Çağdaş DERDİYOK
Eurasian Journal of Emergency Medicine - 2026;25(1):360-365
Aim: To evaluate provincial variation in false emergency medical service (EMS) call rates across Türkiye and to examine the association between education indicators and these rates after accounting for EMS accessibility and primary care availability. Materials and Methods: This ecological study analyzed province-level data for 2024 from all 81 Turkish provinces using official datasets from the Ministry of Health General Directorate of Emergency Health Services, the Turkish Statistical Institute, and the Health Statistics Yearbook 2024. The dependent variable was the provincially reported false alarm rate (%), defined as a composite administrative measure including non-emergency conditions manageable in primary care, hoax or malicious calls, and refused transport after ambulance arrival. These three components likely reflect distinct underlying mechanisms: non-emergency calls may represent barriers to primary care access, hoax calls may reflect behavioral and social factors, and refused transport may indicate that the caller has reassessed urgency or is seeking alternative care. Because these components could not be analyzed separately in the available aggregated data, the composite outcome was interpreted cautiously as a system-level operational indicator, rather than as a homogeneous clinical or behavioral construct. Inter-provincial differences in triage protocols and documentation practices may further affect the consistency of classification. Education indicators, EMS accessibility measures, and primary care availability were examined. Pearson correlation analyses, independent-samples t-tests, and multiple linear regression analyses with robust standard errors were performed. Results: The mean false alarm rate was 8.75%+/-2.86% (range 4.2%-14.7%). Metropolitan provinces had significantly higher rates than non-metropolitan provinces (10.12%+/-3.45% vs. 7.88%+/-1.89%, p<0.001). The university education rate showed a weak, non-significant correlation with the false alarm rate (r=0.13, p=0.258). Population per family physician unit showed a moderate positive correlation with the false alarm rate (r=0.545, p<0.001). In the multiple linear regression model (R²=0.378, p<0.001), the university education rate was not independently associated with false alarm rates (beta=-0.062, p=0.434), although the association's direction was negative (suggesting lower false alarm rates with higher education). Population served per EMS station (beta=0.134, p=0.006) and population per family physician unit (beta=7.317, p<0.001) showed independent, statistically significant associations. The number of EMS stations was not independently associated (beta=0.006, p=0.477). Conclusion: In this nationwide ecological analysis, provincial education levels were not independently associated with rates of false EMS calls after adjustment for EMS accessibility and primary care availability. Both EMS accessibility and primary care availability showed significant, independent associations with false alarm rates, suggesting that structural factors related to access to healthcare services are more strongly associated with provincial variation than educational indicators. The findings are consistent with the possibility that limited access to primary care may contribute to increased non-urgent EMS utilization at the population level.
