Sefer ÖZKAYA, Mehmet Serkan YURDAKUL
Eurasian Journal of Emergency Medicine - 2026;25(1):403-410
Aim: A small minority disproportionately burdens emergency medical services (EMS), yet frequent users of Türkiye's 112 system remain uncharacterised. We determined the proportion, predictors, and subgroups associated with frequent EMS use. Materials and Methods: This retrospective cross-sectional study analysed all 112 EMS calls from Karaman Province, Türkiye, in 2025. After excluding records lacking a national identification number and records of inter-facility transfers, 26,347 calls from 18,653 patients remained. Frequent users were defined a priori as >=5 calls/year. Patient-level multivariable logistic regression identified independent predictors; a patient-clustered call-level model separated per-encounter signal from cumulative signal. Results: Of 18,653 patients, 430 (2.3%) were frequent users, generating 3,260 calls (12.4%). The two largest patient-level associations differed: a yellow or red triage code [adjusted odds ratio (AOR): 12.66, 95% confidence interval (CI): 7.30-21.96] carried no per-encounter signal [call-level odds ratio (OR): 0.98], whereas 24-hour recontact (AOR: 12.15, 95% CI: 9.46-15.60) retained the strongest per-encounter association (call-level OR: 4.59). The strongest clinical predictors were primary psychiatric or substance-use diagnoses (AOR: 7.99) and respiratory diagnoses (AOR: 6.53). Psychiatric diagnosis showed no association at the call level (8.1% vs 7.6%), but was present in 26.7% of frequent users versus 8.9% of others at the patient level. Estimates were stable across thresholds. Two subpopulations differed in composition: the younger characterized by psychiatric and social vulnerabilities, and the older by chronic respiratory disease; yet the strength of predictors did not differ by age. Conclusion: Frequent users formed a small group comprising two distinct subpopulations and characterized by identifiable predictors. Coordinated primary care, mental health, and chronic disease pathways warrant evaluation; multi-centre replication is needed before policy change.
