May 15, 2025 • 45 mins
You might think unbelievably loud, shrill sirens on ambulances and fire trucks are just a fact of life. But what if we got the facts all wrong? In this special episode of Revisionist History, Ben Naddaff-Hafrey starts a movement to end the reign of the siren.
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Speaker 1 (00:16):
Pushkin. Hey, last Archive listeners, it's Ben. I've been hard
at work on another show at Pushkin called Revisionist History,
and I've done four episodes for this most recent season
that I wanted to share with you too. They run
the gamut from an argument about why we don't need
emergency vehicle sirens as much as we think we do,
to a history of psychology involving some mischievous raccoons, and
(00:39):
a two part blowout about a big trade secrecy case
that turns on the top secret recipe for Thomas's English muffins.
We're going to be releasing one a week over in
this feed, and we're starting today with the episode about sirens.
You can find more episodes of Revisionist History wherever you
get your podcasts. Thanks for listening and enjoy.
Speaker 2 (01:02):
Hello. Hello everyone. This is the first of what are
going to be a couple of episodes in this mini
season from my colleague Benadaph Haffray. 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.
(01:25):
Ben started telling me the 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 J. Gould, The spandrel is a thing
that doesn't have a function, but which hangs around like
a random hitchhiker, because it happens to be riding along
(01:46):
with things that do have a function, like your ear lobes.
I mean, what are they there for? Doesn't it seem
like they were all just along for the ride with
a 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.
(02:11):
My name is Malcolm Gladwell. This is Revisionist History, my
podcast about things overlooked and misunderstood. In this episode, my
colleague Ben the daf 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,
(02:36):
about sirens.
Speaker 1 (02:51):
Walk me through, No, you really do walk me 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.
Speaker 3 (03:04):
This is a log that you created. Although I am
rippers 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.
Speaker 1 (03:19):
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 fifteen, sometimes from trucks bearing
I assume one sprig of artismal basel. Next door, there's
a noisy playground and crucially a fire station, a really
active fire station. What happens is the grocery store trucks
(03:41):
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.
(04:01):
We counted from nine am till ten at night, and
we heard a siren twenty four times twenty four times
in 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.
Speaker 3 (04:19):
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.
Speaker 1 (04:30):
I don't mean this. I could get enough of this
in my job. I don't hear from you. I will
confess that the spreadsheet, consisting of mauv 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
(04:51):
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 one hundred and ten decibels
to over one hundred and thirty. That is ear damagingly loud.
The classic fire sirens sound like what you hear in
your head. If you imagine a fire truck right now,
is called the Federal Q TWOV and it's a whopping
(05:13):
one hundred and twenty three decibels at one hundred feet 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.
Speaker 4 (05:27):
As we say, it's not a fire truck unless it's got.
Speaker 1 (05:30):
A key siren. According to a helpful chart from Yale University,
one hundred and twenty three decibels is just two decibels
(05:53):
lower than the point at which quote 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
(06:15):
we have heard the siren.
Speaker 3 (06:17):
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 lodged for front
and back, so that's when you know it's a really
big sire.
Speaker 1 (06:30):
There's also a field for reporter Ben slash Julia and
another for notes, and then what is the final column.
Speaker 3 (06:38):
The final column is called dog question mark.
Speaker 1 (06:41):
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
(07:03):
dog who, by the standards of people on my block,
is practically famous. Have you heard a dog who howls
every time the sirens go off? Yeah? I have.
Speaker 5 (07:12):
I mean, they're pretty consistent with it.
Speaker 1 (07:13):
They're they're dedicated to their.
Speaker 5 (07:17):
Howling.
Speaker 4 (07:18):
I think I feel like my wife has heard the dog.
Speaker 6 (07:20):
But does a guy Kevin that lives after that garage
right there.
Speaker 1 (07:25):
And he does so, he's talked about this dog heare Yeah,
what does he say?
Speaker 7 (07:29):
Oh, he's ready to do.
Speaker 1 (07:32):
Something about it.
Speaker 3 (07:33):
It starts really low and guttural.
Speaker 1 (07:35):
I thought it was like a wearwolf or something. I
decided to take a too pronged approach to my siren
problem planet. 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.
(07:59):
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.
(08:21):
So I pushed ahead with plan a noise research, which
led me straight to doctor Arlene Bronze Aft.
Speaker 8 (08:31):
We're going to take you into the noise room.
Speaker 1 (08:33):
What's the noise room?
Speaker 9 (08:34):
Oh?
Speaker 8 (08:34):
Okay, no, see when you get there, sir.
Speaker 1 (08:36):
Doctor Bronze Aft is an eighty nine 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
(09:00):
to her noise room. The noise room sounds possibly like
the opposite of what I mean.
Speaker 8 (09:05):
Let me tell you it is a very quiet room.
Speaker 4 (09:13):
This is quiet.
Speaker 1 (09:15):
Wow. How did you get it so quiet? Oh?
Speaker 8 (09:18):
Did I help make it quiet? The answer, yes, I
did have a role and making it quieter than it
would have been. Can you see the cooling units? Are
they all closed?
Speaker 1 (09:30):
Yep?
Speaker 8 (09:31):
Who anything made that request?
Speaker 1 (09:33):
Bronze Aft started her work during the golden age of
noise control the nineteen seventies, when the EPA began regulating noise.
Early work demonstrated that noise isn't just annoying, They 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 two thousand and seven.
Speaker 8 (09:52):
In fact, it was my suggestion that they updated, it
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 critical and that includes mental health as
(10:13):
well in learning.
Speaker 1 (10:15):
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 and overall noise to
significantly increased risk of heart disease, to say nothing of stress,
poor sleep and its associated ailments, and crucially the effective
noise on exasperated podcasters.
Speaker 8 (10:37):
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, aren't they. The point is, if
(10:58):
Europe could have quiet at once, you could come up
with a method of quieting the sirens and still be
as effective. I have not seen a st I had
shown that if you have a less offensive intrusive siren
that more people will die.
Speaker 4 (11:17):
Have you no so here I am.
Speaker 8 (11:20):
I'm a data person, Show me the data.
Speaker 1 (11:26):
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 believe that that data was going to
(11:46):
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 sirens existence.
We'll be right back. Barrion County, Michigan, sits on the
(12:21):
southeastern shore of Lake Michigan. It's not too far from Kalamazoo,
quaint lake front towns, golf courses, quiet unless you work
as a paramedic.
Speaker 4 (12:32):
I have like four jobs because it doesn't everyone, and
I'm like, right now, I'm at the Burrian County Health Department.
Speaker 1 (12:38):
Jonathan Byer, former EMT and now medical director for the
Barrion County Health Department.
Speaker 4 (12:44):
I am not speaking on behalf of the Barrion County
Health Department.
Speaker 1 (12:48):
Buyer was a boy scout, scrupulous. The reason he was
speaking to me is because, in his capacity as the
EMS medical director of the Barrion County Medical Control Authority,
he is responsible for the ambulances of Barrion 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.
Speaker 4 (13:10):
There is no evidence that lights and sirens helps anybody.
There's plenty of evidence that it hurts people.
Speaker 1 (13:15):
No evidence that lights and sirens helps anybody. This, even
to me, an inveterate complainer about sirens, was a huge surprise.
Speaker 4 (13:23):
I started life as a paramedic before I got demoted
to doctor. I was a paramedic for eleven years and
when I was a paramedic in the Philadelphia area. We
respotted lights and sirens to everything. Like you called nine
to one, we just let you know, there we go.
When I got here to Michigan, they had two sets
(13:43):
of priorities, Priority one in Priority two.
Speaker 1 (13:46):
A lot of ems across the country has a similar
kind of tiered intake system, a way to rank every
incoming nine to one one call based not on its
importance but on its time sensitivity. In Barryon County, they
would tag a call with priority one or two, depending
on what the issue was.
Speaker 4 (14:05):
There are more calls for service than there are ambulances,
so we have to find some way to prioritize.
Speaker 1 (14:10):
Except the system wasn't really working.
Speaker 4 (14:14):
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. Well,
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
(14:36):
making hard to breathe. We were about fifty to fifty
for Priority ones, which were lights and sirens, and Priority twos,
which were not lights and sirens. Speed of traffic.
Speaker 1 (14:45):
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
(15:08):
it's a little more complicated than that.
Speaker 4 (15:10):
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.
Speaker 1 (15:21):
Specifically, it increases your chance of an accident by over
fifty percent, which is crazy. This is according to a
peer reviewed twenty nineteen 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
(15:42):
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.
Speaker 4 (15:53):
I started going, why are we responding to dental pain
priority one? So myself 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 determined codes, going
does that really need priority one?
Speaker 1 (16:12):
So there's the accident's 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 forty two seconds and three minutes and
forty eight seconds. It's about one and a half minutes
(16:34):
of savings if you're in a city, and a little
over three and a half minutes if you're in the country.
Speaker 4 (16:39):
On average, Yes, it's about forty five seconds or three minutes.
Speaker 1 (16:43):
And there are that's not a critical that's not a
critical interval most of the time for.
Speaker 4 (16:49):
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 every minute that you go without
CPR being done, there's about a ten percent increase in
mortality and decrease in survivable brain fusction come in.
Speaker 1 (17:07):
That's huge. Yeah, so that's huge. 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 Buyer to do something big.
He restructured the tears.
Speaker 4 (17:25):
I tell the medics, and this is how I presented
it is consider lights and sirens a medical therapy. Right,
there's 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 upin effort, well,
why would I give you epin effort? And the benefits
have to outweigh the risks. So I wanted to think
of lights and sirens that way. It is a high
(17:46):
risk procedure. When are we going to do it when
the risks are outweighed by the benefits.
Speaker 1 (17:52):
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.
Speaker 4 (18:01):
Sirens, 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
(18:23):
going to make a difference in that person's outcome.
Speaker 1 (18:26):
No, So with all this data, Buyer and his team
changed how the calls were coded.
Speaker 4 (18:33):
I wiped out about fifty percent of the Priority one
calls in Burying ount.
Speaker 1 (18:38):
Let that sink in ambulance lights and sirrons in Barrion
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
(18:58):
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 It was the same number. Wow, there was
basically no difference. As in, he halved the number of
(19:21):
lights and sirens responses in Barrion County. He reduced the
risk of accidents as a result, and it cost the
people of Barrion County nothing.
Speaker 4 (19:34):
When I instituted the change, I didn't really have much
of a problem. Nine to one one 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 were going on are not.
Speaker 1 (19:49):
Priority buyers on board, the paramedics are on board. Smooth sailing,
except what ended up happening.
Speaker 4 (19:56):
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 Burying County medical control is killing
(20:17):
people with slow responses, and oh.
Speaker 1 (20:20):
Boy, unbeknownst to Bayer, word had gotten out to the
people who call ambulances big problem.
Speaker 10 (20:29):
If you're drive in Barrian County, you won't see as
many lights and sirens as you're driving. Ambulances will be
using them only for time sensitive cases like a heart attack.
Speaker 1 (20:37):
The local news began doing man on the street interviews.
Speaker 4 (20:40):
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.
Speaker 1 (20:48):
Explode over what did they say?
Speaker 4 (20:50):
It's like, I can't believe this, and you know that
this is terrible. Of course I weren't an ambulance there
fast and the hospital started getting a lot of flak.
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.
Speaker 1 (21:08):
At the time, though Byer was blissfully unaware any of
this was happening. Other jobs were keeping him very busy.
But then one morning he got a call.
Speaker 4 (21:18):
I had done a six p to two am shift
and at eight am I got a call from the
administrative assistant to the CEO of the hospital. Hi, there,
doctor Buyer, it's eight am. What are you doing at
eight thirty? I'm like, and I'm still swaking up because
again I've had four hours of sleep, And she's like,
doctor Hamill. At that point, the CEO of the hospital
(21:38):
would like to speak to you.
Speaker 1 (21:40):
Buyer gets dressed in hurries to doctor Hamill's office.
Speaker 4 (21:43):
And I'm met by them in the hospital attorney and
being shown this Facebook page and they're like, what did
you do? This is terrible?
Speaker 1 (21:52):
Buyer stunned, and then he begins to lay out the
case against sirens in a very doctor buyer way.
Speaker 4 (21:59):
I tried to explain what I had done. Is have
you ever taken physics?
Speaker 1 (22:05):
Buyer explained his move, maybe a little inefficiently, by using
the equation for velocity distance divided by time changed to
solve for time or tea. 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
(22:26):
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 tea. Does time really
need to come down by the small increment that we
(22:48):
now know lights and sirens is going to reduce it?
Not for most things.
Speaker 4 (22:52):
I showed him some of the studies. He's like, your
science is sound. You may you go next time do
a press conference. Oh, I had a press conference, which
is what you saw online.
Speaker 1 (23:01):
Buyer confronted the outrage masses.
Speaker 4 (23:04):
And once that went out, all complaints disappeared in six
weeks and I've heard not a thing since then. In fact,
now we are considered we right now are the leader
in Michigan for the lowest rates of lights and sirens
use in the state of Michigan for ems.
Speaker 1 (23:16):
Things worked out for Buyer in the end, But I'm
interested in that initial freak out 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 does
(23:38):
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, Barrion County is just
one place, approximately twenty thousand MS calls a year, and
(24:01):
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
(24:22):
place we fell in love with EMS once upon a time.
We'll be right back.
Speaker 11 (24:41):
If you would have asked eighteen 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 eighteen anymore.
Speaker 1 (24:54):
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
fourteen surrounding cities. He's been a param since the nineteen eighties,
he served around New York City in Austin. So eighteen
(25:14):
year old Jeff who's made his decision to begin to
be a paramedic. So let me ask you. Let me
ask you a question. In the nineteen seventies, did you
ever watch the television show Emergency?
Speaker 6 (25:27):
Oh?
Speaker 1 (25:27):
Of course, and did that have an effect on your
becoming a paramedic?
Speaker 7 (25:32):
It did.
Speaker 11 (25:33):
I thought it was the coolest thing ever.
Speaker 1 (25:35):
In nineteen seventy two, 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
(25:56):
Johnny and Roy, two young paramedics working out of fire
Station fifty one in Los Angeles, except they're not paramedics
in the beginning that special training program.
Speaker 12 (26:06):
Remember we were talking about it a couple of days ago.
Speaker 9 (26:08):
Answer the or something or other paramedics.
Speaker 1 (26:13):
The series begins in a world where there basically aren't
any paramedics, which was our world fifty three years ago.
Fifty three years in nineteen seventy one, there were a
slim twelve 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
(26:35):
to give someone medical care if you weren't a doctor
or a nurse. So about fifty percent of ambulances were
just purses 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
(26:58):
was a show dreamed up in partnership with the father
of modern ms, 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 thirty million viewers at a time, not a few
(27:19):
of whom became paramedics.
Speaker 12 (27:21):
People are dying at the scene, people who could stay
alive if there was somebody on the spot who knew
what to do.
Speaker 9 (27:26):
Look, if that bill passed the legislature today, do you
know how many people we'd have ready for the job?
Speaker 11 (27:32):
Six men for six and a half million people.
Speaker 1 (27:34):
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 nine
to one one call is.
Speaker 12 (27:52):
We almost head him back. Damn it, we almost head
him back if you.
Speaker 9 (27:56):
Could have been to fibrillated the moment they pulled him
off the wire.
Speaker 1 (27:59):
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.
Speaker 12 (28:11):
Somebody should have been there with a machine in their bucket,
not somebody the paramedics again.
Speaker 9 (28:19):
Paul, and 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.
Speaker 12 (28:27):
Now, I won't use this situation that justifies sending amaters
out the practice medicine on the street.
Speaker 9 (28:32):
Trained amaters, trained by you, and doctors.
Speaker 12 (28:35):
Like you, amateurs, Dixie. I spent twelve years in school
and residency, and I'm still learning my trade.
Speaker 1 (28:41):
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
(29:02):
could possibly be a success.
Speaker 12 (29:07):
Well or or may not function as well as it
used to. At least it'll be your own You're getting
out here as fast as you did.
Speaker 1 (29:13):
Made the difference Brandy to have her own doc. Gotta
give us a try. Bergmann, 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
(29:33):
early years of the show, forty six 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.
Speaker 12 (29:57):
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.
Speaker 1 (30:06):
This is from the second part of the pilot episode,
when the skeptical doctor has come around.
Speaker 12 (30:11):
They die by the hundreds every year, not from mortal wounds,
but neglected wounds, not from incompetence or indifference, but from time.
Speaker 11 (30:20):
From lack of time.
Speaker 12 (30:23):
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.
Speaker 1 (30:41):
He's looking directly into the camera right at those thirty
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 nine one one. And how
(31:04):
many of the calls in emergency do they respond to
with lights since.
Speaker 11 (31:10):
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 team of the first episode of 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.
(31:33):
There are a lot of paramedics who joined up for
those life threatening emergencies only to find out that eighty
five percent of the calls is holding somebody's hand.
Speaker 1 (31:43):
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 sire and 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.
(32:04):
So every fire is an urgent situation, and according to FEMA, anecdotally,
firefighter 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 twenty twenty three, less than four percent of
(32:24):
all nine one one calls firefighters responded to or 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,
(32:48):
They save time, but not that much, and things are
often less urgent than they appear.
Speaker 11 (32:54):
Sometimes that three to four minutes is clinically valuable. Most
of the time it's not.
Speaker 1 (33:00):
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.
Speaker 11 (33:12):
Seven and a half million records. Five point nine million
of those were non on known responses. We analyzed every
one of those and calculated the proportion that used lights
and sirens, and eighty five point eight eighty six percent
of them responded to the scene with lights and sirens.
Speaker 1 (33:30):
Oh my god.
Speaker 11 (33:31):
The fundamental question we ask is of those responses where
you use license sirens, how many of them did we
do something potentially life saving? And what we ended up
finding is six point nine percent of those nine one
one lights and sirens responses did we do something even
vaguely potentially life saving? And we were rather generous with
(33:54):
our description of what potentially life saving is.
Speaker 1 (33:58):
So this is crucial paramedics are responding with lights and
sirens to around eighty six percent of calls when only
seven percent of them are resulting any vaguely potentially life
saving intervention, So why were they urgent? That means that
in the United States, we're using lights and sirens somewhere
(34:20):
between eighty percent and ninety percent 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?
Speaker 11 (34:34):
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
ECO level calls, which are most likely to be life threatening,
(34:55):
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 eye problem. Zero point sixty
(35:17):
seven percent of those calls resulted in a potentially life
saving intervention.
Speaker 1 (35:22):
And how many people run hot to all of them?
Speaker 11 (35:26):
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.
Speaker 1 (35:36):
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.
Speaker 12 (35:46):
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.
Speaker 1 (35:55):
But those other things have come along. More doctors, advances
in the ways we take nine to one one calls, better,
in more emergency rooms, better in more emergency medicine, better,
and more paramedics. To you use Buyer's formula, we have
reduced distance. Paramedic units are all over the place now
(36:16):
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
nineteen seventies. 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 nine one one, there
(36:38):
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,
(37:01):
sky Met Live Rescue, Helicopter Heroes, Island Medics, Air Ambulance Er,
a show that was literally called 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.
Start them young.
Speaker 11 (37:22):
There is in emergency departments everywhere I see as there's
this concept called the 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 the sirens.
They're not doing the job.
Speaker 1 (37:43):
So Jarvis, like Buyer, reduced the use of lights and sirens.
He cut them by about a third. Did their response
time increase, Yes, by a median of six seconds, and
in the vast majority of cases, by less.
Speaker 11 (38:00):
So it's turning out it's not making that much of
a difference in we're being much safer.
Speaker 1 (38:05):
And this I realize this is purely in the realm
of hypothesis, but it seems to me common sensical that
were lights and sirens reserved for truly emergency use, you
would see a more potent reaction to them, and likely
then it would it could it could possibly decrease response times.
Speaker 11 (38:24):
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 in my pragmatic public health hat on
and say, absolutely, gid up. I absolutely think you'll see that.
Speaker 1 (38:39):
I like that hat. That's a very stylish hat. You're right,
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 responders who go to work to save lives
(38:59):
and wind up responding to everything as if it's a crisis,
wearing themselves out and losing their hearing in the process.
In twenty fifteen, fifteen one hundred 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,
(39:20):
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.
Speaker 7 (39:56):
That's right, I found out.
Speaker 1 (39:59):
Okay, I am approaching Davy's house, which is coincidentally directly
behind my us. I was just walking down my street
one day when an ambulance rushed by and I saw
this dopey yellow lab stiffening owl. I'd know that owl anywhere.
(40:21):
I rushed over and I was like, hey, I've got
a question about your dog. And his owner was very obliging.
His name is Joe. The dog's name Davy. And a
while later I came by their house for an.
Speaker 6 (40:32):
Interview that was very satisfied, said, I got.
Speaker 1 (40:47):
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 am curious if
you could tell me about when you realize that you
had a sort of eccentric dog.
Speaker 10 (41:08):
Well, yes, 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
(41:30):
that before.
Speaker 1 (41:31):
It turns out Davey is starting a movement.
Speaker 10 (41:33):
His dog walker always like posts like sends us emails
like describing their walk. So you know, sometimes Davey has
gotten his his co his co partners in walking to
the other dogs to start to howl with him.
Speaker 1 (41:47):
But he's always the first howler.
Speaker 10 (41:49):
It's definitely always the first towler. But I think he
has taught some of the other dogs like how to
maybe start doing this, so.
Speaker 1 (41:55):
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 Davy'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
(42:16):
given up yet. Do you share this view of Davy's
howel origins or what.
Speaker 5 (42:22):
So, there's there's another theory, which this is the one
I think I if I had to choose one, that
I would like to believe the most, it is. 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 like a
calling answer from a lost dog. That's another one of
(42:44):
the series. And that Davy is saying, we're over here.
Come on, lost buddy, this is where we are.
Speaker 10 (42:53):
He is a very name early dog and loves to hang.
Speaker 1 (42:57):
Jen and Joe are very name rely people. I'm glad
to know them now, even if their dog is a
huge disappointment. My anti siren Crusade saying, as he really
love 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
(43:18):
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. Davy's howl
isn't quite a spandrel if we're being banantic. 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
(43:40):
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.
Speaker 13 (43:56):
Who howls just because that's what he's always done.
Speaker 1 (44:20):
Revisionist History is produced by me Ben Mattah Haffrey, Nino Bird, Lawrence,
and Lucy Sullivan. Our editor is Karen Chakerji. Original scoring
and team by Louis Gara. Additional scoring by Jake Gorski.
Jacob Smith is our executive producer. Engineering by Marcelo di Olavera.
(44:42):
I relied on quite a few studies in researching this.
You put a link to the bibliography in the show
notes should you want any references for starting your own
local movement. Special things also to Douglas Koupas, whose work
helped launch the field of sign and reform studies, Mike Tageman,
Helen k Rosenthal, Steven Solomon, and Paul Bergman. I'm Ben
(45:09):
Mattah Haffrey, The really alarming music you're hearing right now
was composed by Davy's owner Joe Saba for the trailer
of the Michael Bay film Ambulance
Pushkin. Hey, last Archive listeners, it's Ben. I've been hard
at work on another show at Pushkin called Revisionist History,
and I've done four episodes for this most recent season
that I wanted to share with you too. They run
the gamut from an argument about why we don't need
emergency vehicle sirens as much as we think we do,
to a history of psychology involving some mischievous raccoons, and
(00:39):
a two part blowout about a big trade secrecy case
that turns on the top secret recipe for Thomas's English muffins.
We're going to be releasing one a week over in
this feed, and we're starting today with the episode about sirens.
You can find more episodes of Revisionist History wherever you
get your podcasts. Thanks for listening and enjoy.
Speaker 2 (01:02):
Hello. Hello everyone. This is the first of what are
going to be a couple of episodes in this mini
season from my colleague Benadaph Haffray. 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.
(01:25):
Ben started telling me the 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 J. Gould, The spandrel is a thing
that doesn't have a function, but which hangs around like
a random hitchhiker, because it happens to be riding along
(01:46):
with things that do have a function, like your ear lobes.
I mean, what are they there for? Doesn't it seem
like they were all just along for the ride with
a 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.
(02:11):
My name is Malcolm Gladwell. This is Revisionist History, my
podcast about things overlooked and misunderstood. In this episode, my
colleague Ben the daf 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,
(02:36):
about sirens.
Speaker 1 (02:51):
Walk me through, No, you really do walk me 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.
Speaker 3 (03:04):
This is a log that you created. Although I am
rippers 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.
Speaker 1 (03:19):
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 fifteen, sometimes from trucks bearing
I assume one sprig of artismal basel. Next door, there's
a noisy playground and crucially a fire station, a really
active fire station. What happens is the grocery store trucks
(03:41):
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.
(04:01):
We counted from nine am till ten at night, and
we heard a siren twenty four times twenty four times
in 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.
Speaker 3 (04:19):
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.
Speaker 1 (04:30):
I don't mean this. I could get enough of this
in my job. I don't hear from you. I will
confess that the spreadsheet, consisting of mauv 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
(04:51):
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 one hundred and ten decibels
to over one hundred and thirty. That is ear damagingly loud.
The classic fire sirens sound like what you hear in
your head. If you imagine a fire truck right now,
is called the Federal Q TWOV and it's a whopping
(05:13):
one hundred and twenty three decibels at one hundred feet 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.
Speaker 4 (05:27):
As we say, it's not a fire truck unless it's got.
Speaker 1 (05:30):
A key siren. According to a helpful chart from Yale University,
one hundred and twenty three decibels is just two decibels
(05:53):
lower than the point at which quote 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
(06:15):
we have heard the siren.
Speaker 3 (06:17):
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 lodged for front
and back, so that's when you know it's a really
big sire.
Speaker 1 (06:30):
There's also a field for reporter Ben slash Julia and
another for notes, and then what is the final column.
Speaker 3 (06:38):
The final column is called dog question mark.
Speaker 1 (06:41):
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
(07:03):
dog who, by the standards of people on my block,
is practically famous. Have you heard a dog who howls
every time the sirens go off? Yeah? I have.
Speaker 5 (07:12):
I mean, they're pretty consistent with it.
Speaker 1 (07:13):
They're they're dedicated to their.
Speaker 5 (07:17):
Howling.
Speaker 4 (07:18):
I think I feel like my wife has heard the dog.
Speaker 6 (07:20):
But does a guy Kevin that lives after that garage
right there.
Speaker 1 (07:25):
And he does so, he's talked about this dog heare Yeah,
what does he say?
Speaker 7 (07:29):
Oh, he's ready to do.
Speaker 1 (07:32):
Something about it.
Speaker 3 (07:33):
It starts really low and guttural.
Speaker 1 (07:35):
I thought it was like a wearwolf or something. I
decided to take a too pronged approach to my siren
problem planet. 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.
(07:59):
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.
(08:21):
So I pushed ahead with plan a noise research, which
led me straight to doctor Arlene Bronze Aft.
Speaker 8 (08:31):
We're going to take you into the noise room.
Speaker 1 (08:33):
What's the noise room?
Speaker 9 (08:34):
Oh?
Speaker 8 (08:34):
Okay, no, see when you get there, sir.
Speaker 1 (08:36):
Doctor Bronze Aft is an eighty nine 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
(09:00):
to her noise room. The noise room sounds possibly like
the opposite of what I mean.
Speaker 8 (09:05):
Let me tell you it is a very quiet room.
Speaker 4 (09:13):
This is quiet.
Speaker 1 (09:15):
Wow. How did you get it so quiet? Oh?
Speaker 8 (09:18):
Did I help make it quiet? The answer, yes, I
did have a role and making it quieter than it
would have been. Can you see the cooling units? Are
they all closed?
Speaker 1 (09:30):
Yep?
Speaker 8 (09:31):
Who anything made that request?
Speaker 1 (09:33):
Bronze Aft started her work during the golden age of
noise control the nineteen seventies, when the EPA began regulating noise.
Early work demonstrated that noise isn't just annoying, They 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 two thousand and seven.
Speaker 8 (09:52):
In fact, it was my suggestion that they updated, it
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 critical and that includes mental health as
(10:13):
well in learning.
Speaker 1 (10:15):
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 and overall noise to
significantly increased risk of heart disease, to say nothing of stress,
poor sleep and its associated ailments, and crucially the effective
noise on exasperated podcasters.
Speaker 8 (10:37):
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, aren't they. The point is, if
(10:58):
Europe could have quiet at once, you could come up
with a method of quieting the sirens and still be
as effective. I have not seen a st I had
shown that if you have a less offensive intrusive siren
that more people will die.
Speaker 4 (11:17):
Have you no so here I am.
Speaker 8 (11:20):
I'm a data person, Show me the data.
Speaker 1 (11:26):
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 believe that that data was going to
(11:46):
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 sirens existence.
We'll be right back. Barrion County, Michigan, sits on the
(12:21):
southeastern shore of Lake Michigan. It's not too far from Kalamazoo,
quaint lake front towns, golf courses, quiet unless you work
as a paramedic.
Speaker 4 (12:32):
I have like four jobs because it doesn't everyone, and
I'm like, right now, I'm at the Burrian County Health Department.
Speaker 1 (12:38):
Jonathan Byer, former EMT and now medical director for the
Barrion County Health Department.
Speaker 4 (12:44):
I am not speaking on behalf of the Barrion County
Health Department.
Speaker 1 (12:48):
Buyer was a boy scout, scrupulous. The reason he was
speaking to me is because, in his capacity as the
EMS medical director of the Barrion County Medical Control Authority,
he is responsible for the ambulances of Barrion 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.
Speaker 4 (13:10):
There is no evidence that lights and sirens helps anybody.
There's plenty of evidence that it hurts people.
Speaker 1 (13:15):
No evidence that lights and sirens helps anybody. This, even
to me, an inveterate complainer about sirens, was a huge surprise.
Speaker 4 (13:23):
I started life as a paramedic before I got demoted
to doctor. I was a paramedic for eleven years and
when I was a paramedic in the Philadelphia area. We
respotted lights and sirens to everything. Like you called nine
to one, we just let you know, there we go.
When I got here to Michigan, they had two sets
(13:43):
of priorities, Priority one in Priority two.
Speaker 1 (13:46):
A lot of ems across the country has a similar
kind of tiered intake system, a way to rank every
incoming nine to one one call based not on its
importance but on its time sensitivity. In Barryon County, they
would tag a call with priority one or two, depending
on what the issue was.
Speaker 4 (14:05):
There are more calls for service than there are ambulances,
so we have to find some way to prioritize.
Speaker 1 (14:10):
Except the system wasn't really working.
Speaker 4 (14:14):
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. Well,
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
(14:36):
making hard to breathe. We were about fifty to fifty
for Priority ones, which were lights and sirens, and Priority twos,
which were not lights and sirens. Speed of traffic.
Speaker 1 (14:45):
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
(15:08):
it's a little more complicated than that.
Speaker 4 (15:10):
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.
Speaker 1 (15:21):
Specifically, it increases your chance of an accident by over
fifty percent, which is crazy. This is according to a
peer reviewed twenty nineteen 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
(15:42):
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.
Speaker 4 (15:53):
I started going, why are we responding to dental pain
priority one? So myself 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 determined codes, going
does that really need priority one?
Speaker 1 (16:12):
So there's the accident's 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 forty two seconds and three minutes and
forty eight seconds. It's about one and a half minutes
(16:34):
of savings if you're in a city, and a little
over three and a half minutes if you're in the country.
Speaker 4 (16:39):
On average, Yes, it's about forty five seconds or three minutes.
Speaker 1 (16:43):
And there are that's not a critical that's not a
critical interval most of the time for.
Speaker 4 (16:49):
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 every minute that you go without
CPR being done, there's about a ten percent increase in
mortality and decrease in survivable brain fusction come in.
Speaker 1 (17:07):
That's huge. Yeah, so that's huge. 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 Buyer to do something big.
He restructured the tears.
Speaker 4 (17:25):
I tell the medics, and this is how I presented
it is consider lights and sirens a medical therapy. Right,
there's 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 upin effort, well,
why would I give you epin effort? And the benefits
have to outweigh the risks. So I wanted to think
of lights and sirens that way. It is a high
(17:46):
risk procedure. When are we going to do it when
the risks are outweighed by the benefits.
Speaker 1 (17:52):
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.
Speaker 4 (18:01):
Sirens, 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
(18:23):
going to make a difference in that person's outcome.
Speaker 1 (18:26):
No, So with all this data, Buyer and his team
changed how the calls were coded.
Speaker 4 (18:33):
I wiped out about fifty percent of the Priority one
calls in Burying ount.
Speaker 1 (18:38):
Let that sink in ambulance lights and sirrons in Barrion
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
(18:58):
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 It was the same number. Wow, there was
basically no difference. As in, he halved the number of
(19:21):
lights and sirens responses in Barrion County. He reduced the
risk of accidents as a result, and it cost the
people of Barrion County nothing.
Speaker 4 (19:34):
When I instituted the change, I didn't really have much
of a problem. Nine to one one 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 were going on are not.
Speaker 1 (19:49):
Priority buyers on board, the paramedics are on board. Smooth sailing,
except what ended up happening.
Speaker 4 (19:56):
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 Burying County medical control is killing
(20:17):
people with slow responses, and oh.
Speaker 1 (20:20):
Boy, unbeknownst to Bayer, word had gotten out to the
people who call ambulances big problem.
Speaker 10 (20:29):
If you're drive in Barrian County, you won't see as
many lights and sirens as you're driving. Ambulances will be
using them only for time sensitive cases like a heart attack.
Speaker 1 (20:37):
The local news began doing man on the street interviews.
Speaker 4 (20:40):
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.
Speaker 1 (20:48):
Explode over what did they say?
Speaker 4 (20:50):
It's like, I can't believe this, and you know that
this is terrible. Of course I weren't an ambulance there
fast and the hospital started getting a lot of flak.
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.
Speaker 1 (21:08):
At the time, though Byer was blissfully unaware any of
this was happening. Other jobs were keeping him very busy.
But then one morning he got a call.
Speaker 4 (21:18):
I had done a six p to two am shift
and at eight am I got a call from the
administrative assistant to the CEO of the hospital. Hi, there,
doctor Buyer, it's eight am. What are you doing at
eight thirty? I'm like, and I'm still swaking up because
again I've had four hours of sleep, And she's like,
doctor Hamill. At that point, the CEO of the hospital
(21:38):
would like to speak to you.
Speaker 1 (21:40):
Buyer gets dressed in hurries to doctor Hamill's office.
Speaker 4 (21:43):
And I'm met by them in the hospital attorney and
being shown this Facebook page and they're like, what did
you do? This is terrible?
Speaker 1 (21:52):
Buyer stunned, and then he begins to lay out the
case against sirens in a very doctor buyer way.
Speaker 4 (21:59):
I tried to explain what I had done. Is have
you ever taken physics?
Speaker 1 (22:05):
Buyer explained his move, maybe a little inefficiently, by using
the equation for velocity distance divided by time changed to
solve for time or tea. 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
(22:26):
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 tea. Does time really
need to come down by the small increment that we
(22:48):
now know lights and sirens is going to reduce it?
Not for most things.
Speaker 4 (22:52):
I showed him some of the studies. He's like, your
science is sound. You may you go next time do
a press conference. Oh, I had a press conference, which
is what you saw online.
Speaker 1 (23:01):
Buyer confronted the outrage masses.
Speaker 4 (23:04):
And once that went out, all complaints disappeared in six
weeks and I've heard not a thing since then. In fact,
now we are considered we right now are the leader
in Michigan for the lowest rates of lights and sirens
use in the state of Michigan for ems.
Speaker 1 (23:16):
Things worked out for Buyer in the end, But I'm
interested in that initial freak out 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 does
(23:38):
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, Barrion County is just
one place, approximately twenty thousand MS calls a year, and
(24:01):
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
(24:22):
place we fell in love with EMS once upon a time.
We'll be right back.
Speaker 11 (24:41):
If you would have asked eighteen 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 eighteen anymore.
Speaker 1 (24:54):
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
fourteen surrounding cities. He's been a param since the nineteen eighties,
he served around New York City in Austin. So eighteen
(25:14):
year old Jeff who's made his decision to begin to
be a paramedic. So let me ask you. Let me
ask you a question. In the nineteen seventies, did you
ever watch the television show Emergency?
Speaker 6 (25:27):
Oh?
Speaker 1 (25:27):
Of course, and did that have an effect on your
becoming a paramedic?
Speaker 7 (25:32):
It did.
Speaker 11 (25:33):
I thought it was the coolest thing ever.
Speaker 1 (25:35):
In nineteen seventy two, 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
(25:56):
Johnny and Roy, two young paramedics working out of fire
Station fifty one in Los Angeles, except they're not paramedics
in the beginning that special training program.
Speaker 12 (26:06):
Remember we were talking about it a couple of days ago.
Speaker 9 (26:08):
Answer the or something or other paramedics.
Speaker 1 (26:13):
The series begins in a world where there basically aren't
any paramedics, which was our world fifty three years ago.
Fifty three years in nineteen seventy one, there were a
slim twelve 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
(26:35):
to give someone medical care if you weren't a doctor
or a nurse. So about fifty percent of ambulances were
just purses 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
(26:58):
was a show dreamed up in partnership with the father
of modern ms, 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 thirty million viewers at a time, not a few
(27:19):
of whom became paramedics.
Speaker 12 (27:21):
People are dying at the scene, people who could stay
alive if there was somebody on the spot who knew
what to do.
Speaker 9 (27:26):
Look, if that bill passed the legislature today, do you
know how many people we'd have ready for the job?
Speaker 11 (27:32):
Six men for six and a half million people.
Speaker 1 (27:34):
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 nine
to one one call is.
Speaker 12 (27:52):
We almost head him back. Damn it, we almost head
him back if you.
Speaker 9 (27:56):
Could have been to fibrillated the moment they pulled him
off the wire.
Speaker 1 (27:59):
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.
Speaker 12 (28:11):
Somebody should have been there with a machine in their bucket,
not somebody the paramedics again.
Speaker 9 (28:19):
Paul, and 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.
Speaker 12 (28:27):
Now, I won't use this situation that justifies sending amaters
out the practice medicine on the street.
Speaker 9 (28:32):
Trained amaters, trained by you, and doctors.
Speaker 12 (28:35):
Like you, amateurs, Dixie. I spent twelve years in school
and residency, and I'm still learning my trade.
Speaker 1 (28:41):
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
(29:02):
could possibly be a success.
Speaker 12 (29:07):
Well or or may not function as well as it
used to. At least it'll be your own You're getting
out here as fast as you did.
Speaker 1 (29:13):
Made the difference Brandy to have her own doc. Gotta
give us a try. Bergmann, 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
(29:33):
early years of the show, forty six 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.
Speaker 12 (29:57):
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.
Speaker 1 (30:06):
This is from the second part of the pilot episode,
when the skeptical doctor has come around.
Speaker 12 (30:11):
They die by the hundreds every year, not from mortal wounds,
but neglected wounds, not from incompetence or indifference, but from time.
Speaker 11 (30:20):
From lack of time.
Speaker 12 (30:23):
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.
Speaker 1 (30:41):
He's looking directly into the camera right at those thirty
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 nine one one. And how
(31:04):
many of the calls in emergency do they respond to
with lights since.
Speaker 11 (31:10):
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 team of the first episode of 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.
(31:33):
There are a lot of paramedics who joined up for
those life threatening emergencies only to find out that eighty
five percent of the calls is holding somebody's hand.
Speaker 1 (31:43):
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 sire and 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.
(32:04):
So every fire is an urgent situation, and according to FEMA, anecdotally,
firefighter 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 twenty twenty three, less than four percent of
(32:24):
all nine one one calls firefighters responded to or 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,
(32:48):
They save time, but not that much, and things are
often less urgent than they appear.
Speaker 11 (32:54):
Sometimes that three to four minutes is clinically valuable. Most
of the time it's not.
Speaker 1 (33:00):
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.
Speaker 11 (33:12):
Seven and a half million records. Five point nine million
of those were non on known responses. We analyzed every
one of those and calculated the proportion that used lights
and sirens, and eighty five point eight eighty six percent
of them responded to the scene with lights and sirens.
Speaker 1 (33:30):
Oh my god.
Speaker 11 (33:31):
The fundamental question we ask is of those responses where
you use license sirens, how many of them did we
do something potentially life saving? And what we ended up
finding is six point nine percent of those nine one
one lights and sirens responses did we do something even
vaguely potentially life saving? And we were rather generous with
(33:54):
our description of what potentially life saving is.
Speaker 1 (33:58):
So this is crucial paramedics are responding with lights and
sirens to around eighty six percent of calls when only
seven percent of them are resulting any vaguely potentially life
saving intervention, So why were they urgent? That means that
in the United States, we're using lights and sirens somewhere
(34:20):
between eighty percent and ninety percent 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?
Speaker 11 (34:34):
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
ECO level calls, which are most likely to be life threatening,
(34:55):
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 eye problem. Zero point sixty
(35:17):
seven percent of those calls resulted in a potentially life
saving intervention.
Speaker 1 (35:22):
And how many people run hot to all of them?
Speaker 11 (35:26):
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.
Speaker 1 (35:36):
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.
Speaker 12 (35:46):
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.
Speaker 1 (35:55):
But those other things have come along. More doctors, advances
in the ways we take nine to one one calls, better,
in more emergency rooms, better in more emergency medicine, better,
and more paramedics. To you use Buyer's formula, we have
reduced distance. Paramedic units are all over the place now
(36:16):
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
nineteen seventies. 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 nine one one, there
(36:38):
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,
(37:01):
sky Met Live Rescue, Helicopter Heroes, Island Medics, Air Ambulance Er,
a show that was literally called 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.
Start them young.
Speaker 11 (37:22):
There is in emergency departments everywhere I see as there's
this concept called the 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 the sirens.
They're not doing the job.
Speaker 1 (37:43):
So Jarvis, like Buyer, reduced the use of lights and sirens.
He cut them by about a third. Did their response
time increase, Yes, by a median of six seconds, and
in the vast majority of cases, by less.
Speaker 11 (38:00):
So it's turning out it's not making that much of
a difference in we're being much safer.
Speaker 1 (38:05):
And this I realize this is purely in the realm
of hypothesis, but it seems to me common sensical that
were lights and sirens reserved for truly emergency use, you
would see a more potent reaction to them, and likely
then it would it could it could possibly decrease response times.
Speaker 11 (38:24):
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 in my pragmatic public health hat on
and say, absolutely, gid up. I absolutely think you'll see that.
Speaker 1 (38:39):
I like that hat. That's a very stylish hat. You're right,
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 responders who go to work to save lives
(38:59):
and wind up responding to everything as if it's a crisis,
wearing themselves out and losing their hearing in the process.
In twenty fifteen, fifteen one hundred 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,
(39:20):
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.
Speaker 7 (39:56):
That's right, I found out.
Speaker 1 (39:59):
Okay, I am approaching Davy's house, which is coincidentally directly
behind my us. I was just walking down my street
one day when an ambulance rushed by and I saw
this dopey yellow lab stiffening owl. I'd know that owl anywhere.
(40:21):
I rushed over and I was like, hey, I've got
a question about your dog. And his owner was very obliging.
His name is Joe. The dog's name Davy. And a
while later I came by their house for an.
Speaker 6 (40:32):
Interview that was very satisfied, said, I got.
Speaker 1 (40:47):
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 am curious if
you could tell me about when you realize that you
had a sort of eccentric dog.
Speaker 10 (41:08):
Well, yes, 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
(41:30):
that before.
Speaker 1 (41:31):
It turns out Davey is starting a movement.
Speaker 10 (41:33):
His dog walker always like posts like sends us emails
like describing their walk. So you know, sometimes Davey has
gotten his his co his co partners in walking to
the other dogs to start to howl with him.
Speaker 1 (41:47):
But he's always the first howler.
Speaker 10 (41:49):
It's definitely always the first towler. But I think he
has taught some of the other dogs like how to
maybe start doing this, so.
Speaker 1 (41:55):
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 Davy'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
(42:16):
given up yet. Do you share this view of Davy's
howel origins or what.
Speaker 5 (42:22):
So, there's there's another theory, which this is the one
I think I if I had to choose one, that
I would like to believe the most, it is. 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 like a
calling answer from a lost dog. That's another one of
(42:44):
the series. And that Davy is saying, we're over here.
Come on, lost buddy, this is where we are.
Speaker 10 (42:53):
He is a very name early dog and loves to hang.
Speaker 1 (42:57):
Jen and Joe are very name rely people. I'm glad
to know them now, even if their dog is a
huge disappointment. My anti siren Crusade saying, as he really
love 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
(43:18):
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. Davy's howl
isn't quite a spandrel if we're being banantic. 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
(43:40):
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.
Speaker 13 (43:56):
Who howls just because that's what he's always done.
Speaker 1 (44:20):
Revisionist History is produced by me Ben Mattah Haffrey, Nino Bird, Lawrence,
and Lucy Sullivan. Our editor is Karen Chakerji. Original scoring
and team by Louis Gara. Additional scoring by Jake Gorski.
Jacob Smith is our executive producer. Engineering by Marcelo di Olavera.
(44:42):
I relied on quite a few studies in researching this.
You put a link to the bibliography in the show
notes should you want any references for starting your own
local movement. Special things also to Douglas Koupas, whose work
helped launch the field of sign and reform studies, Mike Tageman,
Helen k Rosenthal, Steven Solomon, and Paul Bergman. I'm Ben
(45:09):
Mattah Haffrey, The really alarming music you're hearing right now
was composed by Davy's owner Joe Saba for the trailer
of the Michael Bay film Ambulance
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True Crime Tonight
If you eat, sleep, and breathe true crime, TRUE CRIME TONIGHT is serving up your nightly fix. Five nights a week, KT STUDIOS & iHEART RADIO invite listeners to pull up a seat for an unfiltered look at the biggest cases making headlines, celebrity scandals, and the trials everyone is watching. With a mix of expert analysis, hot takes, and listener call-ins, TRUE CRIME TONIGHT goes beyond the headlines to uncover the twists, turns, and unanswered questions that keep us all obsessed—because, at TRUE CRIME TONIGHT, there’s a seat for everyone. Whether breaking down crime scene forensics, scrutinizing serial killers, or debating the most binge-worthy true crime docs, True Crime Tonight is the fresh, fast-paced, and slightly addictive home for true crime lovers.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com