If you need to make your way through a crowded room, saying things like "excuse me" and "make way" will generally clear a path. The more urgent the need to get through, the louder the person says "make way" and the faster the path opens. That's pretty much the basis of running lights and sirens on apparatus and ambulances: make a lot of commotion and folks scatter.

Yet the dynamics of pushing a stretcher through an airport is worlds apart from hurling tons of iron into an intersection. There's no shortage of anecdotal evidence of how dangerous it is driving emergency vehicles. And statistically, vehicle crashes are the second-leading cause of firefighter deaths.

St. Louis Chief Dennis Jenkerson knows just how wrong things can go while responding to a scene. Last August two of the department's apparatus collided at an intersection while responding to a fire; both were running with lights and sirens. The problem in that case was that the intersection was the scene of the fire, and both drivers were looking for the best place to position the rig and not watching for cross traffic. Compounding matters were reports of trapped people and a traffic signal control system that didn't handle the competing signal changes.

"It was bad," Jenkerson says. "On film, everything pointed the finger at us, which it should have. We also have police responding on these calls and they are running lights and sirens. I would hate to see a fire truck hit a police car."

As dramatic as incidents like this are, they are still the exception to the rule. Billy Goldfeder is deputy chief of the Loveland-Symmes (Ohio) Fire Department, an EFO, chair of the International Association of Fire Chief's Safety, Health and Survival Section, and probably the nation's most-informed person when it comes to firefighter deaths and injuries. He says that when you remove emotion from the equation, the overall report card for the fire industry regarding apparatus crashes is very good.

"The fact is that in the millions of runs that fire departments do everyday, in the great majority of cases, we are doing fine," Goldfeder says. "We are not crashing on a daily basis. There are 1.1 million firefighters in the United States and there are 30 or so fatal crashes per year."

However, Goldfeder says vehicular deaths are the most preventable of all the ways firefighters die. "We need to slow down, put our seatbelts on, stop at stop signs and red lights, and we'll pretty much wipe that [death category] out," he says. "There are a couple of line-of-duty deaths each year where everything was done right. If you are doing everything right and a vehicle slams into yours, there's nothing you can do about it. [But] almost all of our vehicular line-of-duty deaths were preventable. Overall, the class is doing well. But some people are wearing dunce caps and we need to deal with those problems."

Several chiefs believe running lights and sirens contribute to these accidents.

"I'm not sure there is any research that will substantiate it, but in many cases, it will increase [drivers'] adrenalin," says Jeff Lindsey, a retired fire chief and currently the director of graduate studies at George Washington University. He co-authored a book on emergency-vehicle operations and wrote his Ph.D. dissertation on the use of simulation in emergency-vehicle driver training. One thing the statistics do bear out is that it is not the new drivers getting in the collisions.

"We looked at it and it was the individuals with five to 15 years of experience who were involved in most of the incidents," Lindsey says. Near the beginning of their careers, drivers are more cautions. Later, he says, they develop a halo effect where they believe nothing bad can happen to them in their bubble.

The National Fire Protection Association offers some guidelines in NFPA 1500, Chapter six. What it largely says is that all drivers are responsible for operating the apparatus safely and that departments need to establish policies on how that operation is conducted. It does say that an apparatus should not roll until all passengers are seated and buckled in with seatbelts. It also gives eight scenarios when a complete stop is needed.

Goldfeder places less emphasis on lights and sirens and more on training and responsibility. It comes down to risk management, he says. He says departments need to develop a driving policy, train their drivers both in class and in the rig on that policy, have supervisors in place to enforce the policy, and use corrective actions when the policy is broken. He also says it is important for the driver to have the discipline or restraint to understand and follow the policy.

"We can't control what happens outside the cab, but we totally control what happens inside the cab," Goldfeder says.