An ambulance tour is a shift, not a transport. For whatever reason, it's always been called a tour. Units run for either 8 or 12 hour tours. It's just referring to how many units are run. Any unit will do multiple calls a tour.

You're misinterpreting what that means. Of the 1,425,719 reported calls for "medical emergencies", 1,092,752 resulted in a transport to the hospital.

FDNY does not provide non-emergency interfacility transport service. In New York City, non-emergency ambulance services are provided by private ambulance companies or a hospital's own EMS department.

It actually is that busy. It's not that a ninth of the population uses an ambulance a year, there are just some individuals who are hyper-utilizers.

Anecdotally, every paramedic or EMT will have regulars that we know very well. These are individuals often with poor healthcare literacy and chronic conditions that they are either unable or unwilling to address in a more appropriate setting than an ER. Then there's also the regular drunks, homeless people just trying to get a bed and a sandwich, you get the idea.