This all comes down to one simple question:
Does this patient require medical care, assessment, or observation enroute to immediate definitive care?
Yes = Transport
No = No transport
Even Medicare addresses this in their reimbursement, so this is not a new concept of screening. Simply being ill or injured does not necessarily mean that you need EMS care and/or transportation. A great many people call 911 not because they believe they need -- or even want -- EMS care or transportation, but simply because they believe that is what they have to do to get seen in an ER. Those people are quite happy to make alternative arrangements when they are educated about the process.
Of course, this is all a very theoretical discussion. The number of medics (and certainly no EMTs) in this country educated and experienced enough to competently make these sorts of decisions intelligently, and consistently without error, is so microscopic as to be statistically insignificant. So this discussion is not so much about what we should be doing, but what EMS should be doing in the future. We can't continue to forever keep doing things this way simply because it's the way we've always done it. That is a recipe for professional failure.
