Oral Reducing Ambulance Dispatches through Using a Multi-interventional Approach – A Prospective Observational Study

Introduction: The increasing number of ambulance calls and emergency department overcrowding have become a global issue during the past decade. The aging population and increasing morbidity play only a partial role in the increased demand. Ambulance service is often called upon, even when other, more appropriate services would be readily available. This inappropriate utilization of ambulances imposes a significant burden on the emergency health care system. This study aimed to evaluate the effectiveness of various interventions aimed at controlling ambulance dispatch volume and to facilitate the referral of patients to appropriate alternative services. Methods: This was a prospective, observational cohort study covering all ambulance dispatches in Helsinki, Finland, in 2021- 2024. Interhospital patient transfers were excluded. The main interventions used were 1) providing guidelines and training for home care and nursing homes, 2) conducting public campaigns and increasing media coverage, 3) updating dispatching guidelines, 4) enabling case-based decision making by dispatchers, and 5) allowing dispatchers to refer callers to alternative services. The interventions were introduced between 2021 and 2023. The study plan was approved by Helsinki University Hospital. Results: The number of ambulance missions (and total number of units dispatched) decreased from 74,197 (86,860) in 2021 to 72,596 (84,377) in 2022 and to 72,480 (83,161) in 2023. During the first nine months of 2024, the dispatch volume was 48,344 (54,543), with a predictive model estimating a total volume of 64,507 (74,013) by the end of the year. From 2021 to the end of 2024, the estimated total reduction is expected to be 13,1% (14,8%). Conclusion: The use of multiple, simultaneous interventions managed to stop rise in ambulance dispatches, leading to a reduction. This may be the first report of interventions that have managed to reverse the current trend.