1991
In the article
"Lights and Siren: A review of emergency vehicle warning systems"(Annals of Emergency Medicine, 1991), R.A. De Lorenzo and M.A. Eilers provide a clinical and technical evaluation of the effectiveness of sirens and lights, noting their limitations in alerting modern drivers due to factors like soundproofing in vehicles and high ambient noise.
The Max Neuhaus Connection: Aural Design
This medical review is frequently cited alongside the work of Max Neuhaus because he applied the same critiques of standard sirens to create a functional artistic solution: