Clogged arteries: the unseen cost of road-blocking protests

Recent events in Israel and Gaza have sparked a wave of protests, with some activists in major cities using a familiar tactic: obstructing traffic.

While this seems to have been an effective strategy by protesters across the political spectrum to draw attention to a variety of issues in recent years — including racial injustice, climate change, and pandemic restrictions — these protests raise an important question: At what cost do these disruptions come?

Speaking to the Los Angeles Times about a demonstration disrupting traffic at the Los Angeles airport recently, Michael Beer, the director of Nonviolence International, said that it can be hard for protesters to cut through the media environment without disruptive action like blocking traffic. He then added, “But you have to think: Are you stopping the ambulance from getting to a hospital and somebody’s going to die?”

Research on road closures suggests the answer is probably yes.

A study by one of us examining the impact of road closures brought on by marathons in major cities found that death rates for elderly patients with major cardiac emergencies — like heart attacks or cardiac arrest — were 13.3% higher on marathon days compared with typical days. The best explanation for this finding? Ambulances took longer to get patients to the hospital. The study found that the average time required by ambulances to transport patients to the hospital increased by about 32% on marathon days.

Traffic-blocking protests, of course, are different from marathons. They may not span 26.2 miles, but on the other hand, the goal is to be disruptive. They are unannounced, they tend to occur during busy rush hours when traffic blockages can easily spread and amplify, and their locations are chosen to be the most disruptive. The result is a situation that could easily lead to significant ambulance delays.

There is a saying in medicine that when it comes to the heart, “time is tissue.” During a heart attack or a cardiac arrest, the heart itself receives insufficient amounts of oxygen without proper treatment. Without oxygen, the heart’s muscle cells die off, exacerbating the underlying problem and potentially leading to death. The same principle is true for many life-threatening diseases: Time matters.

It’s important to clear the way for ambulances because even minor delays in definitive, hospital-based treatment can be potentially deadly. And while lights and sirens can help, ambulances, and the patients inside them, are not immune to delays brought on by roadway congestion.

In preparation for marathons, parades, permitted protests, or other large-scale events where roads are closed, municipalities can adjust to ensure emergency medical services can still provide service to the community. For example, when one tunnel under Boston Harbor was closed for construction this summer, emergency medical services made plans to add additional services to affected areas and facilitated emergency transport to hospitals. But even with preparation, patients with serious emergencies can still suffer from traffic delays. After all, the effect seen in the marathon study was despite local emergency services’ advance planning — which can’t happen with unannounced highly disruptive protests.

The issue at hand, of course, is not the right to protest; non-violent protest is a cornerstone of our democracy and our American identity. But a commonsense extrapolation of the marathon study, and other studies that illustrate how mere minutes matter in medical emergencies, tells us that even when the protest itself is peaceful and protesters clear the way for ambulances or other emergency vehicles, transit times will still be longer, particularly when accounting for the ripple effects that a blockage in one area can cause for motorists miles away.

If activists are indeed committed to peaceful protest, they must be cognizant of the real harms of road-blocking protests that are more problematic than a simple nuisance to commuters, nearby businesses, and others. It is unlikely that protesters would ever find out if an ambulance was delayed and a patient was physically harmed or died as a result of that delay. If protesters were aware of the extent to which those with life-threatening medical emergencies could be dying as a result of their blockade, would they choose differently?

The way in which protests are organized, conducted, and regulated should at a minimum consider the very real harms to health that such protests create. A municipality’s duty is to ensure public safety, which is why protests involving road closures often require advance permitting, to reduce the safety risks a demonstration may impose on others. Rights to protest are thus not without limitations, as the American Civil Liberties Union has noted: “You don’t need a permit to march in the streets or on sidewalks, as long as marchers don’t obstruct car or pedestrian traffic. If you don’t have a permit, police officers can ask you to move to the side of a street or sidewalk to let others pass or for safety reasons.”

Both protesters and law enforcement should recognize and act as if the harms to health posed by road-blocking protests aren’t theoretical — because they are not.

Christopher Worsham and Anupam B. Jena are physicians and researchers at Harvard Medical School. They are authors of “Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients and Shape Our Health” and the Random Acts of Medicine newsletter.