Researchers: Yoseph Mekori¹, Ayala Cohen¹, Mohammad Khatib², Khaled Awawdi³

Background: The elapse of time prior to receiving medical treatment is a primary factor in successful treatment in life-threatening conditions.

Objectives: The purpose of the study was to examine in-depth ambulance use patterns in life-threatening conditions in the northern part of Israel.

Method: In a mixed-method study, 71 people that arrived, some of them in an ambulance, at three hospitals in the northern part of Israel with a life-threatening condition, were interviewed and a socio-demographic questionnaire and a quality-of-life questionnaire associated with health were also filled.

Findings: Two key themes emerged from the analysis of the interviews - the decision-making process, and attitudes and perceptions toward the use of an ambulance. The data indicate the underuse of ambulance, especially in the Western Galilee. Emergency department directors positioned that the use of an ambulance in life-threatening conditions is of acute importance at all hours of the day.

Conclusions: The qualitative part of the study enabled tracing the decision-making process from symptom onset to medical treatment and to identify different stages of the process. The study findings indicated barriers to the use of ambulance, preferring to use private vehicles, including arrival time to the hospital, failure to perceive the situation as life-threatening, lack of knowledge of where to seek help, lack of understanding of the advantages of using ambulances, family and community barriers and the desire to avoid high costs. An additional barrier that was not found in the literature, and which was raised in the study, relates to the lack of clear instructions from community caretakers regarding the way to get to the hospital.

Recommendations: In order to encourage the public to use the ambulance, especially in life-threatening conditions, action should be taken to strengthen public health literacy, to train doctors to make unequivocal recommendations regarding the need for an ambulance and to change the payment mechanism.

Research end date: 02/2019