{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:04:00Z","timestamp":1791522240109,"version":"4.3.4"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients\u2019 perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens\u2019 knowledge of how the service works and the territorial services available.<\/jats:p>","DOI":"10.3390\/nursrep15050165","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T04:13:44Z","timestamp":1746764024000},"page":"165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ambulance Use Appropriateness: Emergency Medical Service Technicians\u2019 and Triage Nurses\u2019 Assessments and Patients\u2019 Perceptions"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1656-2273","authenticated-orcid":false,"given":"Ilenia","family":"Piras","sequence":"first","affiliation":[{"name":"Department of Emergency, SS Trinit\u00e0 Hospital, ASL Cagliari, 09100 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9910-1036","authenticated-orcid":false,"given":"Francesca","family":"Sanna","sequence":"additional","affiliation":[{"name":"Geospatial Health and Development, Telethon Kids Institute, Nedlands, WA 6872, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8122-3259","authenticated-orcid":false,"given":"Michele","family":"Garau","sequence":"additional","affiliation":[{"name":"Medicasa Italia S.p.A., 09100 Cagliari, Italy"},{"name":"Emergency Medical Service Technician, Misericordia Association, 09100 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5387-4068","authenticated-orcid":false,"given":"Gabriele","family":"Sole","sequence":"additional","affiliation":[{"name":"ARNAS G Brotzu, S. Michele Hospital, 09100 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampaolo","family":"Piras","sequence":"additional","affiliation":[{"name":"Azienda Regionale Emergenza Urgenza Sardegna, 09100 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"d\u2019Aloja","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-4248","authenticated-orcid":false,"given":"Maura","family":"Galletta","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e016845","DOI":"10.1136\/bmjopen-2017-016845","article-title":"Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: A retrospective cohort study","volume":"7","author":"Eastwood","year":"2017","journal-title":"BMJ Open"},{"key":"ref_2","first-page":"240","article-title":"Primary Objective of Emergency Medical Services (EMS) After Organizes Aspects of Care Provided to Patients","volume":"12","author":"Sheikh","year":"2022","journal-title":"Emerg. Med."},{"key":"ref_3","first-page":"67","article-title":"Inappropriate Ambulance Use: A Qualitative Study of Paramedics\u2019 Views. Utilisation inad\u00e9quate de l\u2019ambulance: \u00c9tude qualitative du point de vue des ambulanciers","volume":"11","author":"Dejean","year":"2016","journal-title":"Healthc. Policy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1620\/tjem.235.89","article-title":"Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs","volume":"235","author":"Horibata","year":"2015","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1017\/S1463423621000098","article-title":"The implementation of the nationwide out-of-hours phone number 1733 in Belgium: Analysis of efficiency and safety","volume":"22","author":"Schoenmakers","year":"2021","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1553-2712.1999.tb00088.x","article-title":"Inappropriate Use of Emergency Medical Services Transport: Comparison of Provider and Patient Perspectives","volume":"6","author":"Richards","year":"1999","journal-title":"Acad. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1136\/emj.19.5.449","article-title":"Emergency (999) calls to the ambulance service that do not result in the patient being transported to hospital: An epidemiological study","volume":"19","author":"Marks","year":"2002","journal-title":"Emerg. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1080\/10903120600885209","article-title":"Path Analysis Modeling Indicates Free Transport Increases Ambulance Use for Minor Indications","volume":"10","author":"Ting","year":"2006","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_9","first-page":"1","article-title":"Appropriatezza dell\u2019utilizzo dei mezzi di soccorso per l\u2019accesso al Pronto Soccorso dell\u2019ospedale San Paolo di Savona","volume":"3","author":"Lerza","year":"2016","journal-title":"Ital. J. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1136\/emermed-2013-202762","article-title":"Insights on the effects of patient perceptions and awareness on ambulance usage in Karachi, Pakistan","volume":"31","author":"Chandran","year":"2013","journal-title":"Emerg. Med. J."},{"key":"ref_11","unstructured":"Presidenza del Consiglio dei Ministri (2025, April 17). Accordo, ai Sensi Dell\u2019articolo 4, del Decreto Legislativo 28 Agosto 1997, n. 281, tra il Governo, le Regioni e le Province Autonome di Trento e Bolzano. Rep. Atti n.143\/CSR del 1 agosto 2019, Available online: https:\/\/www.statoregioni.it\/it\/conferenza-stato-regioni\/sedute-2019\/seduta-del-01082019\/atti\/repertorio-atto-n-143csr."},{"key":"ref_12","unstructured":"Regione Autonoma della Sardegna (2025, April 17). Linee di Indirizzo per il Modello Organizzativo per Percorsi Omogenei di Triage in Pronto Soccorso della Regione Autonoma della Sardegna. Deliberazione n. 10\/23 del 16.03.2023. Available online: https:\/\/delibere.regione.sardegna.it\/protected\/64326\/0\/def\/ref\/DBR64172\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e033037","DOI":"10.1136\/bmjopen-2019-033037","article-title":"Ambulance use for \u2018primary care\u2019 problems: An ethnographic study of seeking and providing help in a UK ambulance service","volume":"9","author":"Booker","year":"2019","journal-title":"BMJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1111\/acem.12253","article-title":"Patient demographic and health factors associated with frequent use of emergency medical services in a midsized city","volume":"20","author":"Knowlton","year":"2013","journal-title":"Acad. Emerg. Med."},{"key":"ref_15","unstructured":"ISTAT 2021 (2025, April 17). Incidenti Stradali Report. Available online: https:\/\/www.istat.it\/it\/files\/\/2022\/07\/REPORT_INCIDENTI_STRADALI_2021.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e0350","DOI":"10.1097\/CCE.0000000000000350","article-title":"Mode of Arrival to the Emergency Department and Outcomes in Nontraumatic Critically Ill Adults","volume":"3","author":"Borg","year":"2021","journal-title":"Crit. Care Explor."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4081\/ecj.2010.1.23","article-title":"How public ambulance arrivals impact on Emergency Department workload and resource use","volume":"6","author":"Ferri","year":"2010","journal-title":"Emerg. Care J."},{"key":"ref_18","first-page":"e51988","article-title":"Public Awareness of Triage Systems and Waiting Times During Emergency Department Visits in the Eastern Province, Saudi Arabia","volume":"16","author":"Abuljadail","year":"2024","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ienj.2017.12.003","article-title":"A descriptive study of registered nurses\u2019 application of the triage scale RETTS\u00a9; a Swedish reliability study","volume":"38","author":"Wireklint","year":"2018","journal-title":"Int. Emerg. Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1054\/aaen.2000.0166","article-title":"Triage nurses\u2019 decisions using the National Triage Scale for Australian emergency departments","volume":"8","author":"Considine","year":"2000","journal-title":"Accid. Emerg. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ienj.2007.10.002","article-title":"Experiences of and actions towards worries among ambulance nurses in their professional life: A critical incident study","volume":"16","author":"Svensson","year":"2008","journal-title":"Int. Emerg. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.annemergmed.2017.03.029","article-title":"Geographic Variation in Use of Ambulance Transport to the Emergency Department","volume":"70","author":"Hanchate","year":"2017","journal-title":"Ann. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1111\/aas.12889","article-title":"A high proportion of prehospital emergency patients are not transported by ambulance: A retrospective cohort study in Northern Finland","volume":"61","author":"Hoikka","year":"2017","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1136\/eb-2013-101494","article-title":"Understanding triangulation in research","volume":"16","author":"Heale","year":"2013","journal-title":"Evid. Based Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Katayama, Y., Kitamura, T., Nakao, S., Himura, H., Deguchi, R., Tai, S., Tsujino, J., Mizobata, Y., Shimazu, T., and Nakagawa, Y. (2022). Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.896506"}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/5\/165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:29:48Z","timestamp":1760030988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/5\/165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,9]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["nursrep15050165"],"URL":"https:\/\/doi.org\/10.3390\/nursrep15050165","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,9]]}}}