The Paramedic Case for Safer Streets

By Jules Mattsson, Student Paramedic and committee member of the London Cycling Campaign in Hackney



An ambulance response car uses a protected cycle lane to bypass general traffic. Picture: Cyclingmikey

As the Covid-19 pandemic continues, one big change for residents of towns and cities has been how we get around. With public transport capacity reduced, many took to private cars to avoid the guy wearing a mask under his chin while sitting opposite you on the train. Unfortunately, if this trend had continued we were heading towards long-term gridlock - so urgent action was needed to enable alternatives like walking and cycling.

Fast forward a few months and we’ve seen Low Traffic Neighbourhoods (LTNs) and pop-up bike lanes appear across the country, following new government guidelines. LTNs use filters to calm residential streets - preserving vehicle access to all addresses but removing through routes (Living Streets, 2020) and improving space for social distancing - while protected lanes make cycling a safer (Lusk et al, 2011) and more attractive (Hull and O’Holleran, 2014) transport option. These trials started with public consultation running alongside rather than before them, unusually, and have not been without controversy.

A recent headline read “Top paramedic warns bike lanes are holding up ambulances in traffic jams” - with the newspaper describing them as “paralysing Britain” - while concerns over the emergency services are often cited by LTN opponents. I suspect many have horror stories of emergency responses being delayed by the sheer weight of traffic, dodgy parking, and questionable drivers - but these seem to be accepted as inevitable. Our field strives for evidence-based practice, so I’d like to examine the evidence for bold changes towards safer, healthier streets.

We know how time critical certain calls are, this is reflected in the College’s concern that LTNs and bike lanes could delay ambulances, but well-designed infrastructure can actually enable quicker response. In Walthamstow, London since a series of LTN-like schemes were installed in 2014 - Fire Brigade response times actually went down (LFB, 2020) while King’s College (2018) researchers found that life expectancy for local residents went up. Both of these changes are likely to be, simply, the result of fewer vehicles on the area’s roads.

With cycle lanes, as well as encouraging people out of cars and onto more space efficient bikes for shorter journeys, wide segregated lanes can be accessed by ambulance vehicles to bypass traffic. Narrower lanes that replace parked cars with bendy bollards, meanwhile, make it easier for drivers to pull aside and well-designed LTNs have seen emergency services able to fly through streets that previously suffered localised gridlock.

A London ambulance passes through an ANPR traffic filter. Picture: Oval LTN

It’s fair to say that recent changes have been of varying quality. Some LTNs use Automatic Number Plate Recognition (ANPR) filters to ensure rapid emergency access via any route, while others have cheaper unlockable bollards and specific unfiltered routes for emergency vehicles - which are sometimes defeated by outdated ambulance navigation systems.

The use of ‘hard’ point closures like bollards and planters often forms part of the design mix, but unlocking bollards if the standard entry/exit points are unsuitable takes time - so permeable ANPR filters at key access points would likely be preferable for response driving. Though there is a lack of published research on the interaction between emergency responders and LTNs, ambulance services are among the consulted bodies who must be involved in a scheme’s design. Many UK cities have historic LTNs (Laker, 2020), with no documented emergency access issues for these areas.

Since the advent of apps like Waze, traffic using minor residential streets has increased by around 20 billion vehicle miles in ten years (DfT, 2020a), with every mile driven on a minor urban road posing a greater risk of pedestrian injury than if it was on an A road (Aldred, 2019). Residential streets cannot safely cope with so many drivers following satnavs along any available shortcut, so LTNs reduce this overflow of the main road network.

A graph showing the increase in traffic on minor roads, from

Main roads will often see some initial increase in vehicles as a result of LTNs, where volume traffic had previously been displaced onto unsuitable minor roads. As alternatives to driving are made easier and short car journeys made harder through infrastructure changes, residents tend to reduce their car use (Aldred, 2020). This paradoxical phenomenon of evaporating traffic (Cairns et al, 2002) has, in previous schemes, seen main road volumes level out or decrease over time - with a large overall reduction in traffic across an area (LCC, 2020). The resulting drop in traffic numbers frees up road space for those of us who need it.

In public health terms, air pollution has been called this country’s “largest environmental risk” to health, linked to tens of thousands of annual deaths (PHE, 2019). In London, for example, vehicles are the single biggest cause and our children lose around 10% of their lung capacity to pollution (TfL, no date). Considering the particulate emissions from tyres and brakes, a shift towards electric vehicles alone cannot negate this harm. LTNs reduce air pollution in residential areas by stopping ‘rat running’ and discouraging driving short distances - while infrastructure for alternatives to driving facilitates this broader ‘modal shift’ away from cars.

A lot of work goes into improving outcomes from trauma, the world’s leading cause of death and disability for under 40s (Krug et al, 2000), but we must also look at root causes. According to injury data, a third of major trauma in the UK is still caused by Road Traffic Collisions (Kehoe et al, 2015). In 2018/19, adult and child pedestrians and cyclists made up 37% of those killed and seriously injured in British collisions (DfT, 2019), showing the need for safer street design. This is reflected in the fact that all of London’s Major Trauma Centres have previously called for more protected bike lanes in the city (Kenyon, 2014).

We are also in an obesity and inactivity crisis, with physical inactivity behind one in six UK deaths, childhood obesity on the rise and our population’s movement levels declining over time (PHE, 2016). So-called ‘active travel’ is an important solution, incorporating exercise into daily life, and has been shown to significantly improve health (Celis-Morales et al, 2017). There’s an abundance of evidence (CeGB, 2020) suggesting the main barriers to active travel are safety perceptions. A recent government survey found 66% of English adults felt "it is too dangerous for me to cycle on the roads" (DfT, 2020b). Compare this to the Netherlands, where protests over children killed by cars were a catalyst for protected infrastructure - and cycling is now commonplace (van der Zee, 2015).

Such are the strengths of the health arguments in favour of street design interventions, many of which were also called for by NHS leaders to help their staff travel safely during the Covid pandemic (Kelly, 2020), that healthcare providers are now getting involved themselves in creating new schemes. There are three newly proposed LTNs in deprived parts of South London which are to be part-funded and studied by Guy's and St Thomas' NHS trust’s charity - to help tackle childhood obesity and air pollution around local schools (Salisbury, 2020).

New schemes need to be bold to be effective, and need time to work, but have already shown their worth. Paramedics see the harms of traumatic injury, preventable illness and congestion every day. We have an important voice in the future of our streets - which are now changing rapidly.

We must be part of the conversation, ensuring the needs of the emergency services are a key part of new designs, but the evidence suggests we should avoid joining the chorus of voices that stand against change altogether. The status quo isn’t working, so let’s stand up against preventable harm, and for better public health.

Author: Jules Mattsson, Student Paramedic and committee member of the London Cycling Campaign in Hackney. Twitter: @julesmattsson

Reference list:

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