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345 The use of coercion in the ambulance service – a qualitative study of a large urban ambulance service
  1. NO Thorvaldsen1,2,
  2. TL Husum1,3,
  3. SJM Sollid2,4
  1. 1Faculty of Health Sciences, Oslo Metropolitan University
  2. 2Faculty of Health Sciences, University of Stavanger
  3. 3Centre for Medical Ethics University of Oslo and Oslo Metropolitan University
  4. 4Norwegian Air Ambulance Foundation


Background Voluntary and informed consent is a fundamental principle of healthcare provision. However, health care laws in some countries allow for exceptions from the consent requirement when patients are not competent to consent or pose a danger to themselves or others. In these cases, the use of coercion may be an alternative to voluntary health care. Ambulance personnel are confronted with patients who need healthcare but refuse it and/or refuse to cooperate. To what extent coercion is used by ambulance personnel in these situations or what constitutes coercion in a pre-hospital setting has not previously been explored. This study therefore examines (i) ambulance personnel’s perceptions of coercion, (ii) their experience of the use of coercion, (iii) situations in which they have used coercion, and (iv) forms of coercion they have used.

Method We conducted focus group interviews with a group of ambulance personnel from a large Norwegian ambulance service. Digital recordings of the interviews were transcribed verbatim and the transcripts were analysed using Systemic Text Condensation.

Results Informants primarily interpreted and described coercion as the use of physical force. Other types of coercion as persuasion, pragmatic force, pharmacological coercion and securing during transport were described.

Conclusion The different methods of force/coercion are mainly used in situations where the ambulance personnel consider that healthcare is necessary but the patients refuses. The findings indicate that adherence to emergency law, a duty to help, the welfare of the patient and insecurity or fear promote the use of coercion among ambulance personnel. Insecurity and fear seem to be rooted in: 1) an experienced contradiction between the ambulance service’s guidelines and the legislation, 2) fear of breaching guidelines and leaving patients behind because of lack of support from management, and 3) fear of charges of misconduct. The difficulty of applying the law in real-life situations and assessing competence is also a contributory factor.

Conflict of interest None.

Funding None.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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