Making up one’s mind: – Patients’ experiences of calling an ambulance

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Summary

The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals’ and caregivers’ perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients’ existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients’ experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals’ point of view but also take account of the patients’ reactions when they experience a threat to their life and health.

Introduction

Prehospital emergency care is care and treatment provided at the scene of an accident or acute and sudden illness, in an ambulance, emergency vehicle or helicopter. It also includes the interval between the receipt of a call by the emergency call centre and the hand-over of the patient to the receiving unit. Today, ambulance care is thus a general term for both the transport and specialized treatment for sick and injured patients. Ambulance care can also be defined as the examination, care and treatment carried out in connection with the transportation of patients. It has improved both in quality and quantity, in the areas of staff competence, the development of vehicles, sickbay and medical technical equipment. Today, most ambulances are equipped to provide qualified care for seriously ill or injured patients. Swedish health legislation states that ambulance care is a part of the public health and medical service and should be able to provide adequate care in a personalized and humane manner (Suserud et al., 2003a, Suserud et al., 2003b).

Recently, many researchers have highlighted the fact that ambulance care is used in a way for which it was not intended (Billittier et al., 1996, Clark and Fitzgerald, 1999, Gardner, 1990, Gratton et al., 2003, Hauswald and Jambrosic, 2004, Pallazzo et al., 1998, Rademaker et al., 1987, Richards and Ferrall, 1999). These studies reflect the professionals’ view that there are many calls to the emergency call centres that do not require an emergency response. Those studies also reveal that the number of non-urgent cases managed by ambulance care has increased. Accordingly, some studies have focused on the inappropriate use of valuable health care resources and the overuse of ambulance care, which is considered a major problem. A recent study by Hjälte et al. (submitted) reveals that ambulance personnel in Sweden estimate that every third journey is unnecessary. The results of the study suggest that efficiency in the care of seriously ill and injured patients would increase if unnecessary ambulance journeys could be avoided.

Hence, assessment of the need for ambulance and emergency care must be made. In many cases, patients, emergency call centres and caregivers assess the need for ambulance/emergency care differently (Hauswald, 2002, Silvestri et al., 2002). From the professionals’ point of view, too many people use ambulance and emergency care in an inappropriate way, and the emergency departments are filled by non-urgent patients (Gill and Riley, 1996, Malone, 1995, Murphy, 1998, Walsh, 1994). From the patients’ point of view, the problems are quite different (Nairn et al., 2004). Olsson and Hangasi (2001) suggest that patients who frequently use emergency care make strong efforts to cope with the perceived threat and try to maintain their autonomy. It is the feeling of powerlessness that compels them to seek help.

At present, there are few studies focusing on the patient and his/her experiences of prehospital care. However, Pallazzo et al. (1998) interviewed 300 patients about the reason for calling an ambulance. According to the criterion set by the study, i.e., having used ambulance care within the past three months, 50% of the patients were considered to have been in need of an ambulance. Approximately 60% of these patients believed that they were in a serious or life-threatening condition; 16% did not know whom to call when they needed help and a further 16% were not aware of any other way of getting to a hospital. The remaining 8% decided to call an ambulance because they wanted to avoid having to wait at the emergency department. Mattiasson and Andersson (1995) found that staff attitudes to patient autonomy are crucial for patients’ ability to act autonomously and take responsibility for their own decisions. Hence, it is obvious that medical staff play a key role in supporting or limiting patients’ rights in health care.

The issue of inappropriate use of ambulance transport has mainly been studied from the caregivers’ perspective. To further understand whether or not patients use ambulance care in an inappropriate manner, and why, it is important to obtain an overall picture of the patients’ existential situation at the time they call an ambulance. Thus, the aim of the present study is to analyze and describe patients’ experiences related to the decision to call an ambulance and when waiting for it to arrive.

Section snippets

Design and participants

The design of the study is explorative for the purpose of describing patients’ experiences. Twenty patients participated, 12 women and 8 men, aged between 34 and 82 years, who had experienced ambulance care in towns and rural areas of southern Sweden. The informants were selected in order to achieve a large variation in age, gender, emergency priorities and medical diagnosis. A general criterion was that the informants had used ambulance care within the past three months. Their medical

Findings

The findings are reported as two themes, making up one’s mind and waiting for help. Categories and subcategories of each theme are presented in table form, after which they are described and illustrated by quotations from the interviews.

Discussion

The purpose of this study was to describe patients’ experiences related to their decision to call and wait for an ambulance. The findings are more nuanced and partly contradict those of previous studies, in which researchers revealed indications of overuse/misuse in all cases where patients have assessed ambulance care as necessary (Billittier et al., 1996, Clark and Fitzgerald, 1999, Gardner, 1990, Gratton et al., 2003, Pallazzo et al., 1998, Rademaker et al., 1987, Richards and Ferrall, 1999

Conclusion

According to the findings of this study the definition of inappropriate use of valuable health care resources should not only be based on the professional point of view. Professionals may not be aware of the situation leading to the decision to call an ambulance, since some symptoms decrease while waiting. It seems fair to assume that professional judgment should consider both medical knowledge and patients’ reactions when they experience threat to their health and life.

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