title: Effects of the institutional structure and legislative framework on ambulance accidents in developing emergency medical services systems.
abstract: OBJECTIVE
  Turkey is a developing country undergoing a system change in the prehospital emergency medical services (EMS). The purpose of this study was to evaluate the effects of the institutional structure and legislative framework on the number of ambulance accidents in Turkey.
  
  
  METHODS
  During the first phase of the study, ambulance accident data was requested and obtained from the Ministry of the Interior. Similarly, data on ambulance numbers were requested and obtained from the Ministry of Health through the Right to Information law. During the second phase of the study, a survey consisting of 112 EMS personnel viewpoints about the effects of the institutional structure and legislative framework on ambulance accidents was conducted using a structured questionnaire. A total of 209 EMS personnel completed the survey.
  
  
  RESULTS
  The number of ambulance accidents increased by 42.5% over the last five years, whereas the area of coverage increased by 57.3% during the same period. The rate of EMS personnel experiencing ambulance accidents was 69.4%. When age, sex, and profession variables were considered, the varying profiles of the ambulance operators were found to have no significant effect on the number of ambulance accidents following the system change.
  
  
  CONCLUSIONS
  The rise in the number of ambulance accidents in Turkey was not significant when compared with the increase in the area of responsibility. The present system change was also found to have no effect on the number of accidents. On the other hand, problematic areas in the institutional structure and the legislative framework increased the risk of accidents.
authors.affiliation: Ege Universty Ataturk Medical Technology Vocational Training School Paramedic Program, Izmir, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Eksi
authors.affiliation: Hasan Kalyoncu University Medical Technology Vocational Training School Paramedic Program, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Celikli
authors.affiliation: Izmir 112 Ambulance Service, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Catak
keywords: Ambulance accidents; Ambulance speeding; Intersection accidents; Light and siren protocols