Frequency of prehospital ambulance utilization by patients with chronic diseases: A retrospective study

Abstract

The increasing number of elderly people will coincide with the increasing number of chronic diseases, because every elderly person is said to have a predominant one or more chronic diseases [3]. The increase in numbers can have an impact on increasing the use of health services. Repeat ambulance use is frequent and has an association with chronic health problems such as chronic respiratory disorders, epilepsy, mental disorders with alcohol abuse, and comorbidities [4]. Another study also reported that chest pain was present in one in 10 ambulance calls and the causes of the cases varied, with substantial differences depending on age and sex [5]. The data was presented using graphs and frequency distribution tables.

Utilization in Denpasar City
Denpasar City has an ambulance that serves pre-hospital cases under the coordination of the Regional Disaster Management Agency.

The Integrated Emergency Management
System in Denpasar City is managed by the              Table 1 The number of chronic diseases served by Denpasar City ambulance 2019   Table 3 The number of chronic diseases served by ambulances in Denpasar City 2021  The use of the pre-hospital ambulance has begun to be used by people with chronic diseases, but not optimized. This can be seen in the number of chronic disease ambulance utilizations that do not reach half of total ambulance services. Similar results were also presented on the low use of ambulances in the country of Ethiopia. In that country, victims experiencing emergency conditions are mostly delivered by Bajaj or taxi [11]. The results of this study also did not find any repetition of the use of the service by patients.

Chronic diseases
Other studies have reported that patients with complaints such as breathing difficulties, seizures, chest pain, and alcohol poisoning sometimes repeat the use of ambulance services [4]. Furthermore, lack of awareness of ambulance access and / or lack of an integrated EMS system are barriers that can contribute to low ambulance utilization [11]. pandemic [12]. The data in Table 3 showed that stroke, diabetes mellitus, and heart disease are the three main chronic diseases comorbid with COVID-19, which have contributed to the increase in the use of prehospital ambulance services due to chronic diseases. These three diseases also experience an increase in patients every year, as can be seen in Figure 5. An increase in the use of prehospital services was also suggested to be associated with an increase in COVID-19 infections.

LIMITATION OF STUDY
This study only summarizes the number of ambulance uses, and the researchers did not examine the types of services or actions provided to patients or accident victims.

RECOMMENDATION
The three highest cases of pre-hospital ambulance use in Denpasar City are accident, fire, and sick patient evacuation services. The use of ambulances by chronic diseases has not yet reached half of the ambulance services.
Stroke, diabetes mellitus, and heart disease are the three most common chronic diseases that use pre-hospital ambulance services.
It is necessary to increase the capacity of ambulance services, so that the utilization of pre-hospital ambulance services increases.
The government, through related agencies, should conduct socialization so that there is an increase in the use of pre-hospital ambulance services by the community.

ACKNOWLEDGMENT
The researcher would like to thank the Institute of Technology and Health Bali for funding assistance so that this research could be carried out. The researchers also thank the participation and support of the Denpasar City Regional Disaster Management Agency and the Denpasar City Health Office, especially the Damakesmas Ambulance, for the opportunity to collect research data.

CONFLICT OF INTEREST
Authors disclose no conflicts of interest related to the work in this manuscript.