What question did this study set out to answer?

To assess the relationship between lights and sirens use and in-hospital stroke care timing and outcomes.

May 7, 2026Journal of the American College of Emergency Physicians Open0 citationsOpen Access

Prehospital Use of Lights and Sirens in Stroke Is Associated With Faster Door-to-CT Times but Not Door-to-Thrombolysis or Door-to-Endovascular Therapy Times

CWCourtney WhamUniversity of Colorado Denver DNDaria NickeUniversity of Colorado Denver IEIan S. EspinozaUniversity of Colorado Denver

Key Points

To assess the relationship between lights and sirens use and in-hospital stroke care timing and outcomes.
Retrospective cohort study of 3,161 patients identified by EMS with suspected stroke.
Data analyzed from the IMPACT network spanning 70 EMS agencies and 30 hospitals.
Multivariable regression models evaluated associations with door-to-CT, door-to-IVT, and door-to-EVT times, adjusting for confounders.
Logistic regression modeled the association between L&S and discharge disposition.
75.4% of patients were transported with lights and sirens.
Door-to-CT time was significantly shorter with lights and sirens (ratio estimate, 0.51).
No significant differences in door-to-IVT or door-to-EVT times with lights and sirens.
Lights and sirens did not improve discharge outcomes.

Abstract

AbstractObjectives Lights and sirens (L&S) during Emergency Medical Services (EMS) transport may shorten transport times and improve outcomes in acute stroke but carry significant roadway risk. This study assesses L&S and in-hospital stroke care, including door-to-CT, door-to-intravenous thrombolysis (IVT), door-to-endovascular thrombectomy (EVT), and discharge disposition. Methods This retrospective cohort study analyzed data from 2020 to 2022, including adult patients identified by EMS as having suspected stroke and who had a final diagnosis of stroke or transient ischemic attack. Data were collected from the IMPACT network (70 EMS agencies, 30 hospitals, 2 states). Multivariable regression modeled the association between L&S and door-to-CT, door-to-IVT, and door-to-EVT times, controlling for confounders. Logistic regression modeled the association between L&S and discharge disposition, adjusting for confounders and in-hospital intervention. Results Of 3,161 patients, 75.4% (n = 2384) were transported with L&S. Transport time with L&S was shorter than without (geometric mean 8.9 minutes 95% CI 8.7-9.1 vs 11.6 minutes 95% CI 11.0-12.1, p Conclusion While L&S were associated with faster door-to-CT times, they did not shorten time to IVT or EVT or improve discharge outcomes. These findings suggest that perceived urgency of L&S may prompt quicker imaging, but transport time savings are minimal and may not improve outcomes. Alternative EMS prenotification and hospital activation strategies merit consideration.

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