Among the patients transported by the emergency medical service system in the study areas, a significant percentage were judged by the ambulance staff as not being in need of prehospital interventions. The majority were transported by a fully equipped emergency medical ambulance to an emergency medical department at a hospital, without requiring any prehospital interventions either at the scene or during transportation. The emergency medical service organization has to develop clear criteria for the utilization of ambulance services that can be accepted and implemented by the dispatch centres and by healthcare personnel. These criteria need to include safety margins and at the same time enable the appropriate use of resources.

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Using the criteria-based dispatch protocol, the personnel at the emergency medical dispatch centres work with a safety margin in their priority assessments for ambulance response. Generally, this 'overtriage' and safety margin for initial priority settings were supported as appropriate by the ambulance staff. According to the judgement of the ambulance staff, one-third of all the patients who were assigned an ambulance response did not require ambulance transport.

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s7 experiences of their own and of others. These outcomes suggest that the ways that patients decide whether an event is a health emergency differs from traditional medical decision-making, and provide some answers as to why patients access emergency health services "inappropriately". Objective: To assess the medical needs of patients transported by ambulance in urban and rural areas within the same county and with the same theoretical criteria for triage.Methods: A prospective consecutive study was carried out during a six-week period. The ambulance staff completed a questionnaire on which they assessed each patient's need for prehospital care, based on on-scene assessment and the need for prehospital interventions. In addition to the questionnaire, data were extracted from the ambulance medical records database for each case.Results: A total of 1,977 ambulance missions were enrolled in the study. The results indicate that there is a substantial safety margin in the priority assessments made by the call center, and that the ambulance staffs support the call center's safety margin for initial priorities despite lack of on-scene confirmation. There are difficulties for the emergency medical services (EMS) organization in meeting patients' essential needs. For example, on-scene assessments indicate that one-third of the patients for whom the dispatch center orders an ambulance do not need the ambulance service, and the advanced life support unit is not systematically involved in the most serious cases. Conclusions:Demands for ambulance response are not the same as needs for prehospital care. There are inappropriate uses of the EMS, and in a minority of cases, the dispatch center could possibly direct the patients to alternative transports. Evaluation on scene must be considered in the prehospital needs assessment.