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A12 Patient priorities and decision-making about using 999 EMS? A review of the literature
  1. P Coleman,
  2. J Turner
  1. Medical Care Research Unit (MCRU), ScHARR, University of Sheffield, Sheffield, UK


Background Against a background of increasing demands for emergency ambulances in the UK, there are ongoing concerns about the proportion of users (between 30% and 52%) who are transported to EDs inappropriately or unnecessarily. Less attention has been paid to understanding the factors that influence patients' decisions to use, delay, or not to use an emergency ambulance.

Aims and Objectives To summarise what is known about patient priorities and decision-making around 999 EMS use, we carried out a rapid review of the literature.

Methods We initiated searches of MEDLINE from 1996 to the present using a series of MESH terms linking patient self-reports of utilisation of health care AND emergency ambulance. The strategy yielded 84 potential items. To identify recent papers, we limited publications to prospective surveys of user views published after 1999. Eleven papers were reviewed. Two of these were from the UK.

Results The papers divided into two broad categories: (1) users who delayed contacting an emergency ambulance in medical emergencies, and (2) users whose presenting condition did not require an emergency transportation to an ED. Patients struggled to distinguish the symptoms of a serious medical emergency from a less serious need. Underestimating the progression of symptoms, guilt or potential embarrassment around requesting an ambulance was associated with inappropriate delayed contact or non-use. Other recurring themes associated with use and non-use were: someone else making or sharing the decision, gender, pain, coping strategies, ease of access to other transport and resources, previous experience of the health problem or ambulance use.

Conclusions Further patient-centred research is required in the UK to increase understanding of the important factors that influence decisions about whether to use an emergency ambulance or not.

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