Code 1 Transport – Is it worth the risk?

Everything we do comes with risk. Grocery store aspirin can cause GI bleeds, a poorly prepared cannula can cause life threatening sepsis, and the regrettable, but increasingly popular, ‘ondansetron flush’ can give your patient dystonia; it also gives you a chance of winning a staring competition with the 3-year-old in the adjacent bed. 

All of our interventions, whilst potentially beneficial, also come with risk. None more than transporting patients ‘lights and sirens’ to hospital. 

Yes, transporting lights and sirens to hospital is dangerous. We may think that our uniform, reflective delivery van and 4 days of driver training keep us safe, but the reality paints a different picture. You are more than twice as likely to crash going light and sirens compared to driving road speed. Every two weeks a paramedic is seriously injured in a traffic accident in this country. The vehicle fatality rate for paramedics is 11 times higher in Australia compared to all workers. 

Does it really surprise you when you think about some of the code 1 transports you’ve done in the past? It’s 4am and you’re half asleep, you’re distracted by what is going on in the back, you’re doing 30km/hr over the speed limit and running red lights. Up front is probably the most inexperienced driver, and you can almost guarantee the paramedics and the patient are not properly restrained. Take the ambulance out of the equation and this driving behaviour would be considered abhorrent. 

We take on this risk, because we believe that faster leads to better patients outcomes. But how much time are we really saving?

Three US studies say about 2 minutes. 

Do you really think that 2 minutes is going to change the outcome?

Lights and sirens transport stems from an era where we could offer very little assessment or intervention to our patients. Times have changed and there are not many truly time critical interventions we cannot offer our patients. 

What evidence base do we call upon when we decide to transport lights and sirens to hospital? What practice guideline exists to identify those patients who actually benefit? To our knowledge, neither exist. 

We have clinical protocols and guidelines to guide our decision making with other interventions. Yet none focus on the risks of code one driving. 

Consider this:

Does cannulation risk killing an innocent family driving home from school? No.

Does an LMA insertion risk seriously injuring our colleagues? No. 

Yet no guideline or protocol exists for what is arguably our most dangerous intervention. 

So how do we get better?

We need to identify the patients who, despite our cares, will truly benefit from getting to a hospital faster. We need to change our culture of ‘just the driver’. If anything, this is the most important role in the team. 

At the end of the day, we all want to go home safe at night; let’s make it happen. 

And please please please, wear your seatbelt. 

To hear more about this, check out Episode 16: Transport to hospital: an intervention that can kill.


Lawrence HB et al. Do warning lights and sirens reduce ambulance response times? Prehosp Emerg Care. 2000 Jan;1(4):70-74

Maguire BJ, O’Meara PF, Brightwell RF, O’Neill BJ, Fitzgerald GJ. Occupational injury risk among Australian paramedics: an analysis of national data. Med J Aust. 2014;200(8):477‐480. 

Watanabe BL, Patterson GS, Kempema JM, Magallanes O, Brown LH. Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes? A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. Ann Emerg Med. 2019;74(1):101‐109.

Bledsoe B. EMS Myth #4: Lights and sirens save a significant amount of travel time and lives. EMS World. 2003 Dec. 

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