EMS1 recently reported on a new study which analyzed 9.5 million 911 EMS responses nationwide and found that roughly 3% of patients accounted for 16% of all calls. The researchers, drawing on 2024 data from the ESO Health Data Exchange, noted that these high-frequency utilizers are disproportionately enrolled in Medicaid, live in disadvantaged areas and manage chronic conditions — signs of unmet healthcare needs rather than system abuse.
More than 150 readers weighed in on the study’s results. Some shared stories of patients whose conditions genuinely worsen between calls, while plenty of others pushed back hard, arguing the numbers understate how often an ambulance gets used as a free ride.
911 abuse vs. unmet medical needs
The most common reader reaction was blunt disagreement with the study’s framing. Commenters swapped stories of patients who call 911 for minor complaints or free transportation, arguing that “unmet need” undersells how often the system gets used as a taxi service.
One commenter wrote, “Do a study on how many patients use the ambulance as an Uber.”
Another reader put it more colorfully: “I love being an expensive Uber to the hospital. Why spend $30-40 on an actual Uber when you can use insurance and spend at least $200 more on me and not even get a cold pack?”
Others pointed to the incentive built into the system itself: “They think, ‘I’ll get in faster if you take me,’” one reader wrote, describing how some patients use ambulance transport to theoretically skip the emergency department waiting line.
The calls are driving burnout
A recurring theme in reader responses was less about the patients themselves and more about the toll of repeat non-emergency calls on providers.
One commenter wrote, “I think it needs to be noted how often patients like these create burnout and compassion fatigue.”
Another described the difficulty over the lack of control: “I work in one of the largest cities in the U.S. with a very high homeless population. Over 85% of our calls don’t need to call 911 at all and we’re not even allowed to say ‘no’ — we must take them. Most days we feel like abused Uber drivers; the work is exhausting.”
Providers still work every call up, just in case
Even readers who agreed most of these calls didn’t need an ambulance crew said they still treat every one like a real emergency — because the cost of guessing wrong is too high.
“I’d rather treat them like a patient every time than be found guilty of negligence for their death,” one commenter wrote.
One provider described a specific patient: “We have a patient our service transports every day at 1830 hours. When he complains of chest pain, I work him up as such, because the one time I don’t, he’ll be having an MI, and I’m not losing everything I have because of him.”
It’s not just patients — institutions call 911 too
Several commenters shifted the focus away from individual patients entirely, pointing instead to facilities — jails, medical centers, urgent cares and detention centers — that call 911 routinely rather than staffing for their own patients’ needs.
One commenter wrote, “Let’s talk about ICE facilities calling multiple times a day for non-emergencies and tying up essential services to transport in rural areas, leaving the county without an ambulance.”
One reader explained how some institutions use EMS as a catch-all service: “Our county prison, staffed with RNs, averages at least two calls a day. Surgery centers, endoscopy centers, dialysis centers, drug and alcohol rehab centers — they call because a client is high or drunk, and we get dispatched for ‘altered mental status.’ Any doctor’s office attached to the hospital can call in ‘EKG changes’ when they don’t have an old EKG to compare it to, and suddenly it’s a ‘cardiac emergency.’ In reality, the patient could’ve walked down the hall to the ED faster than it took someone to call 911 instead. We are regularly let down by other medical professionals.”
Readers proposed fixes: Copays, refusal authority and treat-and-refer
Plenty of commenters offered potential solutions, floating everything from financial penalties, to giving medics more discretion in the field.
One reader wrote, “I’ve been saying for years that EMS nationwide needs a PSA on what constitutes an emergency.”
Another proposed a tiered response model: “Treat at home, triage to urgent or primary care or transport to the appropriate level of care. We should be able to establish a really basic system on a national level to do this, with EMS agencies’ ability to bill for the level of care provided.”
One commenter argued for a financial deterrent: “Add a $25 copay to an ambulance ride and a $50 copay for the ER visit that’s waived if you’re admitted, otherwise it comes out of the patient’s pocket. There, I just saved us about $230 million a year in Medicaid.”
Others wanted more authority for medics themselves: “Paramedics should be allowed to assess patients and refuse transport if appropriate.”
The most detailed proposal combined several ideas: “We need laws in place that allow medics to decide if a patient is actually acute enough to go to the ER. Instead of just refusing a patient outright if they aren’t having an actual medical emergency, drop them off at an urgent care — there are so many of them, and they’re well equipped for most non-life-threatening complaints.”
Poverty and limited healthcare access do not constitute abuse
A significant number of readers defended the study’s framing directly, arguing that chronic illness, poverty and a lack of alternatives — not laziness or fraud — explain most of the pattern.
“People with chronic medical problems have more emergencies than healthy people,” one commenter wrote.
Another pointed to homelessness specifically: “Many people are homeless. Sometimes what they need is three hot meals and a cot, but society doesn’t want to provide a reasonable alternative.”
One commenter pointed out that the disparity cuts both ways: “Some people literally would die before calling an ambulance on themselves, meanwhile we have people who could safely get to the hospital themselves or who aren’t even having an emergency, yet they insist on taking one out of service. Make the disparity make sense.”
Another described the range within high 911 utilizers themselves: “Yes, there are some frequent flyers and over-reactors, but there are also some who have worsening conditions, like the elderly, and aren’t sure what’s going on — they have a laundry list of problems that would require a lot of workup. My neighbor had EMS come almost every two weeks before she passed; most of the time she was transported and admitted but came home a day later.”
And one reader turned the study’s framing back on the skeptics: “You mean some people with chronic severe health problems might have to be transported by ambulance more than once? I’m shocked.”
The EMS Pulse takeaway
EMS1 readers generally agreed on the pattern — a small share of patients and local facilities are generating an outsized share of 911 calls — but were split hard on the cause. Is it unmet healthcare needs, tied to poverty and chronic illness, or a system with no real consequences for misuse?
Most commenters landed somewhere in between: With complicated refusal protocols, no reliable place to divert patients and real liability on the line if a provider guesses wrong, most EMS professionals are still working every high utilizer call the same way they’d work any other patient — just in case.
