[Platapus]

When I was riding on the squads in Nebraska, it depended on where we were and the individual case

In residential areas, we rolled in on the scene with lights only and used the siren only at intersections or when someone was too stupid to notice an EMS squad behind them (yes these types do exist). The rational was that sirens only tend to attract people.

In industrial areas, We rode in with lights and sirens.

On the way to the hospital we rode with lights and sirens all the time. Many times if it was a call in a residential area and it was in the dead of night, we might kill the siren until we get out of the neighbourhood, but that was usually up to the driver.