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Efficacy on Patient Outcomes between Using Private and Public Emergency Medical Services (EMS) Transporting Emergency Patients to the Emergency Department

Author: Parama Kaninworapan PMD | | Division of Paramedicine, Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospit

Associate Authors: Jenpanitpong,Chetsadakon,PMD.Ph.D | Nuanprom,Promphet, PMD.Ph.D | Aramvanitch,Kasamon,MD.FTCEP.

Background

Thailand’s Emergency Medical Services System (EMSS) has been established under the Emergency Medical Act since 2008. Despite serving nearly 2 million patients in 2023, only 18% of critical patients accessed, and just 41% of them received care within optimal time. While private ambulance services are expanding, current regulations remain limited, and their effectiveness compared to public services remains controversial. This study aims to compare the clinical outcomes of emergency patients transported by private versus public ambulances to the Emergency Department (ED) of Ramathibodi Hospital — a university-affiliated facility located in Bangkok, Thailand.
Method: This was a retrospective cohort study. Patients transported to the ED of Ramathibodi Hospital between January 1, 2022, and April 30, 2024, were enrolled. Data included type of service, patient demographics, prehospital vital signs and interventions, and on-scene triage, were retrieved from pre-arrival notification records. Vital signs upon ED arrival, ED triage, and disposition status were obtained from the hospital’s electronic medical records. Age, chief complaint according to the EMD code, Scene to ED distance, insurance, and comorbidity status, were included in the propensity score matching analysis.

Results

Totally there were 1,417 patients were enrolled which 1,099 (76.92%) and 327 (23.08%) were transported by public and private ambulance services, respectively. Following propensity score matching of 628 patients, patients presenting with dyspnea and fever/fatigue were more likely to utilize private rather than public ambulance services. However, no statistically significant differences were found in patient demographics and prehospital characteristics between the study groups. Public services were more likely to provide prehospital interventions, particularly hemodynamic support when indicated (89.18% vs. 24.59%, p<0.001). Regarding clinical endpoints—including vital signs upon ED arrival, ED triage, and disposition status—no statistically significant differences were observed.

Conclusion

No differences in ED clinical outcomes were observed between private versus public ambulance services. However, public services were more likely to provide prehospital interventions when indicated. These findings highlight the potential value of integrating private ambulance services into Thailand EMSS.