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 episode we ask how we got here in the first place. It’s a story involving a TV show from the 1970s, hearses serving as ambulances, and a dog with a big voice. You can see a list of the sources we consulted while making this episode here. Get ad-free episodes to Revisionist History by subscribing to Pushkin+ on Apple Podcasts or Pushkin.fm. Pushkin+ subscribers can access ad-free episodes, full audiobooks, exclusive binges, and bonus content for all Pushkin shows. Subscribe on Apple: apple.co/pushkinSubscribe on Pushkin: pushkin.fm/plusSee omnystudio.com/listener for privacy information.
Chapter 1: What is the main topic of this episode?
Pushkin. You're listening to an iHeart Podcast.
Chapter 2: Who is Ben-Nadav Hafri?
Hello, hello, everyone. This is the first of what are going to be a couple of episodes in this mini-season from my colleague, Ben-Nadav Hafri. Ben is the guy, when you're hiking through the wilderness, who says, let's go this way. And there's no trail. And you think, oh, I'm going to get eaten by bears. And then, no, you find some lost civilization and large piles of glittering gold.
Ben started telling me this story and I stopped him halfway through and I said, oh Ben, this is a spandrel. And what's a spandrel? One of my all-time favorite concepts invented by Stephen Jay Gould. The spandrel is the thing that doesn't have a function, but which hangs around like a random hitchhiker because it happens to be riding along with things that do have a function. Like your earlobes.
Chapter 3: What is a spandrel and how does it relate to sirens?
I mean, what are they there for? Doesn't it seem like they were all just along for the ride with the part of our ear that actually does useful things? Or your chin. What's up with the chin? We look at a spandrel and we assume there has to be a reason for it. And there isn't. They're just spandrels. My name is Malcolm Gladwell.
This is Revisionist History, my podcast about things overlooked and misunderstood. In this episode, my colleague Ben-Nadav Hafri investigates a spandrel you don't even realize you've been living with, something that none of us would ever think to question. Because it's such a bedrock part of our world, we all just assume it has to be there. And it doesn't. I'm talking, of course, about Sirens.
Sirens.
Walk me through. Oh, 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.
This is a log that you created, although I am represented in it. I think it looks like we only did it for one day of how many times we heard the siren and where we heard it. Wow, what a day.
Julia and I live opposite this grocery store that's all local, small batch, whatnot. So instead of getting just one delivery a day, they get, like, 15. Sometimes from trucks bearing, I assume, one sprig of artisanal basil. Next door, there's a noisy playground, and crucially, a fire station. A really active fire station.
What happens is the grocery store trucks block traffic, which means the fire trucks can't get out. And so, sirens. All the time. This, for me, as a writer, podcaster, and light sleeper, is a problem. So I decided to do some research. I made a spreadsheet. We counted from 9 a.m. till 10 at night, and we heard a siren 24 times. 24 times! And this is reliable data. Julia is a data scientist.
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Chapter 4: Why are sirens so loud?
You have?
I have. I mean, they're pretty consistent with it. They're dedicated to their howling. I feel like my wife has heard the dog.
But there's a guy, Kevin, that lives after that garage right there, and he does.
So he's talked about this dog to you?
Yeah.
What has he said?
Oh, he's ready to...
do something about it it starts really low and guttural i thought it was like a werewolf or something i decided to take a two-pronged approach to my siren problem plan a i had to see if i could prove that the sirens in my neighborhood were dangerously unnecessarily loud and plan b i needed a sympathetic face for my cause Nobody really cares about podcasters, but everybody cares about dogs.
And I had to assume that that dog was howling along with the siren because he was, like me, in serious pain. So, find the dog, stop the siren. It'd be that simple. Except the dog was not immediately forthcoming. So I pushed ahead with plan A, noise research, which led me straight to Dr. Arlene Bronzaft.
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Chapter 5: What does Dr. Arlene Bronzaft say about noise?
Bronzeaft started her work during the golden age of noise control, the 1970s, when the EPA began regulating noise. Her early work demonstrated that noise isn't just annoying, it can get in the way of kids learning in school. And she just kept going from there.
When the city updated its noise code in 2007... In fact, it was my suggestion that they update it. It carried quite a bit of weight. However, the literature that they were depending upon... It was older. So today we have much more solid literature on the link between noise and health. That's critical. And that includes mental health as well in learning.
That all checked out for me. Of course the sirens are too loud, but it can take a while for the research to make its way into policy. Now we have research linking even small changes in overall noise to significantly increased risk of heart disease. To say nothing of stress, poor sleep and its associated ailments, and crucially, the effect of noise on exasperated podcasters.
Now, you mentioned sirens. All right. That deals with safety. That deals with getting someone to the hospital on time. However, the sirens in Europe are less offensive, are less intrusive. European people aren't dying, are they? The point is, if Europe can have quieter ones, you could come up with a method of quieting the sirens and still be as effective.
I have not seen a study that has shown that if you have a less offensive intrusive siren, that more people will die. Have you? No. So here I am. I'm a data person. Show me the data.
I left that meeting full of hope. There's no doubt that sirens are dangerously loud. I just needed to find the data to back this up and figure out a new solution, like Arlene said. I went straight to the library and started digging around. But the more I saw about how clear it is already that these sirens are crazy, the less I believed that that data was going to make any difference in the world.
And then, I found a different set of data. Not something about noise, but something that undermined the very foundation of the siren's existence. We'll be right back. Berrien County, Michigan sits on the southeastern shore of Lake Michigan. It's not too far from Kalamazoo. Quaint lakefront towns, golf courses, quiet. Unless you work as a paramedic.
I have like four jobs because it doesn't everyone. And I'm like, right now I'm at the Berrien County Health Department.
Jonathan Beyer, former EMT and now medical director for the Berrien County Health Department.
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Chapter 6: What new emergency response strategies are being implemented?
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 determinant codes going, does that really need priority one?
So there's the accidents risk, but also, and this is really surprising, using lights and sirens doesn't actually save that much time on your route to the patient. For decades now, studies have shown that lights and sirens seem to save on average between 42 seconds and three minutes and 48 seconds.
It's about one and a half minutes of savings if you're in a city and a little over three and a half minutes if you're in the country on average.
Yes, it's about 45 seconds to three minutes.
And that's not a critical interval most of the time.
For most disease processes. Cardiac arrest is one that I would put in the, that time makes sense. Because in cardiac arrest, for every minute that you go without CPR being done, there's about a 10% increase in mortality and decrease in survivable brain function.
I mean, that's huge. Yeah, that is huge. But heart attacks are actually one of the few exceptions, not the rule. And yet they are the exception on which the rule is largely based. So all of these factors led Bayer to do something big. He restructured the tiers.
I tell the medics, and this is how I presented it, is consider lights and sirens a medical therapy. For every medicine that you give, there is an indication, and there's a contraindication. If I were going to say, I'm going to give you epinephrine, well, why would I give you epinephrine? And the benefits have to outweigh the risks. So I wanted to think of lights and sirens that way.
It is a high-risk procedure. When are we going to do it? When the risks are outweighed by the benefits.
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Chapter 7: How did the public react to changes in ambulance response?
Emergency was a show dreamed up in partnership with the father of modern EMS, a guy named James Page, who worked at one of the first firehouses with a paramedic unit in Los Angeles. And the show was literally meant to make the case for paramedics. Every Saturday night, nationwide, on NBC, 30 million viewers at a time, not a few of whom became paramedics.
People are dying at the scene. People who could stay alive if there was somebody on the spot who knew what to do. Look, if that bill passed the legislature today, do you know how many people we'd have ready for the job? Six men for six and a half million people.
I learned about emergency in a brilliant essay by UCLA emeritus law professor Paul Bergman, where he traces the profound influence the show had not just on paramedics, but on lawmakers too, by dramatizing just how urgent every single 911 call is.
We almost had him back. Damn it, we almost had him back. If he could have been defibrillated the moment they pulled him off the wire.
This is from the first episode, right after a maintenance man gets electrocuted and eventually dies. The doctor and nurse, who, by the way, are of course romantically involved, are talking.
Somebody should have been there with a machine in their pocket.
Not somebody.
The paramedics again?
Call them paramedics or rescue team, that doesn't matter. Cal, if somebody with the right equipment and trained to use it had gotten to this man in time, he'd be alive now.
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