Exploring the experiences and challenges of motorcycle ambulance personnel in pre-hospital emergency healthcare services: A qualitative study

Abstract

BACKROUND

Motorcycle ambulances are particularly useful in navigating narrow and congested areas during premium hours due to their ability to provide rapid access to patients in pre-hospital emergency healthcare services (PHEHS), possessing suitable and necessary advanced life support accessories, and their speed, flexibility, and ease of maneuverability.

OBJECTIVE

This study aims to examine the experiences and challenges encountered by motorcycle ambulance workers in PHEHS.

METHODS

This study adopts a qualitative research methodology, specifically employing a phenomenological approach within the framework of a case study. The research sample consists of 19 paramedics and Emergency Medical Technicians (EMTs) working on motorcycle ambulances. Purposeful sampling method, specifically the snowball sampling technique, was employed in selecting the sample. Research data were collected through in-depth interviews conducted using a semi-structured interview form, from August 2022 to February 2023. The interviews were transcribed, coded, and thematically analyzed using the MAXQDA program.

RESULTS

Participants shared their experiences and the problems they encountered while performing their duties across four themes: purpose of motorcycle ambulances, most frequently assigned cases, challenges encountered, and the importance of teamwork.

CONCLUSIONS

It is crucial to ensure personnel safety by forming the motorcycle ambulance team from selected individuals, subjecting the selected personnel to the same standard and comprehensive advanced driving and technical training, regulating working hours, increasing the number of personnel, and fostering teamwork. Further efforts are needed to improve the working conditions of motorcycle ambulance services.

Keywords

Pre-hospital emergency care motorcycle ambulance paramedic emergency medical technician working conditions

1. Introduction

Pre-hospital emergency health services (PHEHS) encompass a broad spectrum, from saving the lives of the injured and patients to preventing further injuries and transporting them to the nearest well-equipped hospital [1]. The response time and intervention of PHEHS personnel upon emergency calls are the important indicators of the quality of care provided by PHEHS. Access time to patients in need of emergency medical assistance is a critical factor affecting survival. Delay in receiving PHEHS by these patients leads to increased rates of disability and death [2]. The use of traditional ambulances in cities with traffic issues can cause delays in reaching patients in need of emergency assistance [3]. Various approaches have been considered to both reduce the energy and time expended by PHEHS personnel in intervening with patients and enhance the quality of service provided to patients. The use of motorcycle ambulances is one such approach [4]. The use of motorcycles in medical treatment and transportation dates back to World War I, where they were utilized by the United Kingdom, France, and the United States during the war. Motorcycles are now utilized in many countries including Australia, Brazil, Ghana, Hong Kong, India, Israel, Japan, Kenya, Poland, Portugal, and Serbia [3, 5]. In Turkey, motorcycle ambulances began operating in 2009, and there are currently 66 motorized units in the country [6].

Motorcycle ambulances provide easy access to patients in PHEHS, especially in narrow and crowded areas during peak hours, due to their speed, flexibility, and ease of maneuverability, as well as being equipped with appropriate and necessary advanced life support accessories. It is known that the use of motorcycle ambulances in PHEHS reduces the access time to patients in both urban and rural areas [7]. The recommended intervention time for at least 90% of emergency interventions is ≤8 minutes. During a six-month research period, 504 cases were analyzed, revealing that the average intervention time for motorcycle ambulances was shorter compared to traditional ambulances (5.57 minutes versus 7.29 minutes) [8]. Motorcycle ambulances operate in areas where ambulance vehicles cannot access, such as boulevards, streets, and peripheral roads with heavy traffic, traffic-free roads, narrow streets, parks, gardens, recreational areas, jogging paths, and sports fields [9, 11]. Thus, in critical scenarios such as the need for CPR, motorway accidents resulting in multiple injuries (triage of injured patients), instances where traditional ambulances are unavailable, and when the Command Control Center cannot pinpoint the exact location of the incident, motorcycle ambulances promptly perform life-saving measures such as bleeding control, artificial respiration, defibrillation, or chest compressions, assess patients, and manage cases, thereby reducing potential risks in life-threatening situations and minimizing the unnecessary burden on land ambulances, thus optimizing the operational costs of emergency services [12]. Personnel operating motorcycle ambulances should possess the capability to monitor oxygen saturation, manage vital signs, conduct basic airway management, and administer cardiopulmonary resuscitation. Additionally, they should be proficient in driving the vehicle. The driver must pass a motorcycle driving test conducted at a standard training center [13].

Management of complex cases, environmental security threats, risk of accidents and injuries, and the requirement to wear protective equipment and special clothing are among the potential challenges faced by personnel using motorcycle ambulances. It is considered important to improve the current conditions of motorcycle ambulance teams, establish standards for the services they provide, provide training for personnel in their field, procure equipment, and ensure the safety of workers. When the literature was reviewed, an insufficient number of studies regarding motorcycle ambulances were found. Škufca Sterle and Podbregar assessed whether the presence of motorcycle paramedics (MP) improved the survival rates and outcomes of out-of-hospital cardiac arrest (OHCA) patients compared to emergency medical teams (EMT) by reducing response times. The results indicated that the presence of MP led to shorter response times, increased survival rates, and improved neurological outcomes for OHCA patients [3]. Similarly, a study conducted in Iran found that the utilization of motorcycle ambulances alongside regular ambulances was beneficial for critically ill patients [5]. Apiratwarakul et al. investigated the operational efficiency of motorcycle ambulances during the COVID-19 pandemic compared to normal periods. Their findings revealed that the response and transport times of motorcycle ambulances were significantly shorter during the COVID-19 pandemic [9]. Thus, no study has been found in the literature examining the working conditions of motorcycle ambulances. Therefore, this study aims to examine the experiences and challenges encountered by motorcycle ambulance workers in PHEHS.

2. Methods

This research adopts a qualitative research approach, specifically a phenomenological research type within the field of case study.

2.1. Setting and participants

The research population consists of paramedics and Emergency Medical Technicians (EMTs) who are currently employed in operating motorcycle ambulances in Turkey. The sample consists of paramedics and EMTs who volunteered to participate in the study and agreed to have interviews. Interviews were conducted with willing participants until data saturation was reached. Purposive sampling method, specifically the snowball sampling technique, was utilized in determining the sample. Snowball sampling involves reaching other individuals through references after conducting an interview with one participant [14]. Interviews were conducted with 24 participants. Pilot interviews were conducted with 5 participants, and the data collected from them was not included in the main data. Data saturation was reached with 19 participants.

2.2. Data collection and analysis

The research data were collected between August 2022 and February 2023 through in-depth interviews using a pre-prepared semi-structured interview form. When preparing the questions, attention was paid to creating open-ended questions that were understandable and logical to the interviewees. The questions were designed to focus on the topic and context of the study, avoiding any leading language that could influence the participants’ responses.

The questions are as follows;

1.
What are the situations in which motorcycle ambulances are used, and for what purposes are motorcycle ambulances mostly assigned?
2.
Which cases are you assigned to the most?
3.
What are the difficulties you encounter while performing your duties?
4.
What are the situations in which you do not feel safe while performing your duties?
5.
How does working alone affect your patient interventions? What are the advantages and disadvantages of working alone?
6.
How does working as a team affect your patient interventions? What are the advantages and disadvantages of working as a team?
7.
Can you tell us about the problem areas you experience regarding the management and planning of the motorcycle ambulance system?

Since the participants were dispersed across various provinces of the country, the interviews were conducted online via the Microsoft Teams application at a time and in an environment where the participants felt comfortable. The interviews were recorded using the application’s recording feature. The interview questions were asked to each participant by the same researcher using the same words and tone that evoked the same meaning. The interviews lasted on average between 35–45 minutes. To maintain the confidentiality of the participants’ information, codes such as P1 and P2 were assigned to each participant, allowing their responses to be anonymized and protecting their identities throughout the study. Consent was obtained from all participants, and audio recordings of the interviews were securely retained. The interviews were transcribed after each session, maintaining anonymity and confidentiality. The interviews were then transferred to the MAXQDA program for transcription, coding, and theme formation using thematic analysis method.

The following stages were applied in the thematic analysis; 1.
Familiarizing yourself with your data: Transcribing data (if necessary), reading and re-reading the data, noting down initial ideas.
2.
Generating initial codes: Coding interesting features of the data in a systematic fashion across the entire data set, collating data relevant to each code.
3.
Searching for themes: Collating codes into potential themes, gathering all data relevant to each potential theme.
4.
Reviewing themes: Checking if the themes work in relation to the coded extracts (Level 1) and the entire data set (Level 2), generating a thematic ‘map’ of the analysis.
5.
Defining and naming themes: Ongoing analysis to refine the specifics of each theme, and the overall story the analysis tells, generating clear definitions and names for each theme
6.
Producing the report: The final opportunity for analysis. Selection of vivid, compelling extract examples, final analysis of selected extracts, relating back of the analysis to the research question and literature, producing a scholarly report of the analysis [15].

3. Results

The results were categorized into four themes, which are the purpose of motorcycle ambulances, most frequently assigned cases, challenges encountered, and the importance of teamwork.

3.1. Purpose of motorcycle ambulances

The participants have expressed their views regarding the purpose of motorcycle ambulances, particularly emphasizing informing the command center about the status of the case, performing initial intervention, reaching the scene before the ambulance in cases where the ambulance cannot enter the scene, and conducting triage.

3.1.1. Informing the command center about the status of the case

The participants have expressed that the motorcycle team is initially sent to the scene to inform the command center about the status of the case.

“I prevent unnecessary engagement. I never directly call the land ambulance because I first go to the scene, see the patient, inform the command center, and then, if necessary, I request the ambulance via radio.” (P4)

“If the person at the command center thinks that the case will require transfer, they also dispatch a regular ambulance with me. But if they are unsure about the urgency of the case over the phone, then I first go to evaluate the case, inform the command center, and if necessary, request ambulance transfer support.” (P1)

3.1.2. Performing initial intervention

The participants have mentioned that the motorcycle team performs initial interventions on patients and provides necessary interventions until the arrival of the land ambulance to initiate the hospital process.

“We promptly communicate with the ambulance team via radio or phone, informing them of the ongoing initial intervention and requesting immediate ambulance dispatch. While awaiting the ambulance’s arrival, we address any bleeding, establish vascular access, and utilize available equipment such as neck collars to perform necessary interventions. All actions are carried out in a secure area to ensure patient safety until the ambulance arrives.” (P10)

“We proceed to the patient’s location based on the information provided by the command center. However, if the command center furnishes inaccurate information, we promptly notify them, and the ambulance team is promptly dispatched to the correct location. During that time, we perform CPR, intubation, and vascular access interventions for 5–10 minutes until the team arrives. It takes for the ambulance to arrive between five to seven minutes anyway.” (P12)

“Now, as motorcycle teams, we have a defibrillator, most of the other equipment, but we don’t have stretchers. That’s why, we can’t transfer patients. When we determine the need for hospital transfer for the patient, we observe all vital signs, establish vascular access, and wait for the ambulance. When the ambulance arrives, since we have already done everything beforehand, they quickly take the patient and proceed with the transfer.” (P15)

3.1.3. Reaching the scene before the ambulance in cases where the ambulance cannot enter the scene

The participants have stated that due to the motorcycle being faster and more agile in traffic, they can reach the scene before the ambulance in situations where the ambulance cannot enter or has not arrived.

“When traffic is heavy and in places like the E-5 highway where there is an accident, the ambulance can’t come. Even if it tries, it can’t come. We reach the scene quickly from the side of the road and intervene.” (P16)

“The goal is actually to quickly reach cases with a red code, which are triage code cases, such as street cases and traffic accidents, to ensure quick intervention. Most of the cases we intervene in are where the ambulance systems are stuck. The command center assigns us, saying, ‘Do the initial examination first. If necessary, call the ambulance. Otherwise, you can intervene on the spot.’ We are mostly assigned to such cases.” (P18)

3.1.4. Conducting triage

The participants have expressed that they conduct triage in mass accidents or injuries.

“You know, in mass accidents or injuries, triage, scene management, and initial intervention are important, so when we go, we stay. We stay so that one of the ambulances becomes available for the transfer of patients. Afterwards, if we have time, we move on to vascular access and neck collar application for the injured.” (P5)

“Upon our initial arrival, we immediately take charge of triage and allocate responsibilities to incoming teams before dispatching them. As we are typically the first on the scene and the last to depart, if ambulance teams lack medical personnel, they do not assume triage duties. Therefore, we handle all triage operations.” (P12)

3.2. Most frequently assigned cases

The participants have indicated that they are mostly assigned to syncope, injuries, traffic accidents, chest pain, cardiopulmonary arrest, and assault cases.

“We are mostly directed to traffic accidents. Sometimes we are assigned to street cases, traffic-free areas where ambulances have difficulty entering, and busy market centers.” (P5)

“Generally, we are assigned to syncope cases. There are individuals lying on the ground whose condition is unknown or intoxicated individuals. We are always on site for the initial intervention in the case. We also intervene in traffic accidents.” (P16)

“Generally, we go for the initial intervention in syncope, hypotension, hypoglycemia, conversion, heart attack, and bleeding traffic accident cases where the ambulance cannot enter.” (P10).

“When the ambulance is outside the region or busy, we go to the arrest case or to stabilize the condition of the patient with respiratory distress. ” (P3)

“Traffic accidents are the most common cases we intervene in. Apart from that, there are cases of fights, assaults, alcohol-related incidents, and street cases. Sometimes we also intervene in cases of arrest or myocardial infarction.” (P19)

3.3. Challenges encountered

The participants have extensively discussed issues related to security-threatening situations, the negative aspects of solo work, and management-related problems in the context of the challenges encountered.

3.3.1. Situations posing security threats

The participants have expressed significant concerns regarding situations that pose security threats, particularly emphasizing the risk of exposure to violence and the risk of accidents.

3.3.1.1. Risk of exposure to violence The participants have expressed concerns about their safety during interventions, highlighting instances where they have been subjected to verbal and physical violence.

“Most of the time, the relatives of patients have no patience; they often engage in verbal harassment.” (P10)

“It’s not occasional; it’s a common occurrence. I have experienced it a lot. I have been subjected to verbal and partial physical attacks.” (P15)

“Last year, someone pulled out a knife. There was a scuffle. Other people around intervened, and the police arrived.” (P6)

“Our colleague was stabbed. He experienced this while on duty in the motorcycle ambulance; of course, it’s very sad and dangerous. Fortunately, it wasn’t life-threatening.” (P17)

3.3.1.2. Risk of accidents The participants have acknowledged that the risk of accidents while using motorcycles is higher compared to traditional ambulances.

“After all, you are riding a motorcycle. You are responsible for the life of the person behind you. There is a risk of having an accident.” (P4)

“With the motorcycles we have, we are fast while moving, but we don’t have a sheltered ambulance. It’s not very safe; there is a risk of accidents.” (P13)

3.3.2. Drawbacks of solo work

The participants have mentioned experiencing some difficulties due to working alone, as opposed to working in pairs.

3.3.2.1. Difficulty in intervention The participants have expressed that working alone, especially in situations requiring cardiopulmonary resuscitation (CPR), leaves them feeling inadequate and struggling to intervene in some cases, making effective and prompt intervention difficult.

“When working alone, it affects the intervention we provide to the patient negatively. Working alone has negative aspects in terms of providing effective and prompt intervention to the patient.” (P18)

“Working alone is difficult. I perform CPR alone until the ambulance arrives, and I seek assistance from someone nearby for respiratory support.” (P4)

“The ambulance is equipped with sufficient equipment. But when working alone, we do not have the chance to use this equipment effectively. You need to maintain communication with the command center to ask for support. When alone, you are lacking in several aspects during resuscitation: you are lacking in chest compressions, in maintaining an airway, in establishing vascular access, and in administering medications. So, when working alone, performing resuscitation has no meaning. You have to ask for help from others around. It happened to me. I received CPR support from security guards who had received first aid training. I asked one to bring supplies from the ambulance. Meanwhile, I dealt with intubation myself.” (P13)

“If one person is working in the ambulance, they can be the first responder, but if two people are working, it becomes emergency aid. For example, you cannot apply a neck brace alone. ” (P6)

3.3.2.2. Difficulty in accessing equipment The participants have mentioned experiencing difficulty in accessing equipment on the motorcycle during intervention in cases.

“We carry one top box and one rear bag, but access to equipment, presentation of equipment, and support may require a second person.” (P14)

“For example, when the patient needs to be transferred, your radio may not be with you at that moment, and you may find yourself in a situation where you cannot reach your phone while intervening with the patient alone.” (P15)

3.3.3. Issues related to management

The participants in the study have identified issues related to management, such as the lack of legal regulations, inappropriate working hours, and insufficient training.

3.3.3.1. Inappropriate working hours The participants have expressed that the working hours are intense and not suitable for work-life balance.

“There is no standardization in working hours. Since there are no other teams besides us, they want us to be as active as possible. We are off once a week and work for six days. We work for twenty-four or twenty-five days a month; there is no time to enjoy life.” (P7)

“Our problems mostly arise from managerial issues. For example, the working system varies for everyone; some work for 24 hours, some for 16 hours, and some for 12 hours.” (P8)

3.3.3.2. Lack of training Some participants reported that motorcycle riding training is provided by institutions in some regions, but they find these trainings inadequate. Others stated that they started working in motorized teams entirely on their own initiative, either with previous experience or by taking private advanced riding courses.

“The training provided by 112 is insufficient, and it is not conducted in every region. I believe more effective training should be conducted.” (P7)

“I took advanced riding training on my own initiative. There is no official training for this. We already had experience in riding motorcycles. It has become a unit where only those who are enthusiastic about this job eventually work.” (P13)

“There is no effective training planned by our Ministry yet. Although there is a need for good training in our active work, since there is no Ministry training to meet this need, we started our duties with the training we received on our own.” (P14)

“Although I have been riding a motorcycle for three seasons, I did not receive formal training before starting duty. As someone who enjoys riding motorcycles myself, I took an advanced riding course from a private organization with my own money.” (P7)

3.4. The importance of teamwork

The participants mentioned the advantages of teamwork, such as being able to respond quickly and divide tasks efficiently, emphasizing the importance of teamwork for teams consisting of two individuals working as a pair in a complementary manner.

3.4.1. Ability to intervene quickly

The participants stated that teamwork positively influenced the speed of patient intervention.

“When two people start the intervention, the command center already dispatches the ground ambulance team behind us. If it is a cardiac arrest case, we announce it over the radio that we have started the intervention. By then, the ambulance will already have arrived.” (P3)

“We were a team of two, and we never had any issues. We had interventions for drowning incidents. When consciousness was restored, we performed very fast and effective CPR. We achieved good results. Did we have shortcomings? Yes, but in rapid intervention, the motorized unit is so quick to bring shock device and the healthcare provider to the scene.” (P7)

3.4.2. Ability to divide tasks

The participants expressed that division of tasks in teamwork had a positive impact on the interventions performed on the patients.

“I automatically started chest compressions, while the person next to me moved on to intubation to secure the airway. This is how we divide tasks.” (P16)

“Now we also have an automatic external defibrillator device. We connect it directly in cases of cardiac arrest. One person handles the airway, while another person performs chest compressions. The person managing the airway also checks the vascular access simultaneously. We continue like this until the team arrives. Usually, the ground ambulance arrives within five minutes.” (P19)

“When I responded to mass traffic accidents, especially there, I saw the benefits of dividing tasks between two people.” (P17)

4. Discussion

In PHEHS, motorcycle ambulance workers are often required to provide care in areas outside public and sheltered spaces, which have a high potential for traumatic effects. However, it has been determined that there are quite limited studies regarding these circumstances. Therefore, this study aims to investigate the experiences and challenges faced by motorcycle ambulance workers in PHEHS.

It has been stated in the literature that approximately half of emergency calls do not require urgent intervention and do not pose a life-threatening situation, and about half of those transported to the hospital are discharged without any intervention [5, 12]. A study conducted in Iran found that the use of motorcycles in cases where the necessity of a medical emergency and the condition of the patient are unknown reduces the unnecessary tasks of ambulance vehicles [5]. In our study, the participants expressed that they are assigned specifically to conduct the initial assessment of the case, inform the command center about the condition of the case, call for an ambulance if necessary, and ensure transportation to the hospital, especially in cases where the condition of the case is unknown. Considering that the cost of PHEHS missions with motorcycle ambulances is lower than that of vehicle ambulances (due to equipment cost and fewer personnel), assigning motorcycle ambulances for the initial assessment of cases seems to partially prevent resource wastage. Taking these factors into account, the presence of motorcycle ambulances should be considered a strong point for redirecting ambulances to more necessary tasks, preventing overcrowding in hospital emergency departments, and reducing emergency department costs [2].

The primary goal of a motorized ambulance is to reach the patient as quickly as possible to provide the fastest and most effective intervention, thereby increasing the patient’s chances of survival. In cases where traffic is heavy and a land ambulance cannot reach the scene quickly, it is a highly effective and beneficial health service [12]. In our study, the participants reported that they are assigned to reach the patient before the ambulance team arrives in cases where the ambulance cannot enter the scene but the intervention time is crucial, in order to provide initial care and conduct triage. Studies in the literature have also shown that motorcycle ambulances have much greater maneuverability than typical ambulance vehicles, especially in confined spaces or traffic congestion, and they reach the scene faster, significantly increasing the chances of survival for patients they intervene outside the hospital [7, 8, 10]. Motorized ambulances are equipped with essential medical equipment such as intubation devices, pulse oximeters, oxygen devices, blood pressure monitors, stethoscopes, splints, bandages to control bleeding, IV sets, glucometers, and ECG monitors, as well as automatic external defibrillators (AEDs). Therefore, they are tasked with providing rapid access to the scene and initiating initial care in cases such as myocardial infarction, cardiac arrest, hypertension, syncope, and traffic accidents. Additionally, they also take on the role of on-scene management and triage in mass casualty incidents or major accidents [11, 12, 16, 17]. Consistent with the literature, the participants in our study also reported being assigned mainly to syncope, injury, traffic accidents, chest pain, cardiac arrest, and assault cases.

PHEHS workers are often the first responders to patients in need of urgent medical intervention, providing care in unpredictable and unsafe environments at all hours of the day, in close proximity to patients and their families. As a result, they face a higher risk of violence compared to other healthcare workers [18, 19]. Incidents of violence can take various forms, including verbal abuse, physical assault, or sexual harassment, and can lead to serious consequences such as injury, death, or post-traumatic stress disorder [20]. A meta-analysis examining the frequency of workplace violence among paramedics reported violence rates of 75.2% in Canada, 87.5% in Australia, 82% in Spain, and 4.5% in the United States [21]. In a study conducted with PHEHS workers in Turkey, 88.0% of participants reported experiencing some form of violence during the provision of emergency healthcare services, with 90.9% experiencing verbal violence, 45.5% experiencing physical violence, and 18.2% experiencing psychological violence [22]. The findings from our study are consistent with these results, as the participants expressed concerns about their personal safety and reported experiencing verbal and physical violence in the majority of patient interventions. PHEHS workers should prioritize their own safety while performing their duties, and in a risky situation, they should expect the police to ensure the safety of the scene.

Due to their nature, motorized vehicles are inherently less resistant to impacts compared to enclosed vehicles. Additionally, they are less visible to other drivers and pedestrians, and less stable than four-wheeled vehicles. Motorcycle riders are more vulnerable to road conditions and weather conditions compared to drivers of enclosed vehicles [2]. A study conducted in Slovenia found that motorcycle ambulance workers are exposed to high levels of traffic hazards and weather conditions [23]. Research conducted in many countries has shown that ambulance accidents and the resulting loss of life and property are significant [24 –26]. In our study, the participants stated that the risk of motorcycle accidents poses a safety threat to them. To ensure safety, it is essential to determine the distance and optimal working hours for motorcycle ambulance deployment, procure personal protective equipment, and ensure the correct use of personal protective equipment by staff. In the literature, it is emphasized that motorized ambulance drivers should undergo a safety training course on advanced riding and best practices in motorcycle use to reduce the risk of accidents [13]. However, in our study, the participants stated that not all personnel assigned to motorcycle ambulance duty receive state-sponsored advanced motorcycle riding training, and some participants have obtained these training courses at their own expense. In this context, managers overseeing ambulance personnel should prioritize the provision of advanced driving training for staff and ensure the organization of standardized training programs.

PHEHS workers witness various traumatic events throughout the day due to the nature of their work. In addition to being the first responders to traumatic events, factors such as the risky nature of their professional environments, workload, and inappropriate working hours contribute to the exhaustion of the staff [27]. PHEHS schedules involve shift work that includes not only daytime hours but also weekends. According to the legislation in Turkey, the interval between shifts for healthcare personnel working in ambulance services operating 24 hours a day should be at least 48 hours [28]. However, studies conducted in Turkey have shown that the majority of participants work more than the weekly working hours due to insufficient staffing [29, 30]. Consistent with the literature, the participants in our study also expressed that the working hours are intense and not suitable for a healthy work-life balance due to staff shortages. To ensure the continuity of PHEHS and provide high-quality, safe healthcare services while preventing staff burnout and promoting their professional satisfaction, it is crucial to regulate working hours, adjust shifts to appropriate and reasonable durations, increase staffing levels, and enhance the working environment.

Table 1.
Themes and sub-themes.

Themes Code Sub-code

Purpose of motorcycle ambulances First assessment and informing the command center about the status of the case
Performing initial intervention
Reaching the scene before the ambulance in cases where the ambulance cannot enter the scene
Conducting triage

Most frequently assigned cases

Challenges encountered Situations posing security threatsDrawbacks of solo workIssues related to management Risk of exposure to violenceRisk of accidentsDifficulty in interventionDifficulty in accessing equipmentInappropriate working hoursLack of training

The importance of teamwork Ability to intervene quicklyAbility to divide tasks

Themes	Code	Sub-code
Purpose of motorcycle ambulances	First assessment and informing the command center about the status of the case Performing initial intervention Reaching the scene before the ambulance in cases where the ambulance cannot enter the scene Conducting triage
Most frequently assigned cases
Challenges encountered	Situations posing security threatsDrawbacks of solo workIssues related to management	Risk of exposure to violenceRisk of accidentsDifficulty in interventionDifficulty in accessing equipmentInappropriate working hoursLack of training
The importance of teamwork	Ability to intervene quicklyAbility to divide tasks

Healthcare services delivered through teamwork in the health sector bring significant benefits for patients, their families, team members, and the institution itself. Effective teamwork enhances the quality of services provided, reduces patient costs and lengths of hospital stays, increases patients’ lifespan, facilitates learning through environmental interactions within the team, and enhances problem-solving and critical thinking skills. In units where teamwork is inadequate, problems such as delays in diagnosis and treatment, inconsistencies in patient information, and a decrease in service quality may occur. PHEHS workers are also among the sensitive groups in terms of teamwork and time management [31]. Studies in the literature emphasize the necessity for each motorized team to consist of two team members who have received specialized training in this regard [32 –35]. In our study, some participants work alone, while others work in teams of two. The participants working alone stated that a single person is inadequate and deficient, especially in cases requiring CPR, and they faced difficulties in intervening in some cases, leading to ineffective and slow response times. They also mentioned challenges in accessing equipment on the motorcycle during interventions. On the other hand, the participants working in teams of two highlighted the positive impact of teamwork on the speed of patient interventions and the beneficial effect of task division on patient procedures. Based on this result of the study, people in managerial positions should be aware of the importance of team work, especially in emergency health services, and make plans accordingly.

5. Conclusion

It is evident that motorcycle ambulances are functional in PHEHS due to their effectiveness in minimizing patient harm and increasing survival rates, particularly in heavy traffic and narrow streets where transportation times are shorter compared to land ambulances. However, the security problem, which is considered the biggest issue and poses a vital danger to healthcare personnel, cannot be overlooked. Effective management policies should aim to minimize security issues, with PHEHS teams collaborating with the police if necessary to prevent security vulnerabilities in the environment. Forming the motorcycle ambulance team from selected individuals, subjecting them to the same standard and comprehensive advanced driving and technical training, regulating working hours, increasing the number of personnel, and fostering teamwork are all crucial measures to ensure personnel safety.

6. Limitations

The research data was collected using online methods. The findings derived from this qualitative study may not be universally applicable to the entire population, but instead serve as descriptive, conceptual, or theoretical insights within a specific context.

Footnotes

Acknowledgments

The authors would like to thank the motorcycle ambulance workers who volunteered to participate in the study.

ORCID iD

Süreyya Gümüşsoy

Ethical approval

The research was approved by the Medical Research Ethics Committee of Ege University with decision number 22-5T/23 (12.05.2022)

Informed consent

When scheduling interviews, each participant was provided with an explanation regarding the purpose of the study, the method of conducting the interviews, the recording of audio, the confidentiality of personal data, and the assurance that the data obtained would only be used for the purposes of this study. Consent was obtained from each participant for the interviews. The names of the interviewers and the cities where they worked were kept confidential in accordance with ethical principles.

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Esra Yurt: Conceptualization, Methodology, Investigation, Formal analysis, Writing – original draft, Writing – review & editing, Resources.

Süreyya Gümüşsoy: Conceptualization, Methodology, Formal analysis, Writing – review & editing, Supervision, Resources.

References

Ejeta

Ardalan

Paton

. Application of behavioral theories to disaster and emergency health preparedness: A systematic review. PLoS Curr. 2015;7:ecurrents.dis.31a8995ced321301466db400f1357829.

Jafari

Shakeri

Mahmoudian

Bathaei

. Innovation in the use of motor ambulance for prehospital emergency care. J Educ Health Promot. 2019;8:38. doi:10.4103/jehjehp_249_18

Škufca Sterle

Podbregar

. A motorcycle paramedic increases the survival rate of patients after OHCA. Medicina (Kaunas). 2023;59(10):1708. doi:10.3390/medicina59101708

Hilbert-Carius

Braun

Abu-Zidan

, et al. Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: An air ambulance perspective. Scand J Trauma Resusc Emerg Med. 2020;28(1):94. doi:10.1186/s13049-020-00789-8

Mirshafiee

Akbari Sari

Delshad

Sayadnasiri

Kolivand

Takian

. Comparing the effectiveness of motor ambulances in pre-hospital emergency medical services compared to ambulances in Tehran City, Iran. Health in Emergencies and Disasters Quarterly. 2023;8:279–88. https://dx-doi-org.web.bisu.edu.cn/10.32598/hdq.8.specialissue.464.1

Anadolu Agency, https://www.aa.com.tr/tr/saglik/ilk-mudahale-icin-66-motosiklet-gorev-basinda/107222 date of access: 30.01.2024

Van der Pols

Mencl

de Vos

. The impact of an emergency motorcycle response vehicle on prehospital care in an urban area. Eur J Emerg Med. 2011;18(6):328–33. doi:10.1097/MEJ.0b013e32834624e8

Apiratwarakul

Ienghong

Mitsungnern

Kotruchin

Phungoen

Bhudhisawasdi

. Use of a motorlance to deliver emergency medical services; a prospective cross sectional study. Arch Acad Emerg Med. 2019;7(1):e48.

Apiratwarakul

Ienghong

Bhudhisawasdi

Gaysonsiri

Tiamkao

. Response times of motorcycle ambulances during the COVID-19 pandemic. Open Access Maced J Med Sci. 2020;8(T1):526–9.

10.

Apiratwarakul

Tiamkao

Cheung

Celebi

Suzuki

Ienghong

. Application of automated external defibrillators in motorcycle ambulances in Thailand’s emergency medical services. Open Access Emerg Med. 2022;14:141–6. doi:10.2147/OAEM.S361335

11.

Acil Saglık Hizmetleri Genel Müdürlüğü. 2021. (2023, 10 Ocak). Erişim adresi: https://acilafet.saglik.gov.tr/TR-53059/motosiklet-ambulans.html

12.

Bhutta

Rizwan

Chaudhary

Yasir

. Analysis of variables affecting the performance of motorbike ambulance service 1122 in Punjab. Pakistan Journal of Social Issues. 2021;XII.

13.

Bigdeli

Khorasani-Zavareh

Mohammadi

. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study. BMC Public Health. 2010;10:406. doi:10.1186/1471-2458-10-406

14.

Çalık

Sözbilir

. Parameters of content analysis. Education and Science. 2014;39(174):33–8.

15.

Braun

Clarke

. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101. doi:10.1191/1478088706qp063oa

16.

Harmsen

Giannakopoulos

Moerbeek

Jansma

Bonjer

Bloemers

. The influence of prehospital time on trauma patients outcome: A systematic review. Injury. 2015;46(4):602–9. doi:10.1016/j.injury.2015.01.008

17.

Nakstad

Bjelland

Sandberg

. Medical emergency motorcycle–is it useful in a scandinavian emergency medical service?. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2009;17–9. https://doi.org/10.1186/1757-7241-17-9

18.

Viking

Hugelius

Kurland

. Experiences of exposure to workplace violence among ambulance personnel. Int Emerg Nurs. 2022;65:101220. doi:10.1016/j.ienj.2022.101220.

19.

Dadashzadeh

Rahmani

Hassankhani

Boyle

Mohammadi

Campbell

. Iranian pre-hospital emergency care nurses’ strategies to manage workplace violence: A descriptive qualitative study. J Nurs Manag. 2019;27(6):1190–9. doi:10.1111/jonm.12791

20.

Revue

Boyle

Chauvin

Atkinson

. Violence in emergency care: Can we do better?. CJEM. 2022;24(2):107–8. doi:10.1007/s43678-021-00216-6.

21.

Shabanikiya

Kokabisaghi

Mojtabaeian

Sahebi

Varmaghani

. Global prevalence of workplace violence against paramedics: A systematic review and meta-analysis. Health in Emergencies and Disasters Quarterly. 2021;6(4):205–16.

22.

Gökçe

Derya

. Overview of violence perpetrated against the healthcare professionals working at the 112 emergency health department and related factors. Journal of Samsun Health Sciences. 2023;8(2):339–52. https://doi.org/10.47115/jshs.1308587

23.

Chew

Wong

, et al. Prehospital trauma care in Singapore. Prehosp Emerg Care. 2015;19(3):409–15. doi:10.3109/10903127.2014.980477

24.

Ceklic

Tohira

Ball

Brown

Brink

Bailey

, et al. A predictive ambulance dispatch algorithm to the scene of a motor vehicle crash: The search for optimal over and under triage rates. BMC Emergency Medicine. 2022;22(1):74. https://doi.org/10.1186/s12873-022-00609-5

25.

Jou

R-C

Chao

M-C

. Fail to yield? An analysis of ambulance crashes in Taiwan. Sustainability. 2021;13(3):1566. https://doi.org/10.3390/su13031566

26.

Fournier

Chenaitia

Masson

Michelet

Behr

Auffray

. Crew and patient safety in ambulances: Results of a personnel survey and experimental side impact crash test. Prehosp Disaster Med. 2013;28(4:370–5. doi:10.1017/S1049023X13003543

27.

Gümüşsoy

Kıratlı

. Burnout status, occupational satisfaction, and intention to leave the profession of nurses during the COVID-19 pandemic period; The Case of Turkey. Health Care Women Int. 2023;44(7-8):950–67. doi:10.1080/07399332.2022.2134392

28.

T.R. Presidential Legislation Information System. Ambulances, Emergency Health Vehicles and Ambulance Services Regulation https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=10834&MevzuatTur=7&MevzuatTertip=5

29.

Demirbilek

Uzman

. 112 Compassion fatigue, compassion satisfaction and burnout among 112 emergency health workers - The case of province of Kayseri. Gümüşhane University Journal of Health Sciences. 2021;10(1):56–69. doi:10.37989/gumussagbil.818651

30.

Sönmez

Şahin

SucuÇakmak

. Determination of depression, anxiety, and stress levels of paramedics and emergency medical technicians in the covid-19 pandemic. Journal of Pre-Hospital. 2022;7(2):219–35. https://doi.org/10.54409/hod.1132297

31.

Ulaş

. Factors affecting teamwork of pre-hospital emergency health services employees. Journal of Kastamonu University Faculty of Health Sciences. 2023;2(1):s11–23.

32.

Kiefe

Soares-Oliveira

. Medical emergency motorcycles: Are they safe?. Eur J Emerg Med. 2008;15(1):40–2. doi:10.1097/MEJ.0b013e3282861d2f

33.

Hofman

Dzimadzi

Lungu

Ratsma

Hussein

. Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: Do they reduce delay and what do they cost?. Int J Gynaecol Obstet. 2008;102(2):191–7. doi:10.1016/j.ijgo.2008.04.001

34.

Riley

. Motorcycle medics. JEMS: A Journal of Emergency Medical Services. 2000;25(12):32–41.

35.

Pons

Haukoos

Bludworth

Cribley

Pons

Markovchick

. Paramedic response time: Does it affect patient survival?. Acad Emerg Med. 2005;12(7):594–600. doi:10.1197/j.aem.2005.02.013.