Rising Costs & Misuse of 911 Ambulance Service – Any Solutions?

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There’s no two ways about it: Americans are over-utilizing ambulances. In recent years, as healthcare costs have skyrocketed, more and more patients have been calling ambulances for what a number of independent studies have deemed “medically unnecessary” rides.

With the percentages of these costly and superfluous rides in many areas hovering over 10%, it seems a bit outrageous that 1-in-10 medical attention seeking individuals are incurring debts sometimes over $1000 when they needn’t. Why do they call an ambulance in these less than dire circumstances, such as for a blister or a paper cut? For many, it amounts to a lack of education on what constitutes a medical emergency. More troublingly, for others, the decision to call an ambulance amounted to a matter of not having adequate access to hospital transportation services.

So, what can be done to stem the tide avoidable ambulance dispatches? As these unnecessary trips wind up potentially costing American states and cities millions annually, a number of municipalities have started implementing creative solutions to combat this growing burden. With mixed, but primarily positive results, will any of these solutions prove to be scalable on a national level?

Paramedics and EMTs in the greater Houston area take in upwards of 800 calls a day, but in order to weed out those treating the ambulance like a “free” taxicab ride to the hospital, the city has been implementing an Emergency TeleHealth and Navigation program, or ETHAN for short. These firefighters and paramedics carry tablets with HD cameras with them to calls, and then, using a video conferencing app, a doctor in the station would assess whether or not the patient truly needed a trip to the ER.

In the greater Detroit area, patients with more chronic conditions that have already been diagnosed and processed at a hospital are likely to trigger an unnecessary call for a EMS pickup. In response, the area has implemented a new mobile health initiative with a degree of success. In this program, advanced practice paramedics are sent to a continuing care center where previously screened patients can benefit from their services, all while the paramedics have the expertise of standby emergency physicians at a collaborating hospital. The center’s nurses call a 1-800 number for an ailing patient and, after a series of questions with the on-call doctor, the patient is either treated or an ambulance is called.

Both the above methods have proven effective at not only lowering costs for all parties, but also prevent ambulance crews from wasting valuable time that might be used to save a life elsewhere. These are only a part of the solution, however. Clearly, sweeping educational efforts need to be made in lower Socio-Economic Status areas, even before services like Detroit’s and Houston’s are offered, so as to drive home what is and is not an appropriate 911 call. Perhaps bus or billboard ads encouraging a taxi or loved one as driver in non-life-threatening situations could inform those who are truly ignorant to what constitutes a medical emergency. But therein lies a tightrope of a problem, for if a public service announcement campaign’s language is off by one word and it causes a patient to hesitate and grievously harm himself in the process, the entity responsible for the educational ad has just opened itself up to severe legal ramifications. Good luck finding someone in government not too risk averse to spearhead that initiative.

As long as there are people and systems, some people will always abuse or misuse those systems. But the burden of ambulance costs is not an “all or nothing” problem. Assuming there will always be the occasional 911 caller complaining about a hangnail or the like, these modern digital triage methods, coupled with public outreach, might just bring the whole industry back closer to a harmonious equilibrium.