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Ambulance or taxi service?

Editor's note: In the UK, officials are accusing patients of using ambulances like a taxi service. Our Editorial Advisor Art Hsieh says this situation isn't much better in the U.S. Read about his personal experience, below.

In the U.S., we have a similar situation that is described in this article. There have been many comments on EMS Connect and on the EMS1 Facebook Page that describe how the public "abuses" the EMS system. I too have picked up patients standing at the front door, with a bag packed, waiting for EMS to arrive like a taxicab.

There is one event that I remember clearly: At just after midnight on a cold, rainy San Francisco night, I responded to a young woman who had an abscess on her arm. It turns out that it developed after she had injected her heroin with a dirty needle.

It was nasty looking, with angry red streaks running up the side of her arm. Otherwise, she was feeling ok, not too febrile and ambulated easily into the ambulance. I was certainly frustrated with the situation but at that time it was easier to drive her to the hospital rather than argue about the necessity of the transport.

I did however, ask her why she thought calling for the ambulance was a better choice than taking the bus, or calling a taxi, or even having a friend drive her to a clinic? Surprisingly, she responded calmly that she understood that she didn't need the ambulance, but it was free, since we would be minimally reimbursed by Medicaid.

And because she was homeless, free to her meant that she had a few extra dollars to support her drug habit, or buy food, or find shelter for the night. On top of it, she apologized for taking our unit out of service, but she knew that if she didn't take care of the abscess now, she would have really bigger issues later.

I definitely had no response to that. And that's the rub, isn't it? We don't have a good way to discourage the use of EMS services when systems conspire to keep it the way it is. The story I just related comes from 1992 — nearly 18 years ago. From what I gather it's not improved, which tells me that we haven't fixed the systems that are involved — the reimbursement system, the health care system, the legal system. Until there are significant changes there, it's not likely that we will see things change at the street level.

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