By Patrick Nance
Lately, there have been a number of news articles describing the usage of the ride-booking service Uber as an alternative to 911-based EMS for basic first aid and AEDs, as well as mobile integrated health and prevention services. Here are three of those stories:
1. UberHEALTH provides flu shots administered by a nurse on board an Uber vehicle. Pay $10 and get 10 flu shots for you and your friends;
2. Uber can respond to a cardiac event faster than conventional EMS and therefore, all Uber drivers could, and should, be trained to use an AED and be provided with the necessary equipment;
3. Man, shot in the leg, called Uber for a ride home. The Uber driver gave him a ride and then called 911.
Replacing EMS service and paramedics with Uber raises many questions and problems. Is this the future of EMS? Will paramedics be replaced by Uber drivers responding to an app alert because there are more of them than us?
Right response beats fast response
Imagine a 60-year-old female, out for an evening stroll. A passerby notices she is pale, breathing rapidly, and staggering on the sidewalk. The bystander asks, “Are you alright?”
The woman responds, “I feel weak and I have this pain in my back.”
Should the passerby call 911 or open the Uber app?
Since it takes this tech savvy bystander the same amount of time to activate an Uber as it does 911, an Uber driver is requested.
It has even been reported that Uber arrives faster than an ambulance because there are so many more Uber drivers.
While waiting for the Uber driver nearest to the location to arrive, the bystander begins to wonder what is wrong with this woman. But since he is just a layperson, he doesn’t have the skills to determine if she having a heart attack or a stroke? Does she have other medical problems?
The Uber arrives quickly, after just finishing a round of flu shots. The driver jumps out with an AED and applies it to the now unresponsive woman’s chest. The AED chimes “NO SHOCK ADVISED” and the patient is getting paler with occasional gasping noises. Her lips are turning blue.
Someone in the growing crowd asks, “Should we call an ambulance?”
Five to seven minutes have passed since the Uber activation. It takes the ambulance approximately eight minutes to arrive.
Upon arrival, paramedics quickly determine the woman is bradycardic and 12-Lead ECG confirms a STEMI. The assessment takes three to five minutes, so now a total of five to 25 minutes of valuable treatment time, as well as cardiac muscle, has been lost because Uber was called before 911.
The patient is finally transported to the nearest cardiac facility and sent to surgery for repair of her clogged arteries.
In this case calling Uber, instead of 911, might have been the difference between stents and open heart surgery.
Legal reporting obligations
In the states where I have worked there are legal requirements for EMS personnel regarding gunshot wounds. Law enforcement must be notified as the wound may have been sustained in conjunction with the commission of a crime by either the shooting victim or the perpetrator.
In the Michigan incident, the Uber driver did the correct thing by calling 911, but what if he hadn’t? He is under no obligation to report the gunshot wound or any other crime that he may have seen or heard or known. Crime reporting is a completely voluntary act.
Not an ambulance
Uber’s purpose is to provide a gray market ride sharing service. However, an Uber car is not officially an ambulance until it has obtained certain certifications as required by state law. What if an Uber driver decided to carry an oxygen tank and a few other supplies because he took an EMR class? If an Uber driver provides health care, how is he held accountable?
Yes, there are many more Uber drivers than ambulances. Yes, they can get to some scenes, especially in urban areas, faster because of those numbers. But what does quantity mean if there is no quality or oversight? Being trained to operate an AED does not include training in the related skills of patient assessment and recognition of life-threatening events. If there is an effort to equate quantity with quality, it fails every time.
Pre-hospital care can be two of the following; good, fast or cheap. Any service that is good and fast won’t be cheap. Any service that is fast and cheap won’t be good. And a service that is good and cheap won’t be fast.
These rules of choice — good, fast or cheap — apply to Uber providing health care as an alternative to 911-based EMS. You only get two out of three. And time is muscle.
Who would you rather serve the emergency medical needs of your community? An Uber driver who is a math teacher making a few extra bucks and carries an AED or a professional EMS provider that can assess, evaluate and treat?
That decision is literally a decision between life and, sometimes, death.
About the author
Patrick Nance is a nationally registered paramedic employed at the AFRL, Edwards Air Force Base, California. Nance holds three college degrees, credentials as a PHTLS instructor and training in AMLS, ACLS and PALS. He loves cats and his fiancé who is also a paramedic in Kern County, California.