Medical Examiner

In 2018, Should We Take Ubers or Ambulances to the Hospital?

The question of transportation is actually not that new. Here’s what the experts advise.

At left, an ambulance. At right, a hand holds a phone with an open Uber app.
There’s a time and a place for each. Photo illustration by Slate. Photos by Thinkstock.

Here’s a dilemma of the smartphone era: If you are feeling sick enough to need to go the hospital, should you call an ambulance or request an Uber? Some patients appear to be opting for the latter—an analysis conducted by University of Kansas researchers found a 7 percent decline in ambulance calls in areas where UberX was available. Of course, a correlation doesn’t imply a causation, and it’s also worth noting that while they’ve made their conclusions public, the paper has not yet been peer-reviewed for publication. But the dilemma seems inevitable, and isn’t one you’d want to spend a ton of time deliberating over in the moment. So Slate interviewed experts, Uber drivers, and a patient to find out: When should you call an Uber over an ambulance? And when is that a terrible idea?

While the app factor may be new, wondering whether you should call 911 isn’t. “People have been transporting themselves to the ER for decades,” whether by asking a friend to drive or hailing a cab, said Dr. Robert Holman, medical director of D.C. Fire and Emergency Medical Services. At the same time, others call ambulances when they might not need to, using resources that could otherwise go to more urgent calls; Holman said lowest-acuity (basically the least severe) calls constituted 24 percent of D.C.’s transports.

In certain circumstances, the professionals I interviewed agreed: It’s perfectly reasonable to call a ride instead of dialing 911. “If you’re doing it for the right reasons, if you don’t think it’s urgent, if you don’t think that an extra 10 or 15 minutes matter, then I think that it’s perfectly appropriate that you consider alternative transportation,” said Dr. James Langabeer II, an emergency medical technician and professor at the University of Texas Health Science Center at Houston who studies medical decision-making. Riding in an ambulance doesn’t change your place in the triage queue. And in some areas, ambulances are required to take patients to the closest emergency room, so if you want a guaranteed choice of hospital, Uber or Lyft may present a good way to get there.

For their parts, Uber and Lyft discourage riders from using their services to get to the emergency department. In response to my requests for comment, both flatly denied that their services ought to play a role. “When it comes to medical emergencies, Lyft should not be used as a substitute for emergency transportation. People should be calling 911,” wrote a Lyft spokesperson. Similarly, Uber commented, “Uber is not a substitute for law enforcement of medical professionals. In the event of any medical emergency, we always encourage people to call 911.”

There are clear reasons why these companies would issue these statements—legal liability topping the list. Of course they’re not going to encourage you to use their services when experiencing a medical emergency. But when do emergency care providers say ambulances are the necessary choice? If you’re considering the best mode of transport to the ER, first assess severity. How bad is your current state, and how likely is it to worsen soon? Some symptoms that should result in a 911 call include trouble breathing; severe pain; pregnancy-related complications; suspected internal bleeding; signs of stroke like sudden numbness, weakness, or speech problems; or a change in mental status. Dr. Eric L. Weiss, an emergency medicine doctor who teaches at the Stanford University School of Medicine, also recommended taking the ambulance for “anything at risk of becoming bad in short order,” like an asthma attack. After all, an Uber or Lyft could get stuck in traffic with no way out.

Of course, the time spent getting to the hospital is just one half of the equation—it also matters how quickly the vehicle can get to you. According to a research letter in JAMA Surgery that evaluated the data from more than 1.75 million EMS calls that took place in 2015, it took an ambulance in an urban or suburban area an average of about seven minutes to arrive at the scene. A rideshare might be able to get to you faster, although the drivers can’t use sirens to clear the roads or legally speed (ambulances are allowed to go 10 miles over the speed limit in many places in the U.S.).

But more crucially, in serious circumstances, ambulances can not only bust through traffic, but the people inside of them can also provide life-saving care en route. They’re each staffed by two highly trained emergency medical services personnel and have a wide array of medical equipment—IVs, pain medications, nebulizers, body fluid containment, EKGs, and defibrillators. You’re lucky if your Uber driver has mint Life Savers and a water bottle.

Even if your ailment isn’t what professionals would call “life or limb-threatening,” there are issues of courtesy to consider, too. If you have a nonstop cough or severe fever, you don’t want to contaminate a stranger’s car with the same germs that made you ill. In a similar vein, if your bodily fluids aren’t under control, that’s not fair to your driver—and you could get charged a damage fee ($250 for Lyft, unspecified for Uber).

What do rideshare drivers make of this? “It’s really circumstantial,” Neil, an Uber driver in San Jose, California, told me. He added that he could simply cancel the ride upon arriving to pick up the passenger and witnessing the situation if he were uncomfortable with what was happening or the liability it might put on him as a contractor. Another driver posted on an forum, “I had a guy with a busted leg call me. The bone was almost through the skin—it was bad. I called 911 for him.” But an Alexandria, Virginia–based driver aired a different view, writing, “As long as they aren’t puking or bleeding … whatever hop in. I just mark it as a good deed against karma.”

These standards leave several less-urgent, not-a-biohazard ailments where taking Uber or Lyft makes sense, such as an eye, foot, or hand injury that renders you unable to drive; foreign bodies; a small wound with controlled bleeding; or a noncontagious infection (think a urinary tract infection or cellulitis).

When Jose Hernandez, a friend of mine, was in college, he got into a bike accident, conveniently right in front of EMTs attending to a different call. After he cleared a concussion test, the EMTs let him call an Uber. “I was planning on going to the hospital, but I didn’t really know the details of my insurance,” Hernandez explained. He got to the ER for less than $20 and said he’d do the same in the future, “hands down.”

The $20 fee helps underscore why people tend to resist the ambulance ride. Even with insurance, they’re pricey. Costs vary by region and level of care, but the professionals I interviewed from coast to coast gave me ballparks between $450 and $5,000. After insurance, that number decreases (in one example, a bill went from $3,000 to $800), although the ambulance provider may or may not be in-network with your insurance. (If it’s not, you still won’t get billed the ticket price, as insurance and ambulance companies will have negotiated a predetermined out-of-pocket rate.) But, University of Texas researcher Langabeer cautioned, it’s unwise to make the decision based solely on price or other deterrents like embarrassment.

If you’re on the fence, the experts recommended calling 911, especially since patients often misgauge a situation’s urgency. If an ambulance ride ultimately isn’t necessary, the paramedics may release you at the scene (after checking vitals, mental state, and ensuring you’re aware of your condition). You might also consider contacting a primary care physician or nurse to determine the best mode of transportation.

Ultimately, even doctors I interviewed admitted the ambulance system, with its wallet-draining prices, is far from perfect and thought ride-sharing apps could have a place in health care innovation. In the meantime, what we’re left with is: In dire or gray-area medical straits, you should still call 911. But they might just say that you can take an Uber.