Elderly patients with less urgent medical needs represent a high proportion of all emergency patients in Japan; this trend is gradually increasing, presenting a burden on the emergency medical system. To design effective interventions, it is important to understand the basic characteristics of emergency service use. For elderly Japanese patients, there is currently no detailed report on less urgent cases (LUC), or those cases that could be diagnosed by primary care physicians. Since there is a need for a timely reporting of detailed LUC data, we used data of 2004-2006 from an immediately available database at the Yao Tokushukai General Hospital. With a focus on LUC, we analyzed 7,800 cases of elderly patients, aged over 65 years, who were transported via ambulance to a secondary emergency hospital in Osaka. Of these, 3,354 patients (43.0%) were classified as having initial emergencies and were given outpatient care in the emergency department, and 1,544 patients (19.8%) were LUC, in which 541 subjects (6.9%) may have used ambulance services somewhat inappropriately owing to a lack of alternate transportation. In the remaining 1,003 patients, ambulance use could have been avoided if primary care clinics were available at night and during holidays. We therefore focus on three important points: awareness-raising activities to prevent inappropriate ambulance use, strengthening of transport services to healthcare facilities, and expanding primary care clinic office hours. This study is the first detailed report on the use of ambulance services in Japan by elderly patients with less urgent medical needs.