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I can't speak for the ambulances but my father was a police officer and he said 95% of the time people driving without headlights at night were impaired >

I could see some being that, I’m noticing a lot on my evening commute. Sun sets during the long drive and they don’t realize they need lights. Some cars have always on day lights which confuses them too, but the dash lights would all be off so what’s going on in there? >

They don’t look at the dash, that’s how they don’t notice >

This doesn't happen in most countries. 
I've never seen this and I'm driving for over 20 years. 
Sounds wild. 
My advice is to slow down and let them drive away from you and do not approach or try to signal them. 
Just avoid. >

Unfortunately all too common in America. At least modern cars have an auto option, but even then many people don’t realize and turn it fully off. >

it's only happened to me twice.
First time was cause I was tired after working that I didn't notice the auto light thing wasn't on. There were enough lampposts to apparently keep me from noticing.
Second time I was driving in a main city at night and it was already so bright from all the lights that I couldn't tell my lights were off.
Only the second time someone tried to alert me about it. >

It happens, glad someone alerting you worked!