I drive ambulances and response cars daily on blue light runs. Officially we are told that if we are moving with the blue lights on we should also have the sirens on. If we have an accident and don't have the sirens going too we are in a heap of trouble.
The reality is that we get as sick of the sound of them as much as the people who complain about them (including those who buy houses next to hospitals or ambulance stations, then complain about the sirens - sometimes threatening violence against us), so what tends to happen is that in times outside of rush hour we sometimes turn them off until we reach junctions, or slower moving traffic.
I don't think they are any quieter than they were, quite the opposite in fact, but as stated above modern vehicles are very well sound proofed.
Many times a day I approach a car or van (rarely a lorry or bus though) with lights and sirens going and the driver fails to notice me for quite some time, at which point they tend to brake hard and lurch to the left without even seeing what is to the left of them.
The reactions (or lack of) I get from other drivers shows a terrifying lack of awareness in many many cases.
I really enjoyed response driving at first, now I find it exhausting as driving standard are 100% deteriorating, with outright deliberate dangerous and selfish driving being seen from an increasing proportion of drivers.