The recent Herald-Leader report on the enormous costs to taxpayers to provide professional, reliable emergency services when there aren't true emergencies presented is, on the face of it, a classic Catch-22.
It is simply impossible to tell on the telephone in every case if there is a true emergency; that requires an EMS professional to go to the scene, by which time a big chunk of public resources have already been spent.
This problem is not new, and it certainly is not unique to Lexington. As Lexington Fire Chief Keith Jackson and others told Linda Johnson and Beth Musgrave, it comes with the emergency territory.
Several communities have worked on finding ways to use some of the EMS resources, both human and financial, to prevent these emergency calls before they happen.
Never miss a local story.
This could require legal, administrative and cultural changes that are beyond the ability or authority of the Fire Department and should involve the mayor's cabinet and the council as well as medical professionals and social service providers.
One example in the story describes a diabetic woman who, in the words of Battalion Chief Brian Wood, "doesn't take care of herself." During the first three months of last year her family called 911 for help 115 times, or close to every day, and averaged 20 calls a month through the year.
Usually the woman can be revived on the spot with an injection. While that may be a good thing for her and her family, it's costly for the city because emergency runs are only reimbursed by insurers when the patient is taken to a hospital.
But, as Wood pointed out, if the Fire Department refused to respond to the calls, she could have a fatal episode, meaning the unnecessary loss of a life, and potentially opening the city to liability.
The better outcome would be to work with the woman and her family to improve her self-care to avoid these near-constant crises. It would almost certainly cost less, free up services for true emergencies and improve her quality of life.
The issues surrounding unnecessary ambulance calls are very like those that have emerged as the community has studied the dearth of affordable housing and the related problem of homelessness. In fact, many of the calls involve homeless people.
Preventing homelessness is better for the community and the individual in a host of ways, much like avoiding the crisis that results in a non-emergency ambulance run.
In both situations, the people involved often lack resources, information, access to medical care and transportation, all of which make it hard to hold jobs, get to the doctor, secure medications and avoid crises.
The city, after a long time spent studying housing issues, is looking for a person who will have the complex task of coordinating a host of resources, public and private.
So, this would be a good moment to examine closely the related problem of unnecessary ambulance runs, and possible solutions.
For example, fire officials are hopeful that by extending health coverage through the Affordable Care Act more of the ambulance "frequent flyers" will now have access to regular medical care.
Similarly, health crises and lack of insurance are often factors in the downward spiral of financial woes and job losses that push people into homelessness.
If the city is going to play some role in helping people sign up for ACA coverage and get regular, preventive, non-emergency health care, it's reasonable for both the office of homelessness and the Fire Department to be involved in accomplishing that.