Taxis for the Sick

Every EMS (Emergency Medical Services) staff member learns a truism very early in his or her career: EMS is frequently used to provide basic transportation for people who are really not sick enough to need an ambulance and/or taken immediately to the emergency room. In fact, during the everyday operations of many resource-poor systems, ambulances deployed on “taxi ride” calls draw scarce resources away from those endangered by truly life-threatening emergencies. For that reason alone, local medical resources may well be stretched to and beyond their capacity during a local or regional crisis.

Another truism is that the general public has a limited understanding of the role played by EMS; regardless of the quality of the services reasonably available, there will always be at least some of those served who will never be satisfied. Fortunately, most U.S. cities and towns already have taken the opportunity, when available, to help shape public understanding, and individual expectations, by spreading the message that EMS and 9-1-1 calls are intended and should be used “for emergency purposes only.”

Of course, the overarching mandate for most EMS systems within the United States is to provide lifesaving care – including, if and when needed, transportation to a hospital or other healthcare facility. However, a realistic and effective system goal would be: (a) to provide rapid EMS services, including transportation, to all callers who require that level of services; and (b) to provide a somewhat lower level of services (again, including transportation) to those who, insofar as can be determined, do not actually require the same “highest level” of services – and, therefore, do not monopolize the ambulances and other emergency resources available.

Some EMS systems – the one in San Antonio, Texas, is a good example – distribute vouchers that allow nonemergency patients to be transported to hospitals, clinics, or pharmacies via taxi. This practice is a relatively low-cost way to return ambulances to the 9-1-1 system as quickly as possible and make them available primarily for those with truly life-threatening illnesses and injuries.

Establishing Priorities & Permitting Refusals 

Other jurisdictions address the problem by using a prioritization system in which all calls received are sorted by priorities – which are based on what the various callers tell the 9-1-1 operator. The ambulances and EMS staff are then dispatched according to the priorities assigned. In some systems, the dispatchers are even permitted to refuse calls that are categorized into the lowest possible priority level.

The ability to use this model obviously varies from state to state, and from city to city. In New York State, for example, EMS is required to respond to all requests for emergency medical assistance – regardless of the nature of the request. Of course, this policy may reflect an attempt to reduce the legal (and, therefore, financial) risks to the agency, particularly in cases where the caller’s ability to assess and to communicate what is actually happening is uncertain.

Some state laws also now allow EMS to refuse to transport patients suffering from non-life-threatening conditions. The EMS providers are even permitted to leave patients on scene after: (a) responding to the call; (b) assessing the patient’s condition; and (c) determining that the patient does not, in fact, require emergency treatment. The principal concern with this scenario is that EMS staff might (unintentionally, of course) make an erroneous decision and mistakenly leave behind a patient who does in fact need emergency care.

To minimize such types of error, it is particularly important to: (a) involve a physician, whenever possible; (b) provide the thorough training needed to make accurate on-scene decisions; and (c) perform periodic reviews – of both the policies established and the operations actually carried out. Here it should also be noted that, if there really is a justifiable concern about EMS staff making erroneous decisions related to not treating a patient, the same concern should be factored into the decisions made when actually treating patients.

As with most effective plans, the “taxi” model can be scaled either up or down to meet sudden and uncharacteristic increases in the volume of calls received. In a regional crisis, for example, the leadership may decide to lessen the requirement for taxi vouchers to be issued to lower-priority patients, and/or to change the threshold used for leaving patients on the scene. The bottom line is that the taxi-voucher option still offers one reasonably practical solution to reduce the high cost of healthcare in general and, at the same time, expand the availability of emergency resources needed during both routine operations and medical surge events.


For additional information on: San Antonio EMS, visit

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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