The streets may not be as mean as they once were, but that's not stopping director Martin Scorsese and writer Paul Schrader from going back to Gotham's skankier nooks and crannies for one more bone-rattling ride in "Bringing Out the Dead." In this lesser collaboration by the "Taxi Driver" team, however, the man behind the wheel is a hallucinating paramedic and the vehicle from hell is a New York City ambulance.

Based on technical adviser Joe Connelly's novel, the movie follows the tormented hero on his nocturnal rounds--too many of which involve the use of defibrillators--for 56 harrowing hours. TV's "ER" and now "Third Watch" basically have a monopoly on the material, even if Scorsese's take is grander, darker and more surreal. That's not to say it's better or more involving.

Nicolas Cage, his concerned eyes raw from drink and sleeplessness, leads a solid cast as Frank Pierce, a kinder, gentler version of crazed cabby Travis Bickle. He, too, is an alienated loner undergoing a severe spiritual crisis as he careers through seamy nights filled with dying screams and his siren's ululations. Still, he isn't the type to go nuclear.

Frank is more like Cage's lovesick seraph in 1998's "City of Angels"--clearly a noble, nurturing figure, albeit a burned-out one. He's come to believe that he's responsible not only for saving his patients' lives but for releasing the souls of casualties. Lately, he's been haunted by the pallid, reproachful spirits of those who have died on his watch, especially that of a runaway girl.

As the movie makes clear, the story takes place in the early '90s and New York has not undergone its renaissance of recent years. The Emergency Medical Service is in chaos and Frank is on the brink of physical and mental exhaustion as he faces another grueling graveyard shift with the first of three very different partners. Each has found a different, sometimes darkly funny way of coping with the nightmarish realities of their stressful, mostly thankless jobs.

His regular partner, Larry (John Goodman), maintains lethargic indifference, stuffs his face and plans his retirement. Walls (Tom Sizemore), a former partner who has become a sociopath with a medic's license, almost beats one drug addict to death. And as he invariably does, Ving Rhames steals the show, here as Marcus, a genial, God-praising fellow who flirts with the dispatcher, converts wounded sinners and considers himself the finest ambulance driver the world has ever known.

The film is rich in distinctive, deftly played minor characters, including Arthur Nascarella as the captain who refuses to fire the habitually late Frank, Mary Beth Hurt as a cynical nurse at an overcrowded inner-city hospital and Cliff Curtis as a drug lord who attempts to lure Frank's love interest (Patricia Arquette) back to heroin.

The romantic subplot promises hope for the hero and provides relief from the movie's principal business--zooming to and from the hospital. But Arquette, as the daughter of one of Frank's patients, plays the role with all the vivacity of an exhausted moth. Of course, Frank is far from perky himself. Every time they get together, the professed insomniac falls into a deep sleep. Then again, maybe a bland bombshell is just the thing after a long night of the siren's shrieking song.

"Bringing Out the Dead" doesn't pack the punch of Schrader and Scorsese's career-best collaborations ("Raging Bull," "Taxi Driver"), nor does it measure up to Schrader's 1998 solo outing, "Affliction." In those deeper, more disturbing tales, a desperate man teeters on the edge of control, his soul up for grabs, and we, on the edge of our seats, wonder if he'll regain his balance or fall as destined. Here we ponder whether Frank and his partners will opt for Chinese or pizza on their dinner break.

Bringing Out the Dead (120 minutes, at area theaters) is rated R for violent content, drug use and language.

CAPTION: New meaning to the term "sleeper": Patricia Arquette, left, and Nicolas Cage in "Bringing Out the Dead."