Visitors look at a first responder Lotus car at the Gitex Technology week in Dubai on October 15, 2014 . Dubai Ambulance added the sports Lotus car in addition to the two Ford Mustangs to its fleet and they are fitted with 60 per cent of the medical equipment that you would find in a normal full size ambulance. Karim Sahib / AFP / Getty Images
Paramedics in Dubai soon may have a much faster way to reach accidents: a Lotus Evora that can hit 162 mph. If Dubai’s hulking ambulances take about eight minutes to respond to an emergency, a sports car that’s twice as fast can get there in half the time, right?
That seems to be the thinking in the most populous city of the United Arab Emirates, which is seriously considering using an Evora and a pair of Ford Mustangs as emergency response vehicles, getting a paramedic and his equipment to scene to stabilize a patient before the slower ambulance arrives. “We can handle all kinds of emergencies” Zaid Al Mamari, a paramedic with the government-run Dubai Corporation for Ambulance Services, told The National . The plan is to start by showcasing the Evora in tourist areas, then move on to deploying it, though Al Mamari did not say when.
Now, it’s possible Dubai won’t ever put the 276-horsepower Evora and the 300- to 435-horsepower Mustangs into service. Maybe the paramedics got jealous when the police were handed a fleet of supercars, and is doing this to get free driving lessons. That might be for the best, because as fun as this sounds, turning sports cars into emergency response vehicles may not be the best idea Dubai’s ever had. That’s because not only do response times matter far less than we think they do, focusing on getting to those in need at top speed can make things worse.
“It’s cool and it has some good PR value, but clinically, it’s not going to make a difference,” says Matt Zavadksy, director of public affairs at MedStar Mobile Healthcare, which provides ambulance services for Fort Worth and other cities in North Texas. That’s because more and more research shows that response time isn’t a good measure of how patients will fare. “Any response time over five minutes does not make a difference in the patient’s outcome,” Zavadsky says, as long as first responders arrive within 15 minutes or so. The shortest possible response time matters only in cases involving cardiac arrest, and even the best EMS team in the fastest vehicle can’t move that quickly, Zavadsky says.
He’s backed up by research from the U.S. Metropolitan Municipalities EMS Medical Directors Consortium, a group of experts from around the country (they’re also called the “Eagle’s Coalition” for reasons we’re not quite sure of, but okay). “The association of [response-time intervals] with patient outcomes is not supported explicitly by the medical literature,” the group wrote in a 2008 report. The following year, Elizabeth Ty Wilde at Columbia University wrote, “current medical research does not actually show a significant relationship between response time and mortality.”
If that’s so, why do we see such emphasis on how quickly first responders reach the scene? In California, response times are a significant factor in awarding contracts to ambulance companies. In recent years, New York, Chicago, Philadelphia, Denver, and Washington, D.C., among others, have been criticized for “slow” response times. Zavadsky blames this focus on the fact response times are easy to track, and have been ingrained in our collective mind as something that matters.
Dubai and other cities would be better off focusing on collecting more data on clinical outcomes, Zavadsky says. “We need to measure the things that matter,” like how the choice and quality of treatment—not just how quickly it’s delivered—correlate to survival rates. The UK’s National Health Service, for example, financially incentivizes emergency services based on “a more rounded view of clinical outcomes.”
So Dubai’s Evora idea doesn’t seem like a great way to improve public heath. But it could easily make things worse. If a patient is on one side of the Mojave Desert and the responder is on the other, a sports car that can hit 160 mph might be helpful, Zavadsky says. But emergency response vehicles don’t cross deserts, they cross cities. Cities with people and cars and buses and all manner of other obstacles. A car capable of neck-snapping acceleration and triple-digit velocity is of little use when cross-town traffic is stop-and-go.
“Overemphasis on response-time interval metrics may lead to unintended, but harmful, consequences (e.g., emergency vehicle crashes) and an undeserved confidence in quality and performance,” the Eagle’s Coalition report says. Between 1992 and 2011 in the U.S., there were roughly 4,500 crashes involving ambulances each year. It’s a good bet adding cars that go from 0 to 60 mph in under five seconds, piloted at full tilt by paramedics—not professional drivers—won’t push those numbers down.
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