Araştırma Makalesi
BibTex RIS Kaynak Göster

TÜRKİYE’DE 112 ACİL YARDIM AMBULANSLARININ UYGUNSUZ KULLANIMININ EKONOMİK ETKİLERİ: PARAMEDİK VE ATT GÖRÜŞLERİNE DAYALI BİR DEĞERLENDİRME

Yıl 2025, Cilt: 10 Sayı: 1, 1 - 19, 30.04.2025

İbrahim Çınar , Şirin Çınar , Mesut Yıldız , Onur Şahin , Yaşar Gokbayrak , Ceyhan Molla

https://doi.org/10.54409/hod.1593398

Öz

Amaç: Bu araştırma, Türkiye’de 112 acil yardım ambulanslarında görev yapan paramedik ve ATT’lerin, müdahale ettikleri vakaların ne kadarını uygunsuz bulduklarını belirlemeyi amaçlamaktadır.
Gereç ve Yöntem: Kesitsel ve tanımlayıcı tasarıma sahip olan çalışmada, Acil Tıp Teknisyenleri ve Teknikerleri Derneği’ne (ATTDER) üye 5005 kişiden sonlu evren seçimi yöntemiyle örneklem belirlenmiş ve 521 katılımcıyla tamamlanmıştır. Veriler, 10 soruluk bir anket aracılığıyla çevrim içi olarak toplanmış ve SPSS 25 programıyla analiz edilmiştir.
Bulgular: Araştırma sonuçlarına göre, katılımcılar ambulans vakalarının %68,77’sini uygunsuz olarak değerlendirmiştir. Bu durum, sınırlı sağlık kaynaklarının israf edildiğini ve sağlık sisteminin verimliliğinin olumsuz etkilendiğini göstermektedir.
Sonuç: Araştırma, triyaj sistemlerinin yaygınlaştırılması ve etkin kullanılmasının, gereksiz ambulans kullanımını önlemek için kritik olduğunu ortaya koymaktadır. Sağlık çalışanlarının büyük çoğunluğunun uygunsuz kullanım bildirmesi, sorunun ciddi boyutta olduğunu göstermektedir.

Anahtar Kelimeler

Ambulans Uygunsuz Kullanım İsraf

Kaynakça

  • Ambulanslar ve Acil Sağlık Araçları ile Ambulans Hizmetleri Yönetmeliği, Pub. L. No. 26369 (2006).
  • Ayten, S. (2015). Denizli ilinde 112 komuta merkezine yapılan aramalar ve acil ambulans hizmetlerinin kullanımının değerlendirilmesi. Pamukkale Üniversitesi Tıp Fakültesi .
  • Birmingham, L. E., Arens, A., Longinaker, N., & Kummet, C. (2021). Trends in ambulance transports and costs among Medicare beneficiaries, 2007–2018. The American Journal of Emergency Medicine, 47, 205-212. https://doi.org/10.1016/j.ajem.2021.04.039
  • Booker, M. J., Shaw, A. R. G., & Purdy, S. (2015). Why do patients with ‘primary care sensitive’ problems access ambulance services? A systematic mapping review of the literature. BMJ Open, 5(5), e007726. https://doi.org/10.1136/bmjopen-2015-007726
  • Boyacı, H., & Söyük, S. (2024). Perceptions of work stress and workload among healthcare professionals during the COVID-19 Pandemic. International Liberty Interdisciplinary Studies Conference, 664-680.
  • DeJean, D., Giacomini, M., Welsford, M., Schwartz, L., & Decicca, P. (2016). Inappropriate Ambulance Use: A Qualitative Study of Paramedics’ Views. Healthcare Policy | Politiques de Santé, 11(3), 67-79. https://doi.org/10.12927/hcpol.2016.24535
  • Déziel, J. D. (2019). Ambulance transport to the emergency department: A patient-selected signal of acuity and its effect on resource provision. The American Journal of Emergency Medicine, 37(6), 1096-1100. https://doi.org/10.1016/j.ajem.2018.08.068
  • Di Tosto, G., Melnyk, H., Powell, J. R., Kenah, E., Gage, C. B., Panchal, A. R., & McAlearney, A. S. (2024). COVID‐19 and coworker conflict among emergency medical service clinicians. JACEP Open, 5(5), e13282. https://doi.org/10.1002/emp2.13282
  • Durant, E., & Fahimi, J. (2012). Factors Associated with Ambulance Use Among Patients with Low-Acuity Conditions. Prehospital Emergency Care, 16(3), 329-337. https://doi.org/10.3109/10903127.2012.670688
  • Gardett, I., Scott, G., Clawson, J., Miller, K., Richmond, N., Sasson, C., Zavadsky, M., & Olola, O. (2015). 911 emergency communication nurse triage reduces EMS patient costs and directs patients to high-satisfaction alternative point of care. Ann Emerg Dispatch Response, 3, 8-13.
  • Horibata, K., & Takemura, Y. (2015). Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs. The Tohoku Journal of Experimental Medicine, 235(2), 89-95. https://doi.org/10.1620/tjem.235.89
  • Katayama, Y., Kitamura, T., Nakao, S., Himura, H., Deguchi, R., Tai, S., Tsujino, J., Mizobata, Y., Shimazu, T., & Nakagawa, Y. (2022). Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.896506
  • Kawakami, C., Ohshige, K., Kubota, K., & Tochikubo, O. (2007). Influence of socioeconomic factors on medically unnecessary ambulance calls. BMC Health Services Research, 7(1), 120. https://doi.org/10.1186/1472-6963-7-120
  • Koenig, K. L. (2022). Emergency Ambulance Utilization in Harlem, New York (July 1985). Prehospital Emergency Care, 26(3), W1-W17. https://doi.org/10.1080/10903127.2022.2057629
  • Mohd Hassan, N. Z. A., Bahari, M. S., Raman, S., Aminuddin, F., Mohd Nor Sham Kunusagaran, M. S. J., Zaimi, N. A., Wong, M. F., Mostapha, M., Mohamad Nor, A. T., & Shahari, M. R. (2024). Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia. BMC Health Services Research, 24(1), 168. https://doi.org/10.1186/s12913-024-10557-4
  • Morimura, N., Aruga, T., Sakamoto, T., Aoki, N., Ohta, S., Ishihara, T., Kushimoto, S., Ohta, S., & Ishikawa, H. (2011). The impact of an emergency telephone consultation service on the use of ambulances in Tokyo. Emergency Medicine Journal, 28(1), 64-70. https://doi.org/10.1136/emj.2009.073494
  • O’Cathain, A., Connell, J., Long, J., & Coster, J. (2020). ‘Clinically unnecessary’ use of emergency and urgent care: A realist review of patients’ decision making. Health Expectations, 23(1), 19-40. https://doi.org/10.1111/hex.12995
  • Orhaner, E., & Mutlu, S. (2018). Sağlık Personelinin İş Tatmininin Motivasyon Üzerine Etkisi. Uluslararası Sağlık Yönetimi ve Stratejileri Araştırma Dergisi, 4(1), 74-93.
  • Ostermann, H., Bachner, F., Zuba, M., Rainer, L., & Halla, M. (2019). Economic evaluation of the Austrian telephone-based triage system. European Journal of Public Health, 29(Supplement_4). https://doi.org/10.1093/eurpub/ckz185.035
  • Pearson, C., Kim, D. S., Mika, V. H., Imran Ayaz, S., Millis, S. R., Dunne, R., & Levy, P. D. (2018). Emergency department visits in patients with low acuity conditions: Factors associated with resource utilization. The American Journal of Emergency Medicine, 36(8), 1327-1331. https://doi.org/10.1016/j.ajem.2017.12.033
  • Peyravi, M., Örtenwall, P., & Khorram-Manesh, A. (2015). Can Medical Decision-making at the Scene by EMS Staff Reduce the Number of Unnecessary Ambulance Transportations, but Still Be Safe? PLoS Currents. https://doi.org/10.1371/currents.dis.f426e7108516af698c8debf18810aa0a
  • Phillips, J. S. (2020). Paramedics’ perceptions and experiences of NHS 111 in the south west of England. Journal of Paramedic Practice, 12(6), 227-234. https://doi.org/10.12968/jpar.2020.12.6.227
  • Pollard, D., Fuller, G., Goodacre, S., van Rein, E. A. J., Waalwijk, J. F., & van Heijl, M. (2022). An economic evaluation of triage tools for patients with suspected severe injuries in England. BMC Emergency Medicine, 22(1), 4. https://doi.org/10.1186/s12873-021-00557-6
  • Rojak, T. S. P., Basabih, M., Winarto, & Suranta, R. M. (2024). Analysis Of Public Safety Center 119 Ambulance Services Using Lean Six Sigma. Jurnal Administrasi Kesehatan Indonesia, 12(2), 258-269. https://doi.org/10.20473/jaki.v12i2.2024.258-269
  • Sántha, E., Zelenák, K., Bánfai, B., Ferenczy, M., Boncz, I., Pakai, A., Betlehem, J., & Póhr, K. (2024). CO60 A Vocation for Life on Land, Sea and Air - Health Assessment of Ambulance Workers. Value in Health, 27(6), S27. https://doi.org/10.1016/j.jval.2024.03.148
  • Sarı, A. (2020). Pamukkale Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine 112 ambulansı ile başvuran hastaların sosyodemografik özelliklerinin ve klinik sonlanımlarının retrospektif olarak incelenmesi [Uzmanlık]. Pamukkale Üniversitesi .
  • Serin, S., & Çağlar, B. (2020). Yeni açılan acil servise ambulans ile getirilen hastaların analizi. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi, 24(4), 289-293. https://hdl.handle.net/20.500.12462/11992
  • Shukla, M., Rastogi, P., Sethi, G., Sharma, S., Mehra, S., & Sethi, G. (2024). IJCM_20A: Understanding determinants of increased home deliveries in accessing antenatal care in the two blocks of the Chamba, Himachal Pradesh. Indian Journal of Community Medicine, 49(Suppl 1), S6-S6. https://doi.org/10.4103/ijcm.ijcm_abstract20
  • Silibolatlaz, A., Gülen, M., Avcı, A., & Satar, S. (2018). Üçüncü Basamak Acil Servise 112 Ambulansı İle Getirilen Erişkin Hastaların Analizi. Boğaziçi Tıp Dergisi. https://doi.org/10.15659/bogazicitip.18.10.796
  • Tohira, H., Fatovich, D., Williams, T. A., Bremner, A. P., Arendts, G., Rogers, I. R., Celenza, A., Mountain, D., Cameron, P., Sprivulis, P., Ahern, T., & Finn, J. (2016). Is it Appropriate for Patients to be Discharged at the Scene by Paramedics? Prehospital Emergency Care, 20(4), 539-549. https://doi.org/10.3109/10903127.2015.1128028
  • Toloo, G. S., FitzGerald, G. J., Aitken, P. J., Ting, J. Y. S., McKenzie, K., Rego, J., & Enraght-Moony, E. (2013). Ambulance Use Is Associated With Higher Self-rated Illness Seriousness: User Attitudes and Perceptions. Academic Emergency Medicine, 20(6), 576-583. https://doi.org/10.1111/acem.12149
  • Türkiye İstatistik Kurumu. (2023). Sağlık Harcamaları İstatistikleri, 2022.
  • Xie, F., Yan, J., Agarwal, G., & Ferron, R. (2021). Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams. JAMA Network Open, 4(2), e210055. https://doi.org/10.1001/jamanetworkopen.2021.0055

THE ECONOMIC IMPACT OF INAPPROPRIATE USE OF 112 EMERGENCY AMBULANCES IN TURKEY: AN EVALUATION BASED ON THE PERSPECTIVES OF PARAMEDICS AND EMTS

Yıl 2025, Cilt: 10 Sayı: 1, 1 - 19, 30.04.2025

İbrahim Çınar , Şirin Çınar , Mesut Yıldız , Onur Şahin , Yaşar Gokbayrak , Ceyhan Molla

https://doi.org/10.54409/hod.1593398

Öz

Aim: This study aims to determine how many of the cases handled by paramedics and EMTs working in 112 emergency ambulance services across Turkey are deemed inappropriate.
Materials and Methods: Designed as a cross-sectional and descriptive study, the sample was selected from 5005 members of the Emergency Medical Technicians and Paramedics Association (ATTDER) using finite population sampling, with 521 participants completing the survey. Data were collected through an online survey of 10 questions and analyzed using SPSS 25 software.
Findings: The results show that 68.77% of the cases were considered inappropriate for emergency ambulance use, indicating significant waste of limited healthcare resources and a negative impact on system efficiency.
Results: The study highlights that expanding and effectively using triage systems is essential to reducing inappropriate ambulance use. The fact that most healthcare workers reported inappropriate use reflects the seriousness of the issue, emphasizing the need for structural improvements in the 112 emergency system.

Anahtar Kelimeler

Ambulance Health Economic Turkey

Kaynakça

  • Ambulanslar ve Acil Sağlık Araçları ile Ambulans Hizmetleri Yönetmeliği, Pub. L. No. 26369 (2006).
  • Ayten, S. (2015). Denizli ilinde 112 komuta merkezine yapılan aramalar ve acil ambulans hizmetlerinin kullanımının değerlendirilmesi. Pamukkale Üniversitesi Tıp Fakültesi .
  • Birmingham, L. E., Arens, A., Longinaker, N., & Kummet, C. (2021). Trends in ambulance transports and costs among Medicare beneficiaries, 2007–2018. The American Journal of Emergency Medicine, 47, 205-212. https://doi.org/10.1016/j.ajem.2021.04.039
  • Booker, M. J., Shaw, A. R. G., & Purdy, S. (2015). Why do patients with ‘primary care sensitive’ problems access ambulance services? A systematic mapping review of the literature. BMJ Open, 5(5), e007726. https://doi.org/10.1136/bmjopen-2015-007726
  • Boyacı, H., & Söyük, S. (2024). Perceptions of work stress and workload among healthcare professionals during the COVID-19 Pandemic. International Liberty Interdisciplinary Studies Conference, 664-680.
  • DeJean, D., Giacomini, M., Welsford, M., Schwartz, L., & Decicca, P. (2016). Inappropriate Ambulance Use: A Qualitative Study of Paramedics’ Views. Healthcare Policy | Politiques de Santé, 11(3), 67-79. https://doi.org/10.12927/hcpol.2016.24535
  • Déziel, J. D. (2019). Ambulance transport to the emergency department: A patient-selected signal of acuity and its effect on resource provision. The American Journal of Emergency Medicine, 37(6), 1096-1100. https://doi.org/10.1016/j.ajem.2018.08.068
  • Di Tosto, G., Melnyk, H., Powell, J. R., Kenah, E., Gage, C. B., Panchal, A. R., & McAlearney, A. S. (2024). COVID‐19 and coworker conflict among emergency medical service clinicians. JACEP Open, 5(5), e13282. https://doi.org/10.1002/emp2.13282
  • Durant, E., & Fahimi, J. (2012). Factors Associated with Ambulance Use Among Patients with Low-Acuity Conditions. Prehospital Emergency Care, 16(3), 329-337. https://doi.org/10.3109/10903127.2012.670688
  • Gardett, I., Scott, G., Clawson, J., Miller, K., Richmond, N., Sasson, C., Zavadsky, M., & Olola, O. (2015). 911 emergency communication nurse triage reduces EMS patient costs and directs patients to high-satisfaction alternative point of care. Ann Emerg Dispatch Response, 3, 8-13.
  • Horibata, K., & Takemura, Y. (2015). Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs. The Tohoku Journal of Experimental Medicine, 235(2), 89-95. https://doi.org/10.1620/tjem.235.89
  • Katayama, Y., Kitamura, T., Nakao, S., Himura, H., Deguchi, R., Tai, S., Tsujino, J., Mizobata, Y., Shimazu, T., & Nakagawa, Y. (2022). Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.896506
  • Kawakami, C., Ohshige, K., Kubota, K., & Tochikubo, O. (2007). Influence of socioeconomic factors on medically unnecessary ambulance calls. BMC Health Services Research, 7(1), 120. https://doi.org/10.1186/1472-6963-7-120
  • Koenig, K. L. (2022). Emergency Ambulance Utilization in Harlem, New York (July 1985). Prehospital Emergency Care, 26(3), W1-W17. https://doi.org/10.1080/10903127.2022.2057629
  • Mohd Hassan, N. Z. A., Bahari, M. S., Raman, S., Aminuddin, F., Mohd Nor Sham Kunusagaran, M. S. J., Zaimi, N. A., Wong, M. F., Mostapha, M., Mohamad Nor, A. T., & Shahari, M. R. (2024). Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia. BMC Health Services Research, 24(1), 168. https://doi.org/10.1186/s12913-024-10557-4
  • Morimura, N., Aruga, T., Sakamoto, T., Aoki, N., Ohta, S., Ishihara, T., Kushimoto, S., Ohta, S., & Ishikawa, H. (2011). The impact of an emergency telephone consultation service on the use of ambulances in Tokyo. Emergency Medicine Journal, 28(1), 64-70. https://doi.org/10.1136/emj.2009.073494
  • O’Cathain, A., Connell, J., Long, J., & Coster, J. (2020). ‘Clinically unnecessary’ use of emergency and urgent care: A realist review of patients’ decision making. Health Expectations, 23(1), 19-40. https://doi.org/10.1111/hex.12995
  • Orhaner, E., & Mutlu, S. (2018). Sağlık Personelinin İş Tatmininin Motivasyon Üzerine Etkisi. Uluslararası Sağlık Yönetimi ve Stratejileri Araştırma Dergisi, 4(1), 74-93.
  • Ostermann, H., Bachner, F., Zuba, M., Rainer, L., & Halla, M. (2019). Economic evaluation of the Austrian telephone-based triage system. European Journal of Public Health, 29(Supplement_4). https://doi.org/10.1093/eurpub/ckz185.035
  • Pearson, C., Kim, D. S., Mika, V. H., Imran Ayaz, S., Millis, S. R., Dunne, R., & Levy, P. D. (2018). Emergency department visits in patients with low acuity conditions: Factors associated with resource utilization. The American Journal of Emergency Medicine, 36(8), 1327-1331. https://doi.org/10.1016/j.ajem.2017.12.033
  • Peyravi, M., Örtenwall, P., & Khorram-Manesh, A. (2015). Can Medical Decision-making at the Scene by EMS Staff Reduce the Number of Unnecessary Ambulance Transportations, but Still Be Safe? PLoS Currents. https://doi.org/10.1371/currents.dis.f426e7108516af698c8debf18810aa0a
  • Phillips, J. S. (2020). Paramedics’ perceptions and experiences of NHS 111 in the south west of England. Journal of Paramedic Practice, 12(6), 227-234. https://doi.org/10.12968/jpar.2020.12.6.227
  • Pollard, D., Fuller, G., Goodacre, S., van Rein, E. A. J., Waalwijk, J. F., & van Heijl, M. (2022). An economic evaluation of triage tools for patients with suspected severe injuries in England. BMC Emergency Medicine, 22(1), 4. https://doi.org/10.1186/s12873-021-00557-6
  • Rojak, T. S. P., Basabih, M., Winarto, & Suranta, R. M. (2024). Analysis Of Public Safety Center 119 Ambulance Services Using Lean Six Sigma. Jurnal Administrasi Kesehatan Indonesia, 12(2), 258-269. https://doi.org/10.20473/jaki.v12i2.2024.258-269
  • Sántha, E., Zelenák, K., Bánfai, B., Ferenczy, M., Boncz, I., Pakai, A., Betlehem, J., & Póhr, K. (2024). CO60 A Vocation for Life on Land, Sea and Air - Health Assessment of Ambulance Workers. Value in Health, 27(6), S27. https://doi.org/10.1016/j.jval.2024.03.148
  • Sarı, A. (2020). Pamukkale Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine 112 ambulansı ile başvuran hastaların sosyodemografik özelliklerinin ve klinik sonlanımlarının retrospektif olarak incelenmesi [Uzmanlık]. Pamukkale Üniversitesi .
  • Serin, S., & Çağlar, B. (2020). Yeni açılan acil servise ambulans ile getirilen hastaların analizi. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi, 24(4), 289-293. https://hdl.handle.net/20.500.12462/11992
  • Shukla, M., Rastogi, P., Sethi, G., Sharma, S., Mehra, S., & Sethi, G. (2024). IJCM_20A: Understanding determinants of increased home deliveries in accessing antenatal care in the two blocks of the Chamba, Himachal Pradesh. Indian Journal of Community Medicine, 49(Suppl 1), S6-S6. https://doi.org/10.4103/ijcm.ijcm_abstract20
  • Silibolatlaz, A., Gülen, M., Avcı, A., & Satar, S. (2018). Üçüncü Basamak Acil Servise 112 Ambulansı İle Getirilen Erişkin Hastaların Analizi. Boğaziçi Tıp Dergisi. https://doi.org/10.15659/bogazicitip.18.10.796
  • Tohira, H., Fatovich, D., Williams, T. A., Bremner, A. P., Arendts, G., Rogers, I. R., Celenza, A., Mountain, D., Cameron, P., Sprivulis, P., Ahern, T., & Finn, J. (2016). Is it Appropriate for Patients to be Discharged at the Scene by Paramedics? Prehospital Emergency Care, 20(4), 539-549. https://doi.org/10.3109/10903127.2015.1128028
  • Toloo, G. S., FitzGerald, G. J., Aitken, P. J., Ting, J. Y. S., McKenzie, K., Rego, J., & Enraght-Moony, E. (2013). Ambulance Use Is Associated With Higher Self-rated Illness Seriousness: User Attitudes and Perceptions. Academic Emergency Medicine, 20(6), 576-583. https://doi.org/10.1111/acem.12149
  • Türkiye İstatistik Kurumu. (2023). Sağlık Harcamaları İstatistikleri, 2022.
  • Xie, F., Yan, J., Agarwal, G., & Ferron, R. (2021). Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams. JAMA Network Open, 4(2), e210055. https://doi.org/10.1001/jamanetworkopen.2021.0055
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Acil Tıp, Sağlık Hizmetleri ve Sistemleri (Diğer)
Bölüm Araştırma Makaleleri
Yazarlar

İbrahim Çınar 0000-0003-1122-3130

Şirin Çınar 0000-0001-9056-6320

Mesut Yıldız 0000-0002-7398-2354

Onur Şahin 0000-0002-1386-8218

Yaşar Gokbayrak 0000-0002-6126-323X

Ceyhan Molla 0000-0002-2233-8323

Erken Görünüm Tarihi 30 Nisan 2025
Yayımlanma Tarihi 30 Nisan 2025
Gönderilme Tarihi 29 Kasım 2024
Kabul Tarihi 29 Ocak 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 10 Sayı: 1

Kaynak Göster

APA Çınar, İ., Çınar, Ş., Yıldız, M., Şahin, O., vd. (2025). TÜRKİYE’DE 112 ACİL YARDIM AMBULANSLARININ UYGUNSUZ KULLANIMININ EKONOMİK ETKİLERİ: PARAMEDİK VE ATT GÖRÜŞLERİNE DAYALI BİR DEĞERLENDİRME. Hastane Öncesi Dergisi, 10(1), 1-19. https://doi.org/10.54409/hod.1593398
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