Utilization, awareness, and predictors of emergency medical services use in India: a prospective observational study

TL;DR

This study examines how emergency medical services are used in India and finds low awareness and key factors influencing ambulance use.

Contribution

The study identifies predictors of EMS use and highlights gaps in awareness and infrastructure in India.

Findings

47% of patients arrived by ambulance, with males more likely to use it.

Only 43% of participants were aware of emergency medical services.

Triage category, EMS awareness, and perceived severity predict ambulance use.

Abstract

This study aims to investigate the utilization patterns, awareness and factors influencing utilization of emergency medical services among patients reporting to the emergency department of a tertiary care hospital in India.

It is a prospective observational study, conducted at the Emergency Department (ED) of a tertiary care hospital in an urban setting in Southern India, conducted over 45 days in November and December 2024, among 434 patients aged ≥ 18 years. Data was collected using a pre-structured proforma covering demographics, triage category, transportation mode, and EMS awareness. Statistical analysis was performed using R version 4.4.3 software and JAMOVI statistics software version 2.4.11. Descriptive and inferential statistics, including chi-square tests and logistic regression analyses, were applied.

Among the 434 patients enrolled, 47% (204) of participants arrived by ambulance, predominantly males. Among trauma and non-trauma patients, non-trauma cases were more common. Patients in higher triage categories, such as P1 and P2 (as per the Emergency Severity Index, ESI), were more likely to be transported by ambulance than those in the lower triage category, P3. However, awareness about EMS was limited to only 43% (188) of the study population; among them, 56.3% (106) only knew the name of emergency medical services without having basic knowledge about them in India. Overall, 45.8% of the study population reported having no awareness about EMS in India or other countries. Logistic regression analysis showed that triage category (OR = 0.31, p < 0.001), EMS awareness (OR = 1.67, p = 0.029), and perceived severity of the patient’s condition (OR = 1.20, p < 0.001) were predictors for higher utilisation of ambulance services.

The study reveals significant gaps in EMS awareness, infrastructure, preference for private transport and highlights the key predictors of EMS utilization. There is an urgent need for public education, centralised EMS and policy reforms to enhance EMS utilization.

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