Boston and some other cities around the country have seen a significant increase in the number of 911 calls for medical help. But what’s driving the surge in call volume remains somewhat of a mystery.
“It’s a national trend, and people are trying to dissect it,” said Dr. Paul D. Biddinger, vice chairman for emergency preparedness at Massachusetts General Hospital.
Boston EMS said it has seen a 26 percent rise in calls over the past decade, from about 95,500 in 2005 to about 120,000 in 2014. The agency said that the increase has driven a rise in response times.
“The call volume is way up. It’s a very, very busy system,” said James Orsino, union president of the EMS division of the Boston Police Patrolmen’s Association.
He said it’s unclear why the calls are going up. “It’s a difficult thing to pin down,” he said.
Boston EMS said it, too, did not have “a verified cause for the rise in demand.”
The agency’s chief, James Hooley, said the agency has been able to manage the additional workload, but is closely monitoring the call volume rise.
“If call volume keeps going up, there could come a time where we become more concerned, but I don’t know that we’re there yet,” said Hooley.
Increased call volume has been seen in other cities around the country, including Washington, D.C., San Jose, Denver, and Los Angeles, according to experts and news reports. Hooley said he had heard of rising calls numbers in New York and Philadelphia, too.
In several of those cities, the increased volume has also been blamed, at least in part, for rising response times.
The Globe spoke to more than two dozen experts — including national and local medical researchers, doctors, emergency room directors, ambulance company executives, fire and EMS trade association leaders, and public health officials — all of whom said they were not aware of any definitive research that had pinned down why calls for ambulances had risen.
“From everyone I’ve talked to, it’s a bit of a mystery, and that’s definitely concerning to us,” said James L. Robinson, president of the International Association of EMS Chiefs.
The specialists suggested that a number of factors could be involved, probably in combination with each other.
Two of the more common reasons given were growth in the overall population, and increases in how long people live.
“People are living longer and longer and they [at older ages in particular] require more medical care,” said Ken Willette, manager of the public fire protection division at the National Fire Protection Association.
Dr. Howard Mell, a spokesman for the American College of Emergency Physicians and medical director of EMS for Iredell County, North Carolina, said he believes a key reason for increased calls for ambulances is shrinking access to basic medical services.
“We’re overloading the emergency departments with conditions that could have been prevented,” said Mell.
People can suddenly find themselves in need of care because they had not made more routine doctor’s visits, for various reasons. Many primary care physicians are unable to see patients for months, or cannot accept new ones, due to a nationwide shortage of such doctors, he said. Patients cannot always take time away from obligations like work. Out-of-pocket costs have risen as employers and insurers have cut coverage and the general cost of health care has risen.
While a primary care doctor may be hard to see, emergency rooms are open all the time, he said.
“Ambulances and emergency departments are the safety net, and we are always here,” said Mell.
Some experts said that with more people now covered due to health insurance reform several years ago in Massachusetts and more recently under the Affordable Care Act, there may be fewer people who are scared off by the cost of an ambulance ride.
Other possible causes of rising ambulance use included shifting cultural attitudes among patients.
People may be simply less tentative than they once were about calling 911, experts said.
“Before they may have driven themselves, but now people are more comfortable calling 911,” said Willette.
Another expert suggested that people may call ambulances in an effort to skip the emergency department waiting room.
“When you come in by ambulance, you usually go to the head of the line,” said Alan Sager, a health policy and management professor at Boston University’s School of Public Health.
Biddinger said he would not be surprised if patients, more so than in the past, are being extra cautious about their health.
“I think people when they have a medical condition they think could be serious ... they may be more likely to want to have an evaluation to rule out the most serious possibilities,” he said. “They may be more likely to do that than they used to be.”
Dr. Scott Goldberg, director of emergency medical services at Brigham and Women’s Hospital, said the kind of care EMS offers fits our increasingly on-demand lifestyle.
“We have these highly-trained, highly-skilled professionals who are available at the punch of a button 24 hours a day 7 days a week, 365 days a year to come to your house and provide medical care, so it makes sense,” that more people are calling, he said.
The recent opioid crisis could be a small factor in some places, but it does not come close to explaining the surge in call volume, experts said.
Tim Wilson, a spokesman for the fire and EMS department in Washington D.C., said officials there are looking into possible reasons behind a rise in call volume there.
“We still haven’t figured it out yet,” he said.
In San Jose, officials investigated a rise in response times there and found numerous factors at play, including a rise in call volume. But the review did not delve into what had caused call volume to rise
Ron Cunningham, a spokesman for American Medical Response, a national private ambulance company, said the firm has seen a rise in demand in certain areas of the country. Officials there looked at internal data after the Globe inquired about the rises, but they were unable to identify any clear trend, he said.
“We all know transports have risen in certain areas of the country, but ... identifying the why is not easy,” said Cunningham.
Officials warn that, in addition to straining emergency medical services, the rising call volume could have financial impacts.
“It’s definitely concerning to us,” said Robinson of the International Association of EMS Chiefs. “And it should be concerning to the citizens of the United States because it drives up the cost of health care for everyone in our country.”
He and other experts said that data is already routinely collected that could be used to answer the question, but it’s not being analyzed.
“There are not a lot of academic resources looking at it, and there’s no real policy advocate for EMS” to push for such research, Robinson said.
Matt Rocheleau can be reached at matthew.rocheleau@globe.com. Follow him on Twitter @mrochele