is going to reduce it? Not for most things.

[Jonathan Byer]

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

[Malcolm Gladwell]

Bayer confronted the outrage masses and once.

[Jonathan Byer]

That went out, all complaints disappeared in six weeks. And I've heard not a thing since then. In fact, now we right now are the leader in Michigan for the lowest rates of lights and sirens use in the state of Michigan for bms.

[Malcolm Gladwell]

Things worked out for Bayer in the end. But I'm interested in that initial freakout because it reveals a basic assumption people make, myself included. Everything is urgent. So we accept this social loophole where you can break all known traffic laws, provided you possess a device that emits the loudest, shrillest sound imaginable. What kind of world is this? I'm not arguing that we shouldn't have sirens at all, but it seems to me that they're not only too loud and crazy sounding, but like we use them way more often than is necessary because we're unwilling to let go of them. But of course, Berrien county is just one place. Approximately 20,000 EMS calls a year. And paramedics are just one branch of the emergency service. I shouldn't get ahead of myself. I was left with two big questions to answer next. Where did we get the idea that sirens are so necessary? And exactly how unnecessary are they? A good place to look is the same place we fell in love with EMS once upon a time. We'll be right.

[Jeff Jarvis]

If you would have asked 18 year old Jeff when I first drove lights and sirens, I would have said that they are always life saving and we absolutely need to use it. But I'm not 18 anymore.

[Malcolm Gladwell]

Jeff Jarvis, the chief medical officer for the Metropolitan Area EMS Authority in Fort Worth, Texas, an emergency medical service that serves over a million people in Fort Worth and 14 surrounding cities. He's been a paramedic since the 1980s. He served around New York City and Austin. So 18 year old Jeff, who's made his decision to begin to be a paramedic. So let me ask you a question. In the 1970s, did you ever watch the television show Emergency?

[Jeff Jarvis]

Oh, of course.

[Malcolm Gladwell]

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

[Jeff Jarvis]

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

[Malcolm Gladwell]

In 1972, NBC began airing a television show called Emergency. That's got an exclamation point at the end, by the way. The theme song is the music they'd play in my version of hell. The show is about Johnny and Roy, two young paramedics working out of Fire Station 51 in Los Angeles. Except they're not paramedics in the beginning.

[Unknown]

That special training program, remember we were talking about it a couple of days ago?

[Malcolm Gladwell]

Yes, sir. The Para something or other paramedics. The series begins in a world where there basically aren't any paramedics, which was our world 53 years ago. 53 years. In 1971, there were a slim 12 paramedic units in the entire country. And it was kind of a Wild west situation. Details varied from place to place, but in some areas, it was illegal to give someone medical care if you weren't a doctor or a nurse. So about 50% of ambulances were just hearses driven out of funeral homes by morticians whose sole purpose was to get patients to doctors as quickly as possible. And if that failed, back to the funeral home you go. This is actually how it worked. Emergency was a show dreamed up in partnership with the father of modern ems, a guy named James Page, who worked at one of the first firehouses with a paramedic unit in Los Angeles. And the show was literally meant to make the case for paramedics every Saturday night nationwide on NBC, 30 million viewers at a time, not a few of whom became paramedics. People are dying at the scene, people who could stay alive if there was somebody on the spot who knew what to do. Look, if that bill passed the legislature today, do you know how many people.

[Unknown]

We'D have ready for the job?

[Malcolm Gladwell]

Six men for six and a half million people. I learned about Emergency in a brilliant essay by UCLA emeritus law professor Paul Bergman, where he traces the profound influence the show had not just on paramedics, but on Lawmakers, too, by dramatizing just how urgent every single 911 call is.

[Unknown]

We almost had him back. Dammit, we almost had him back.

[Malcolm Gladwell]

If he could have been defibrillated the moment they pulled him off the wire. This is from the first episode, right after a maintenance man gets electrocuted and eventually dies. The doctor and nurse, who, by the way, are, of course, romantically involved, are talking.

[Unknown]

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

[Malcolm Gladwell]

Not somebody.

[Unknown]

The paramedics again.

[Malcolm Gladwell]

Call them paramedics. A rescue team. That doesn't matter, Cal. If somebody with the right equipment and trained to use it had gotten to this man in time, he'd be alive now.

[Unknown]

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

[Malcolm Gladwell]

Trained amateurs. Trained by you and doctors like you.

[Unknown]

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

[Malcolm Gladwell]

It's a doubleheader pilot, and both episodes are full of these situations that dramatize the resistance to paramedics, which was very real. But the show argues that we need paramedics. And why do we need them? Because there are so many accidents where, if only someone had been there in time, we could have saved them. Including myself. I thought it could possibly be a success.

[Unknown]

Well, her arm may not function as well as it used to, but at least it'll be her own. You're getting it here as fast as you did. Made the difference.

[Malcolm Gladwell]

Brandy to have her on. Doc, you ought to give us a try. Bergman, the law professor, talked to the legends of ems, and he heard all these emergency references. Dug through California hearings on the Paramedic act, and he found emergency references, letters from senators, emergency references. In the early years of the show, 46 states legalized paramedicine. To be clear, this was a movement that was already in process. But emergency was a big part of establishing the cultural expectations for what those units would look like. And it looked like lights and sirens to every call, because every call was all about time.

[Unknown]

But you can't ask someone not to die while you're trying to find out what's wrong with him. And they do die, gentlemen, on the way from where it happens to my hospital.

[Malcolm Gladwell]

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

[Unknown]

They die by the hundreds every year. Not from mortal wounds, but neglected wounds. Not from incompetence or indifference, but from time, from lack of time. I'm in favor of more doctors, more hospitals, and better equipment. And I'm also in favor of this bill until those other things come along because it will save lives. Maybe a dozen lives, maybe a thousand, maybe just one.

[Malcolm Gladwell]

He's looking directly into the camera right at those 30 million viewers and who knows which one Time, time, time. And if you succeed at convincing people that every situation is urgent, they're going to come to expect lights and sirens every time they call 91 1. And how many of the calls in emergency do they respond to with lights and sirens?

[Jeff Jarvis]

100%. Absolutely. So think about it this way. On emergency, every call was a life threatening emergency. Now I say that knowing the first call they went on was not, but in the end of the first episode, the pilot, but the vast majority were life threatening emergencies. So sure, people got that, that notion and expectation that that's what would happen. There are a lot of paramedics who joined up for those life threatening emergencies, only to find out that 85% of the calls is holding somebody's hand.

[Malcolm Gladwell]

Sirens are all over the show. You may recall that the literal theme song of emergency features sirens. And I think a lot of this time siren obsession is due to the fact that early EMS departments were part of fire departments. And a fire is a very specific kind of emergency. If you don't contain it, it spreads. So every fire is an urgent situation. And according to fema, anecdotally, firefighters use their sirens way more often than the police. But these days, even the fire service in most places seems to be based on an outdated sense of its mission. As of 2023, less than 4% of all 911 calls firefighters responded to were for fires most or for EMS and rescue. So then it looks like the argument about siren reform broadly applies to firefighters too. The US Fire Administration actually cited a bunch of studies about reducing siren usage just last year. Sirens are dangerous, they save time, but not that much. And things are often less urgent than they appear.

[Jeff Jarvis]

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

[Malcolm Gladwell]

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

[Jeff Jarvis]

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

[Malcolm Gladwell]

Oh my God.

[Jeff Jarvis]

The fundamental question we ask is of those responses, were you used lights and sirens? How many of them did we do something potentially life saving? And what we ended UP finding is 6.9% of those 911 lights and sirens responses. Did we do something even vaguely potentially life saving? And we were rather generous with our description of what potentially life saving is.

[Malcolm Gladwell]

So this is crucial. Paramedics are responding with lights and sirens to around 86% of calls when only 7% of them are resulting in a vaguely potentially life saving intervention. So why were they urgent? That means that in the United States we're using lights and sirens somewhere between 80% and 90% more often than we need to. The question I have that I can imagine people who are skeptical might ask is, well, how much do you really know from the call? Can you tell?

[Jeff Jarvis]

Most folks are using some type of emergency medical dispatch where there are scripted questions and they will give each type of call a number and a letter. And the letter is called the determinant. And it goes from your echo level calls, which are most likely to be life threatening, down to omega level calls which are not very likely at all to be life threatening. And those criteria have been evaluated multiple times with multiple data sets. Again, they're not perfect, but they are pretty accurate. For example, there is a call nature called I problem. 0.67% of those calls resulted in a potentially life saving intervention.

[Malcolm Gladwell]

And how many did people hot to all of them.

[Jeff Jarvis]

It's just dangerous and it's dangerous and it's not really doing what we think it is. So it seems like it is an intervention whose time has come and gone.

[Malcolm Gladwell]

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

[Unknown]

I'm in favor of more doctors, more hospitals and better equipment. And I'm also in favor of this bill until those other things come along.

[Malcolm Gladwell]

But those other things have come along. More doctors, advances in the ways we take 911 calls, better and more emergency rooms, better and more emergency medicine, better and more paramedics to use Byers formula. We have reduced distance. Paramedic units are all over the place now. In a way, they just weren't in the world of emergency. But it seems to me like in our minds and on TV, it's as if nothing has changed since the 1970s. Emergency was the most significant early example of an entire genre of TV show that dramatized the emergency services. Before there was cops or Rescue 911, there was emergency. And here's the trick. All of those TV shows are based on the narrative conventions that emergency pioneered. A world in which the TV show had not yet done its work. And help was always too far away and always came with lights and sirens blaring, because that's what firefighters did. And these shows are everywhere. Rescue Me, Skymed Live, Rescue Helicopter, Heroes Island Medics, Air Ambulance, er. A show that was literally called sky sirens, which is what they'll play on TV in hell for me. They even make this stuff for kids. This is what Paw Patrol is. Stardom Young.

[Jeff Jarvis]

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

[Malcolm Gladwell]

So Jarvis, like Bayer, reduced the use of lights and sirens. He cut them by about a third. Did their response time increase? Yes, by a median of 6 seconds, and in the vast majority of cases, by less.

[Jeff Jarvis]

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

[Malcolm Gladwell]

And I realize this is purely in the realm of hypothesis, but it seems to me commonsensical that were lights and sirens reserved for truly emergency use, you would see a more potent reaction to them and likely then it could plausibly decrease response times.

[Jeff Jarvis]

So I'll put my scientist hat on and say that's an interesting hypothesis that needs to be tested. I will put my realist and my pragmatic public health hat on and say, absolutely. Giddy up. I absolutely think you'll see that I like that hat.

[Malcolm Gladwell]

That's a very stylish hat you're wearing. So here it is. Lights and sirens are a tool that currently seem to be way overused. And that overuse has real consequences, most of all for our burnt out, overstretched first response who go to work to save lives and wind up responding to everything as if it's a crisis, wearing themselves out and losing their hearing in the process. In 2015, 1500 firemen sued that company, Federal Signal, the one that makes the iconic fire siren for causing mass loss of hearing. A lawyer opposing them said, and I quote, what's their solution? If you don't have sirens, people would get mowed down in the streets. The siren works exactly the way it should, end quote. I could not disagree more. And you know who else disagrees? That's right. I found him. Okay. I am approaching Davey's house, which is coincidentally directly behind my house. I was just walking down my street one day when an ambulance rushed by and I saw this dopey yellow lab stiffen and howl. I'D know that howl anywhere. I rushed over and I was like, hey, I've got a question about your dog. And his owner was very obliging. His name's Joe, the dog's name Davey. And a while later I came by their house for an interview. Hello. Hi Davey.

[Julia Conrad]

Hi, I'm Jen.

[Malcolm Gladwell]

I'm Ben. Hi, so nice to meet you. Come on in. That was a very satisfying sniff sound. I got Jen and Joe live one street over from me and Julia. A beautiful brownstone, two kids and a noisy dog. We sat down at their kitchen table. I'm curious if you could tell me about when you realized that you had a sort of eccentric dog.

[Julia Conrad]

Well, I guess it was like the first time we heard him howling at sirens because he didn't seem particularly distressed by it. Like a lot of times his tail wags and he does get quite a reaction from like the neighbors, like the neighborhood. Like everyone usually turns around and stops and like laughs and was there like I've never heard that before.

[Malcolm Gladwell]

It turns out Davey is starting a movement.

[Julia Conrad]

His dog walker always like posts like sends us emails like describing their walk. So you know, sometimes Davey has gotten his co partners in walking the other dogs to start to howl with him.

[Malcolm Gladwell]

But he's always the first howler.

[Julia Conrad]

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

[Malcolm Gladwell]

So their owners must be thrilled. Jen is a psychologist, Joe is a composer for film and television. So together they're experts on mammalian behavior and sound. So I'm inclined to believe their analysis of Davey's views on the siren subject. He's not in distress, which means he's not going to be the poster child for my anti siren campaign. But I hadn't given up yet. Do you share this view of Davies howl origins or what's. So there's another theory. This is the one, I think if I had to choose one, that I would like to believe the most. It is that the sirens hearken back to a lost dog who has been separated from the group and they are howling to reconnect with the pack. Like a call and answer from a lost dog. That's another one of the series and that Davey is saying, we're over here. Come on lost buddy. This is where we are.

[Julia Conrad]

He is a very neighborly dog. He loves to hang.

[Malcolm Gladwell]

Jen and Joe are very neighborly people. I'm glad to know them now, even if their dog is a huge disappointment to my anti siren crusade, seeing as he really loves sirens. But it makes sense. It goes back to that evolutionary theory Malcolm was talking about at the top of the episode, the idea of the spandrel and the things in our bodies and our worlds that we think we're selected for but actually are just there and maybe not doing us a whole lot of good. Davies Howl isn't quite a spandrel, if we're being pedantic. It's more like a vestige. He thinks he's living with a pack of dogs in the wild, but he's not. He's a house dog who lives in Brooklyn, a block away from a busy grocery store, a playground, a frustrated podcaster, a New York City government employee and a fire station, a celebrity ignorant of his own fame, and a howler who howls just because that's what he's always done. Revisionist History is produced by me, Ben Nadif Haffrey, Ena Bird Lawrence and Lucy Sullivan. Our editor is Karen Shakurji. Original scoring and theme by Luis Guerra. Additional scoring by Jay Gorski. Jacob Smith is our executive producer. Engineering by Marcelo D'Oliveira. I relied on quite a few studies in researching this and put a link to the bibliography in the show notes should you want any references for starting your own local movement. Special thanks also to Douglas Kupa, whose work helped launch the field of siren reform studies Mike Tageman, Helen K. Rosenthal, Stephen Solomon, and Paul Bergman. I'm Ben Ndefre. The really alarming music you're hearing right now was composed by Davies owner Joe Sava for the trailer of the Michael Bay film Ambulance.

[Ben Nadaff Haffrey]

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