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April 6, 2017

'911, I need an Uber!' Why some patients are choosing an Uber over an ambulance

Daily Briefing

    Some patients—and at least one city government—are turning to ride-sharing services to provide quick, inexpensive transportation to the ED, but providers warn the practice may not always be safe, Leah Samuel reports for STAT News.

    It is not clear exactly how many people have elected to take an Uber or other ridesharing service to an ED rather than an ambulance, their own car, or another option. But according to an online chat room for ride-sharing drivers and anecdotal reports, "it happens with some regularity," Samuel writes.

    According to Samuel, experts say the trend is driven by several factors, including that ride-hailing services can be less expensive than an ambulance, more predictable, and more flexible in the sense that a patient can go to a hospital of their choosing.

    According to HHS, the price of an ambulance can range from $600 to $1000—but hailing a ride from a ride-sharing service "would rarely hit three figures," Samuel writes. And such services, unlike ambulances, give riders a price upfront.

    Francis Piekut, who drives for Uber and Lyft, recalled picking up a passenger at a Starbucks who was badly burned and in severe pain. "I didn't mind it," Piekut said. "I was already there, and I know the ambulance costs a lot."

    When an Uber ride poses risks

    But in some cases taking an Uber to the ED can be risky for both patients and drivers, Samuel writes. One driver said he turned down a passenger who was not feeling well and wanted a ride to the ED. "I told them no and to just call 911." He pointed out that he couldn't legally speed like an ambulance could, and he was worried about liability if anything happened to the ill individual.

    Why this health system just partnered with Uber

    Officially, Uber says people in distress should stick to calling 911. "Uber is not a substitute for law enforcement or medical professionals," said Brooke Anderson, a spokesperson for the company. But Samuel notes that "despite that official stance, the company does occasionally honor drivers on its website for providing emergency transport."

    Filling a niche

    According to Samuel, some providers and policymakers are incorporating ride-sharing services into their transportation options for certain patients. For instance, in her proposed budget, Washington D.C. Mayor Muriel Bowser has suggested embracing ride-sharing services as a way to transport "non-emergency, low-acuity" patients. Such calls "accounted for nearly half the city's 911 calls in 2015, according to a report released in February," Samuel writes.

    Under the concept, operators would connect people experiencing medical emergencies with a triage nurse who could determine whether the call requires an ambulance, a ride-hailing service, or another option. "It's unclear whether drivers would get any special training for transporting such passengers," Samuel writes. According to Samuel, the budget is up for a vote next month.

    And some physicians agree that ride-hailing services could help supplement ambulances. Mark Plaster, an ED physician in Baltimore, says it makes sense that transportation options would vary based on the situation.

    "If you need medical care en route, a private car is a bad idea, because you won't have the personnel or equipment to treat you," he said. But he added that ride-sharing could help increase the supply of ambulances for true emergencies.

    "I don't care how [patients] get there," he explained. "Just get there" (Samuel, STAT News, 4/5).

    How to reduce ED utilization with community paramedicine

    Many health organizations partner with local EMS providers to provide patient-centered in-home health care services to underserved populations.

    Some of these partnerships—categorized as "community paramedicine"—use "upskilled" or advanced practice paramedics to connect at-risk patients to critical resources and address existing gaps in services within the community.

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