Uber or Ambulance?

By: Guest Author | Posted on: Mar 27, 2018

This article was originally published on nfpa.org by ANGELO VERZONI. View the original article by clicking here. 

Last year, a driver for the ride-sharing service Uber went online to recount the harrowing details of transporting a young woman to a hospital in Chicago.

The call came from a nightclub. When the driver arrived, a bouncer for the club explained that the woman was intoxicated with drugs and alcohol and needed to be taken to the emergency room. The woman and a friend got into the car. “While en route, the girl vomited, stopped breathing, and was unresponsive to her friend,” the driver wrote on uberpeople.net, an online chat forum. “The other girl was losing it, screaming and crying, which only heightened the stress. I blew every red light to the hospital with flashers going and horn wailing. At the hospital, ER personnel crawled through my backseat area to extract and resuscitate the patient.”

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Stories like these aren’t uncommon on the forum. There are posts about bloodied bar brawlers, women in labor, and men having chest pains, all seeking a trip to the hospital by way of an Uber—in many cases, when an ambulance would have been the better option.

As ride-sharing services like Uber and Lyft grow, people using them to get from point A to ER will inevitably increase, too. The practice might eventually be addressed by NFPA, as it develops a new guide to help EMS agencies move toward a community health care model.

Old practice, new twist

For those in EMS, it can be a troubling trend—but not exactly one they’re unaccustomed to.

People have been taking traditional taxi cabs to hospitals for decades. Working for Boston EMS, John Montes, now a public fire protection and emergency services specialist at NFPA, said he frequently responded to incidents where people had tried to make it to the ER in a cab. In those days, he said, taxi drivers’ rule of thumb was if the person could walk, they could get in the cab to go to the hospital—but it also meant that people who were ambulatory one moment could crash the next and require immediate emergency medical care.

Despite the risks, Montes thinks the practice is becoming even more common—especially with young people—in today’s so-called shared economy. Instead of a cabbie suddenly confronted with an unconscious passenger, it’s just as likely to be an Uber or Lyft driver, neither of whom are necessarily any better prepared than the cabbie to handle a potentially serious medical emergency. The public’s familiarity with ride-sharing technology and the corresponding user interfaces can heighten its appeal as a mode of emergency transport, Montes said, even in cases where people should be taking an ambulance. Over the last couple of years, news outlets have increasingly covered the practice of Ubering to the ER.

But it’s also prompting a public response from those in the fire and emergency medical services. In April, Mark Becraft, a veteran paramedic turned fire chief in Utah, condemned the practice in an interview with a local television news station. “It’s just unsafe,” he said. “I think Uber has its place. I just don’t think it’s in emergency medicine.” Becraft gave an example: Say someone is having a heart attack but they don’t know it. Ambulance personnel can figure that out, and instead of going to the ER, the patient can go straight to the catheterization lab—a timeline compression that is highly unlikely if a ride-sharing service is used.

According to Vincent Robbins, people experiencing cardiac events are just one group that has traditionally bypassed the EMS system to get to a hospital. Robbins, president and CEO of MONOC, New Jersey’s largest private, non-profit ambulance service, has over 45 years of experience in EMS. “They often downplay their condition to themselves,” he said of these patients, who are typically older adults. “They want to think it’s just indigestion. They don’t want to believe they’re having a heart attack.” Younger patients with conditions like asthma, who believe they’re able to manage symptoms themselves and don’t want to “bother” EMS providers, also do it, as do elderly people afraid of the cost of an ambulance, Robbins said. “Emergency department physicians will tell you there are a number of walk-ins who arrive without EMS intervention, which is what they really needed as precautionary treatment before getting to the hospital.”

With the obvious dangers of using ride sharing as a means of emergency transport, why would somebody risk it? From a patient’s perspective, the benefit of using Uber or Lyft over an ambulance starts with the comfort and familiarity of ordering one. “Ride sharing is incredibly user-friendly,” Montes said. “You can’t look on your phone and see where an ambulance is coming from, who’s driving, or how long it’ll take to get there. With these apps, you can.”

Beyond the convenience and transparency, ride sharing is significantly cheaper. Most ambulance rides cost between $800 and $1,200, according to Montes, while in most cases an Uber or Lyft ride will cost less than $50. A third benefit for the patient is a greater sense of control, especially when it comes to selecting a hospital to go to, a consideration reflected in the posts that appear on uberpeople.net. “Got a pregnant lady who was in labor who wanted to go to a hospital that was about 30 miles away from her house because she didn’t want to have her baby at the local hospital,” one driver wrote.

Officially, Uber doesn’t endorse the practice, but the company acknowledges it occurs. “We’re grateful our service has helped people get to where they’re going when they need it the most,” the company said in a statement sent to NFPA Journal. “However, it’s important to note that Uber is not a substitute for law enforcement or medical professionals. In the event of any medical emergency, we encourage people to call 911.” Lyft did not respond to a request for comment before the magazine’s deadline.

A role for ride sharing

Despite the concerns surrounding the practice, some EMS providers have started to explore a system where ride-sharing services are utilized for non-emergency medical transport. A number of shifts in the health care landscape over the last decade or so have allowed that to happen, according to Robbins...

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