“Ride-share.” It’s a phrase that surfaces regularly in conversations about innovation, efficiency and modernization. It’s usually well-intentioned, and it’s often delivered with a sense of certainty as though emergency medical services have simply failed to adopt a model that the rest of society has already embraced.
But the comparison is fundamentally flawed.
Because if EMS truly operated like a ride-share, many of the people who rely on it today would never see an ambulance arrive.
| MORE: On shaky ground: The new reality of EMS delivery. Communities are rethinking who delivers care — and how to protect against the next sudden shutdown
The ride-share transaction starts with agreement. EMS starts with need.
Ride-share services work because the transaction is settled before anything moves. The customer requests a ride, sees the price, agrees to the terms, and only then does a vehicle respond. The system is uber efficient when the request is predictable, optional and prepaid — and undeniably uplyfting when the experience works exactly as designed.
Emergency medical services operate in the opposite direction. Ambulances respond whatever the “whether” — without knowing whether the patient can pay, whether insurance exists, whether reimbursement will cover the cost or whether payment will ever arrive at all. Care is initiated first. Treatment begins immediately.
The financial reality is sorted out much later — sometimes months later; sometimes never.
If EMS were truly modeled on a ride-share framework, dispatchers would have to ask a very different opening question; “before we send help, can you confirm your payment method?”
That is not an efficiency problem; it is a moral line that emergency care refuses to cross.
A ride-share vehicle transports. An ambulance treats.
Another failure of the analogy is role simplicity. A ride-share driver’s responsibility is singular: get a passenger from point A to point B safely. They are not expected to assess medical risk, make clinical decisions or intervene when a life is at stake.
An ambulance, by contrast, is not transportation. It is a mobile treatment environment. Within that vehicle, diagnoses are formed, medications are administered, airway and cardiac care are managed, pain is treated and time-critical decisions are made.
In many cases, definitive care begins long before the hospital doors come into view. The ambulance is effectively an emergency department without walls — minus only the hospital bed. Reducing that capability to “a ride” fundamentally misconstrues what EMS actually delivers.
Choice, opt-out and pricing logic don’t translate to emergencies
Ride-share systems are built on optional participation. Drivers can decline trips. Passengers can wait, cancel or choose another provider. Pricing fluctuates with demand, supply and convenience. Emergencies do not allow for any of those mechanisms. When someone collapses, stops breathing or is critically injured, there is no shopping around, no waiting for prices to fall; there is no opting out of responsibility.
Ride-share platforms have conditioned us to expect instant visibility, consumer choice and frictionless outcomes. They promise something way more than transportation — they sell certainty, transparency and control. Emergency medical care cannot offer those guarantees without fundamentally changing its purpose.
This isn’t a technology debate. It’s a policy one.
The appeal of the ride-share comparison is understandable. People (and usually local governing bodies) want faster responses, smarter deployment, better data and modern user experiences, and EMS should absolutely continue to evolve in all of these areas.
But borrowing consumer mobility economics as a stand-in for emergency medical care doesn’t modernize EMS; it obscures the reality of what it is, what it costs to operate and why it exists. EMS is expected to be universal, immediate, clinically sophisticated and financially sustainable often all at once. That tension is not the result of outdated thinking or resistance to innovation. It is the result of deliberate public policy choices.
The real question we should be asking
EMS is not broken because it isn’t a ride-share. It struggles because we ask it to function like a market service while demanding it behave like a public good. If EMS were truly run like a ride-share, it would only respond to those who could pay, who agreed to the price in advance and whose needs fit neatly within a predictable transaction. Most people would be left waiting — or left behind.
That is not a future worth optimizing for. If we want better emergency medical services, the solution is not to make them more like ride-shares. It is more important to acknowledge what they already are — and fund, design and support them accordingly.
