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.
Journal of the American College of Emergency Physicians open · 2026-05-05 · Observational study
Abstract
OBJECTIVES: 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 < .001). L&S were associated with shorter door-to-CT (ratio estimate, 0.51; 95% CI, 0.46-0.56), but not with door-to-IVT (ratio estimate, 0.94; 95% CI, 0.82-1.08) nor door-to-EVT (ratio estimate, 1.03; 95% CI, 0.76-1.39). L&S were not associated with improved discharge outcomes. 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.