THE EMERGENT PROBLEM OF AMBULANCE MISUSE

Study objective: The primary objective was to determine whether rates of ambulance misuse varied systematically by type of health insurance. The secondary objective was to determine whether the level of service provided in the ambulance varied by ambulance company ownership. Design: Survey. Setting: A 175-bed community hospital in central Connecticut. Participants: One hundred forty-five records were selected randomly for study from the records of the 488 patients presenting to the hospital emergency department within a 45-day period. Outcome measures: The urgency of presenting complaint and the use of life support measures within the ambulance were obtained from each ambulance run form. Type of health insurance, clinical data, and disposition were obtained from ED records. Ambulance use was deemed unnecessary if the patient's presenting complaint was nonurgent, the patient was ambulatory, and the patient was not ultimately hospitalized. Advanced life support measures were deemed unnecessary if they were applied to patients with nonurgent complaints. Results: Patients with private insurance made appropriate use of ambulances in 77.8% of cases, patients with Medicare did so in 65.8% of cases, and patients with Medicaid did so in 14.7% of cases. These results were statistically significant at P<.001. Among patients with Medicare, ambulance misuse was more common among nursing home residents. Approximately 20% of the observed misuse was related to alcohol intoxication. Although it did not reach statistical significance, we noted a higher frequency of inappropriate use of advanced life support measures in patients brought to the ED by a private ambulance service than for those brought by a municipal service. Conclusion: Ambulance misuse is common in the studied community and may be related to the broader problem of the provision of care to the poor or otherwise underserved. Our results raise several interesting questions for further research.