Are We In The Transport Business?

Recently I attended a paramedic class updating us on new protocols at the state and local level. The instructor, following what they were told, made the comment that the medical director said that “we are in the transport business.” The purpose of this statement was that we transport patients and should look at refusals as a last resort option.


This October, I celebrated my 23-year anniversary in emergency services. The comment, “We are in the transport business,” is one that I have heard so many times over my 20 years. It always saddens me to hear. There are multiple reasons that I want to explain here.

I do want to note that we should follow our medical director’s policies. The purpose of this is not to demean these people’s thoughts nor to tell them why they are wrong. What I am looking at in this article is to show why this thinking is not efficient for EMS, in my opinion, hopefully to begin a conversation with the decision makers to find what is best for the citizens we serve.

So why do I think that trying to transport every patient is not efficient for EMS?

First and foremost, our society is built on freedoms of choice. We know, and are taught from day one in EMS that we cannot kidnap and force someone to go to the hospital. Even if they are dying we cannot force them. I have personally had cases where I begged people to go to the hospital, but they refused. In one case the lady died hours later. That is their choice. I do not think we often force people, but I personally have seen too many times that we have influenced someone to go to the hospital when they obviously did not need to go.

Secondly, we are wasting resources. I can think of many times where while I was on a transport that was not needed and that we transported due to being in the transport business and a higher-level acuity call came in. That person had to wait since we were on a call that was not necessary. This also goes for the hospitals. How many times have we taken someone to the hospital knowing that their emergency room is busy and the person we are taking does not need an ER. This backs up the system overall.

Next, by having this policy we are contributing to the issues of the healthcare system. Needless transports to the hospitals cost money. Needless trips to the hospital has costs associated with it. This may be something that costs the patient as they try to pay the trip cost themselves or uses insurance and as a result will likely see an increase in their insurance premiums. Even if they do not pay, someone will. This could be from hospitals and EMS having to charge those who can pay more, higher tax rates, etc.

Finally, as patient advocates we should want to give them the care they need with the least cost. For example, I once took a patient to the ER who complained of tooth pain. After a thorough assessment, it was determined that she simply had dental issues. As a provider, I had to follow this “we are in the transport mentality.” However, as a patient advocate, I knew that this patient was going to get an ambulance bill, an ER bill, and was not going to get the care that the patient needed. So how are we being a patient advocate in cases like this when we go by the “we are in the transport business mentality.”

I could go on and on concerning this issue. That being said, please do not think that I am advocating not transporting anyone. However, we must get away from the idea of looking at statistics such as refusal percentages that lead to comments like, “We are in the transport business.” We should advocate for every patient and do what is best for them regardless of cost, time, etc. If a hospital transport is needed, then that is what we should do. We should look at our overall policy to ensure it represents us as patient advocates.

Until next time, be safe.

David Hesselmeyer, M.P.A., has been in emergency services for 16 years. Currently he is a firefighter, rescue technician, paramedic, and North Carolina Executive Emergency Manager. Hesselmeyer is the owner and primary consultant with On Target Preparedness (OTP) which contracts with emergency services agencies and non profits to assist in risk assessments, plan writing, plan revision, exercise development, etc. He currently volunteers with Buies Creek Fire Rescue and works part time with Harnett County EMS. He can be contacted at or visit his website at

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