CLEVELAND, Ohio -- The days of Cleveland paramedics hauling people to the hospital for minor ailments such as hemorrhoids and headaches are over.

At 7 a.m. today, Cleveland Emergency Medical Services will no longer serve as a hospital taxi for problems such as toothaches, boils and similar illnesses.

Callers with the most serious ailments, such as chest pains and trouble breathing, will still be treated before paramedics are dispatched on low-priority runs. Those lesser calls will not be dispatched until 10 ambulances become available and all life-threatening calls are finished.

Cleveland residents have been accustomed to paramedics coming whenever called. Paramedics and firefighters have dubbed the service "You call, we'll haul" because very few calls have been refused since EMS formed in 1975.

"This is a huge step for Cleveland," EMS Commissioner Ed Eckart said. "This is a step back from a long-standing culture in this city."

The change is prompted, at least in part, by budget cuts. Cleveland is trying to close a projected $23 million budget gap in 2010.

The policy should not discourage residents, especially the elderly, from seeking medical help, Eckart said.

"If they need it, they should call," Eckart said. "We don't want to scare anyone away."

The city will operate a minimum of 15 ambulances a day starting today, down from 18 last year. EMS received 80,000 calls last year and transported 66,000 patients to hospitals. The city expects the policy to halt about 2,500 calls this year.

On a daily basis, EMS will analyze every held call and those where ambulances are not sent to ensure ambulances are being properly dispatched.

Eckart expects some people will exaggerate their medical problems to get an ambulances. For example, EMS will look for calls where patients complain of breathing problems but paramedics only find hemorrhoids or minor ailments. Another 25,000 callers could be turned away once EMS determines who abuses the system. But that will take time to figure out, Eckart said.

"I don't feel we have the oversight in place yet," Eckart said. "This is a huge change."

Until October, the city classified medical calls into four categories -- Delta, Charlie, Bravo and Alpha -- based on the severity of the emergency. A call about a heart attack would be classified as a Delta, for example, and a sprained ankle would be an Alpha. It added a fifth category, Omega, in October.

That classification is for nonlife-threatening flu calls. The city feared flu calls could increase response times, limiting the ability to handle other medical emergencies. Callers in serious distress are handled as a typical call regardless of whether it is flu-related.

Highlights of the new policy include:

All Bravo, Alpha and Omega calls will be held until 10 ambulances are available and all life-threatening calls all cleared. EMS dispatchers will call those people every 10 minutes to determine if the call status should be elevated or if they found another route to the hospital.

Callers with minor ailments will be directed to neighborhood clinics, social-service agencies and the United Way's "2-1-1 First Call For Help." The service is a partnership among the agency, the city and county.

The city is working with MetroHealth Medical System, Cleveland Clinic and University Hospitals to establish call lines in order to direct people to neighborhood clinics operated by the hospitals.

Patients with minor ailments will no longer be allowed to pick what hospital they receive treatment. Paramedics will keep people close to their home and in their provider networks. The most severe will still be taken to the hospital that best serves the illnesses or injuries.

Before today, the city sent ambulances for any calls involving people 17 or younger and older than 60. The ages have been expanded to people 70 or older and those 5 years or younger.

EMS union chief Stephen Palek expected some sort of policy change because of the city's looming deficit. The change, he said, is a big departure from the way paramedics have worked for three decades. Paramedics are ready for the challenge, he added.

"We're going to evaluate it and proceed cautiously," Palek said. "We're going to make sure the patients are cared for properly."

The national average for high-priority responses is about nine minutes, Eckart said. He stressed that the time in Cleveland is consistently between six and seven minutes and should improve more with this policy.

For years, paramedics were sent for sprained ankles and slight fevers. City officials acknowledged that other big cites began scaling back their EMS services in the last several years because of rising health care costs and more people lack medical coverage.

Mayor Frank Jackson has ordered pay cuts for non-union employees in an effort to offset a projected deficit this year. Many unions have accepted concessions, while others refused. The city plans to lay off four emergency medical technicians, one EMT trainee and one dispatcher. Seven vacant EMT positions will go unfilled.

Jackson hired a private consultant last year to examine how the city can slash expenses. The 344-page report released in November made more than 175 recommendations for future budget cuts--some of them promised to be painful. This policy change came from that report, said Maureen Harper, a spokeswoman for Jackson.

She added: "This is a good way to help us provide services."