There have been several articles lately about the use of ride-sharing services like Uber and Lyft to get patients to the ER. In one article, AMR is looking at a yet-to-be-defined partnership with a ride-sharing service. Another article making its way around the EMS social media circles describes people getting a ride to the hospital from one of these services.
Of course, the schizophrenic nature of EMS raises its ugly head. You’ve got some people saying, “About time. These people don’t need an ambulance because they’re not having an emergency.” And then you’ve got other people taking the other extreme position in EMS, namely, “If we don’t take you to the emergency room in an ambulance, you could become ‘unconscious, comatose, or dead,'” — just like the speech that most EMS providers give when obtaining a refusal.
And as I’ve said more than once, we somewhat have ourselves to blame for everyone calling 911 for a ride to the emergency room. Especially in comparison to the police and fire services, we’ve done a terrible job of public outreach and education. Everyone knows who the cops and firefighters are and what they do. Us? Not so much. It’s amazing how many people don’t even know that there’s a difference between an EMT and a paramedic and what they do. We’ve delivered one message well, perhaps. That message is “If you’re having a medical emergency, call 911.” When you combine that simplistic message with the failure of American/Western medicine to deliver medical care outside of a 8:00 AM – 5:00 PM, weekdays only model and end up sending patients to multiple specialists, labs, and imaging centers all on those same inconvenient schedules, is it any wonder that John Q. Public decides to “call 911 for an emergency.” In other words, EMS and emergency medicine have become victims of our own success. People know that if they need medical care, EMS and the emergency department exist and won’t turn anyone away.
What we really need are trained professionals who have the ability to assess and transport/refer to someplace in addition to the ER. And while we’re verbally masturbating over whether to be offended by this or an Arby’s ad, we’re not doing what we truly need to be doing — developing our profession into the role of a mid-level provider who’s able to deliver both the medicine and the patient in a manner that meets patient needs in the most cost effective way possible. And what emergency medicine needs to do is to actually read EMTALA, provide a “screening exam,” and refer non-acute patients to an alternative setting. However, we need these prehospital mid-level providers and these alternative settings to exist in the first place. I recognize there’s no funding stream as of yet, which is one of the major failings of the so-called community paramedicine initiative. The truth is that you sometimes have to spend a little to save a lot. That’s a truth that our government and healthcare payment systems have yet to grasp.