title: Inappropriate Ambulance Use: A Qualitative Study of Paramedics' Views.
abstract: Existing studies of inappropriate ambulance use focus on its extent, employing clinical criteria. Little is known about how front-line paramedics assess appropriateness. This study investigates how paramedics view and judge appropriate versus inappropriate ambulance use.
  
  
  
  We conducted interviews with 19 paramedics working in two regions in southwestern Ontario that were analyzed using grounded theory methods.
  
  
  
  While blatantly "inappropriate" use is extraordinary, "misuse" is more common, and paramedics determine misuse largely by interpreting patients' abilities to cope with their situations. Paramedics assess this using multiple patient attributes: patient's age, knowledge of the system, system failures, social support available, presence of transportation alternatives, patient's ability to walk and trial of treatment with home remedies.
  
  
  
  In the future, paramedic-informed, contextual and non-clinical criteria might supplement clinically based criteria for emergency service-use evaluation and may inform more patient-centred policy interventions to reduce ambulance misuse and inappropriate use.
authors.affiliation: Postdoctoral Fellow, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Dejean
authors.affiliation: Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON.
authors.forename: Mita
authors.initials: M
authors.lastname: Giacomini
authors.affiliation: Associate Professor, Division of Emergency Medicine, McMaster University, Hamilton, ON.
authors.forename: Michelle
authors.initials: M
authors.lastname: Welsford
authors.affiliation: Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON.
authors.forename: Lisa
authors.initials: L
authors.lastname: Schwartz
authors.affiliation: Associate Professor, Department of Economics, McMaster University, Hamilton, ON.
authors.forename: Philip
authors.initials: P
authors.lastname: Decicca
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D000552:Ambulances; D006300:Health Services Misuse; D006801:Humans; D008875:Middle Aged; D036301:Qualitative Research; D012944:Social Support; D014186:Transportation