Compensation Claim Due to Delay or Faulty Intervention in Ambulance Services

What are delays or incorrect interventions in ambulance services?

Ambulance service delay or faulty response refers to harm to a patient caused by the delayed, incomplete, incorrect, or substandard delivery of healthcare services during the period from receiving an emergency call to transporting the patient to the appropriate healthcare facility. This harm may manifest as worsening of the illness, permanent disability, organ loss, brain damage, need for intensive care, reduced chances of treatment, or death.

Ambulance service is not simply a transportation service that takes a patient from one place to another. Upon arrival at the scene, the ambulance team assesses the patient, provides necessary emergency medical intervention, transports the patient appropriately, monitors them during transport, and delivers them to the appropriate healthcare facility. The Regulation on Ambulances and Emergency Medical Vehicles and Ambulance Services, dated January 8, 2025, was issued to regulate the establishment, operation, and supervision procedures of ambulance services, as well as the medical and technical equipment specifications of ambulances and emergency medical vehicles; the Regulation also covers ambulance services provided by public institutions and private legal entities.

Therefore, errors in ambulance services are not limited to the classic issue of "the vehicle arrived late." Incorrect assessment of the call, delayed dispatch of the ambulance, going to the wrong address, insufficient assessment of the patient upon arrival, failure to provide the patient with necessary oxygen/cardiac massage/medication/monitoring support, transport in an unsuitable ambulance, transporting the patient to the wrong hospital, dropping the patient from the stretcher, failure to monitor the patient during transport, or failure to maintain patient handover records can also give rise to liability for compensation.

Is every ambulance delay grounds for compensation?

No. Not every ambulance delay automatically entitles you to compensation. The time it takes for an ambulance to arrive at the scene can be affected by many factors, including the nature of the call, the accuracy of the address, traffic, weather conditions, the location of the incident, the volume of simultaneous cases, disasters or extraordinary circumstances, security risks, and available ambulance capacity. Therefore, the claim that "the ambulance arrived late" alone is not sufficient grounds for compensation.

However, liability for compensation arises only if it can be shown that the delay was unreasonable, preventable, and resulted from a service defect. For example, the argument for fault is strengthened if the call center incorrectly assessed the emergency, the ambulance was directed to the wrong address, the team deployment was delayed, no backup measures were taken despite knowing about an ambulance malfunction, the communication and vehicle tracking system was not operated correctly, or an appropriate ambulance or medical personnel was not sent when the patient was at vital risk.

The fundamental question to consider in ambulance services is: Did the delay result from extraordinary and unavoidable circumstances, or was it due to deficiencies in call assessment, dispatch, coordination, personnel, vehicles, equipment, or the record-keeping system? If the delay reduced the patient's chances of treatment, resulting in death or permanent harm, the causal link between the harm and the delay should be assessed through expert examination.

Error in the 112 Call Process

The first stage of ambulance service is receiving and evaluating the call. In a 112 call, the address provided by the caller, patient information, type of incident, number of patients, complaints, and urgency level must be accurately recorded. The Provincial Ambulance Service Operating Guidelines state that the command and control center physician will evaluate incoming emergency calls; ensure that information such as address, telephone number, identity, number of patients/injured persons, and type of incident are recorded; direct emergency cases; and record the time the call was received and given to the ambulance team.

An error at this stage can affect the entire process. For example, if a case is assessed as simple chest pain despite a description of heart attack symptoms, if stroke signs are not noticed, if priority is not given to a patient with respiratory distress, if the address is incomplete, if first aid information is not provided over the phone, or if the wrong ambulance team is dispatched, then a fault in call assessment arises.

The directive also stipulates that first aid information will be provided to the patient, their relative, or the caller as needed until the ambulance team arrives at the scene; and that the arrival time of the ambulance will be monitored and recorded. These records are extremely important in any subsequent compensation lawsuit. Any unreasonable discrepancies between the call time, the team dispatch time, the arrival time at the scene, and the hospital arrival time should be investigated separately in the case file.

The Responsibility of the Ambulance Team at the Scene

When an ambulance crew arrives at the scene, they cannot simply place the patient on a stretcher and transport them. An initial assessment of the patient must be conducted, vital signs checked, and respiration, circulation, consciousness, bleeding, trauma, neurological findings, pain, oxygen requirements, and the need for immediate intervention assessed. According to the 2025 Ambulance Services Regulation, the ambulance crew that reaches the location of the patient or injured person provides the necessary medical emergency assistance or transport; the transportation of the patient is the responsibility of the ambulance crew.

Examples of faulty interventions include failure to perform effective CPR in cases of cardiac arrest, failure to use a defibrillator, failure to administer oxygen, failure to apply appropriate compressions or immobilization to a patient with bleeding, transporting a patient with neck trauma without stabilizing them, failure to refer a patient suspected of stroke or heart attack to an appropriate center, and failure to provide necessary first aid in cases of hypoglycemia or seizures.

The ambulance crew's job is not to definitively diagnose every illness. However, they must recognize urgent medical signs, ensure patient safety, adhere to basic/advanced life support protocols, monitor the patient during transport, and coordinate with the command and control center or physician if necessary.

Faulty Transfer and Referral to the Wrong Hospital

One of the most frequently debated issues in ambulance services is whether the patient is taken to the correct healthcare facility. In some cases, taking the patient to the nearest hospital may suffice. However, in other cases, it is not the nearest hospital that matters, but rather a center with appropriate specialties, intensive care units, trauma centers, stroke centers, cardiology/angiography facilities, neonatal intensive care units, or pediatric intensive care units.

For example, liability for compensation may arise due to incorrect referral if a patient suffering a heart attack is taken to a hospital without angiography facilities, resulting in a loss of time; if a patient with stroke symptoms is not referred to an appropriate stroke center; if a patient with severe trauma is not referred to a fully equipped center; or if a newborn or child patient is transported without the necessary equipment and facilities.

The Ministry of Health's General Directorate of Emergency Medical Services' current regulations and legislation pages regarding the coordination of patient referral processes show that referral coordination in emergency medical services is treated as a separate administrative and medical process. The Ministry's website includes sections on 112 emergency medical services documents and forms, the electronic case system, the vehicle tracking system, and the coordination of patient referral processes.

In cases of wrongful hospital referral, the following questions are asked: What was the patient's condition? Which center was medically appropriate to take the patient to? Which hospital did the command and control center deem appropriate? Is there any information about hospital acceptance or rejection? Did the patient's condition worsen en route? Could harm have been avoided if the patient had been taken to the appropriate center? The answers to these questions are determined through expert examination.

Emergency Patient Transport by Patient Transfer Ambulance

The types of ambulances are important from a legal perspective. The regulation classifies land ambulances as emergency ambulances, patient transport ambulances, intensive care ambulances, and specially equipped ambulances. An emergency ambulance is a vehicle equipped to provide necessary emergency medical intervention at the scene and inside the ambulance in cases requiring emergency assistance. A patient transport ambulance, on the other hand, is a vehicle used for transporting patients or injured individuals who do not require emergency medical intervention.

This distinction is directly important in compensation claims. Because transporting a patient requiring urgent medical attention solely by a patient transport ambulance may deprive the patient of the necessary medical equipment and personnel support. The regulation explicitly stipulates that patient transport ambulances cannot be used to transport patients or injured individuals requiring urgent medical attention.

For example, if a patient with respiratory distress, heart attack, severe trauma, loss of consciousness, seizures, serious bleeding, or the need for intensive care is being transported by a patient transport ambulance and their condition deteriorates en route, the suitability of the ambulance type must be thoroughly investigated. Similarly, transporting a patient requiring intensive care in a standard ambulance may also be subject to a claim of negligence.

Faulty Medical Intervention in the Ambulance

Medical interventions performed inside the ambulance must be recorded and be appropriate to the patient's condition. According to the regulations, medical procedures, patient records, and interventions performed on patients and injured individuals in ambulances are recorded on the ambulance case record form and registered in ASOS (Ambulance Emergency Situation System).

Erroneous interventions may occur in the following examples: failure to administer oxygen when required, failure to use a defibrillator or monitor, failure to establish intravenous access, administration of incorrect medication, failure to immobilize a trauma patient, improper transport of a patient with a potential spinal injury, failure to control bleeding, disregard for the risk of aspiration, failure to provide appropriate intervention to a pregnant woman in labor, applying an adult approach to a pediatric patient, or failure to notify an appropriate center despite the patient's deterioration during transport.

The medical intervention of the ambulance team is evaluated according to the circumstances of the incident. The ambulance team is not expected to perform procedures at the level of an operating room or intensive care unit. However, basic and advanced interventions required for pre-hospital emergency medical services must be performed in accordance with the team's authority and equipment. Liability for compensation may arise if the damage is aggravated due to the failure to perform these interventions, their delayed performance, or their incorrect performance.

The Importance of Records in Ambulance Services

In cases involving ambulance delays or faulty interventions, records are fundamental to the case. Call logs, voice recordings, call evaluation notes, team dispatch time, arrival time at the scene, patient pickup time, hospital arrival time, vehicle tracking system data, case record form, medical procedures performed, medications administered, patient handover report, and hospital emergency department records must all be examined.

The 2025 Regulation stipulates that all tasks performed by the ambulance and all procedures specified in the ambulance case record form will be recorded in ASOS; ambulance operators are obliged to keep all records and present them upon request for inspection or official purposes. Furthermore, the responsible manager is liable for taking the necessary administrative and technical measures to prevent the storage, alteration, or deletion of records.

The regulation also stipulates that ambulance operators must keep records for five years. Therefore, patients or their relatives should apply for access to the relevant records without delay after the incident. Incomplete record keeping, inconsistencies in incident times, or the failure to provide ASOS (Ambulance Service Information System) data weaken the auditability of the service and become a significant point of contention in legal proceedings.

Vehicle Tracking System, Communication and Evidence

The exact time the ambulance departed, the route it followed, when it arrived at the scene, and when it reached the hospital can be determined using vehicle tracking systems and communication records. The regulation stipulates that radios and mobile devices must be kept switched on and ready for communication throughout working hours at call centers, stations, and ambulances; that assignments must be made via mobile device and confirmed by radio announcement; and that cameras, mobile devices, and vehicle tracking devices must be kept operational and traceable throughout the service period.

Therefore, in ambulance delay cases, not only the statement of the patient's relative but also objective electronic data should be investigated. Vehicle tracking system records, radio announcement recordings, mobile device assignment data, call center voice recordings, ASOS records, and hospital admission times should be compared.

For example, if a long time has passed between the call and the dispatch of the team, if the ambulance's departure is delayed after the team is dispatched, if the ambulance's route is unreasonable, or if the team reports arriving at the scene but the patient's relative specifies a different time, then the electronic records need to be retrieved.

Administrative Responsibility in Public Ambulance Services

Delays or faulty interventions in the 112 public ambulance service are, in most cases, evaluated within the framework of administrative law. Public ambulance service is a public service. If a person suffers harm due to the poor functioning, delayed functioning, or complete lack of functioning of this service, the administration's fault in providing the service comes into question.

Before filing a lawsuit regarding public ambulance services, an application must be made to the relevant administration. According to Article 13 of the Administrative Procedure Law No. 2577, individuals whose rights have been violated by administrative actions must apply to the relevant administration for the fulfillment of their rights within one year from the date they learned of the action, and in any case within five years from the date of the action. If the request is rejected or no response is given within thirty days, a full judicial review lawsuit can be filed within the statute of limitations.

This application must clearly state the chronology of the event. The time the 112 call was made, the time the ambulance arrived, the patient's condition, the intervention at the scene, the hospital to which the patient was transferred, when and how the damage occurred, the requested items of material and moral damages, and any records requested as evidence must be clearly specified. An incomplete and abstract application may weaken the subsequent legal process.

Liability in Private Ambulance Services

Private ambulance services may have different legal consequences than public ambulance services. Private ambulance companies and private healthcare institutions can provide ambulance services; however, they must comply with requirements such as certificates of conformity, competency certificates, personnel work permits, medical-technical equipment, and record-keeping obligations. The regulation clearly stipulates that ambulance services cannot commence operations without obtaining a certificate of conformity and completing the ambulance competency certificate; ambulances without competency certificates cannot operate.

Disputes in private ambulance services typically arise from issues such as: delayed ambulance arrival, use of a patient transport ambulance for an emergency, lack of qualified personnel, insufficient equipment, exorbitant fees, transporting the patient to the wrong hospital, failure to prepare a patient handover report, dropping the patient during transport, or failure to intervene despite the patient's deteriorating health condition.

In private ambulance services, consumer law and private law liability may arise. If the patient or their relative has received the service for a fee, breach of contract, defective service, tort, and negligence in providing healthcare services may be considered together. If the private ambulance service was provided within the organization of a private hospital, the private hospital may also be held liable for organizational deficiencies in the ambulance service.

Ambulance Fee and Billing Disputes

Disputes related to ambulance services can arise not only due to medical harm but also due to pricing. The regulation stipulates that fees for ambulance services will be determined by a commission chaired by the provincial health director, taking into account costs, price indices, local conditions, and comparable rates, setting minimum and maximum fees. Factors such as city/intercity travel, initial fees, and distance are determined separately according to the ambulance class; medical interventions performed in the ambulance are billed separately according to the relevant legislation.

Therefore, if a private ambulance company charges arbitrary, unclear, or exorbitant fees, the invoice and service details should be examined. The type of ambulance service for which the patient was charged, the distance, waiting time, medical intervention, personnel, and equipment should all be clearly indicated.

Patients or their relatives in emergency situations are often not in a position to negotiate prices. Therefore, pricing should be transparent, and patients or their relatives should not be left with unexpected and unfair debts later on.

Liability Due to Ambulance Accident

In ambulance services, injury can sometimes result not from medical intervention but from traffic accidents. The patient may be harmed due to an ambulance accident, falling from a stretcher, failure to use seatbelts or restraint systems, driver negligence, vehicle malfunction, excessive speed, or road safety violations.

The fact that an ambulance driver is on an emergency duty does not completely negate traffic safety regulations. The siren and right of way do not mean the ambulance can move without restraint or control. The driver must exercise the appropriate care and attention appropriate to the circumstances of the mission.

In such cases, traffic accident reports, camera recordings, vehicle tracking system data, speed data, ambulance maintenance records, patient securing records, duty orders, driver's licenses, and personnel authorization documents should be examined. If the accident occurred during a public ambulance service, the administration's negligence may be considered; if it occurred during a private ambulance service, the private company and, if applicable, the insurance company may be held liable.

What types of compensation can be claimed due to ambulance malpractice?

A patient who suffers harm due to delays or faulty intervention in ambulance services may claim material and moral compensation if the conditions are met. Material compensation may include treatment expenses, intensive care costs, medication costs, rehabilitation costs, physical therapy costs, private hospital costs, medical device costs, transportation costs, caregiver costs, temporary disability, permanent disability, loss of earnings, and damage to economic future.

For example, if a patient suffering a heart attack receives delayed treatment due to an ambulance delay and develops permanent heart failure, not only the initial treatment costs but also the patient's lifelong needs for medication, check-ups, loss of work capacity, and care must be calculated. If a stroke patient is brought to the appropriate center late and remains paralyzed, rehabilitation, care, equipment, and loss of income become significant expenses.

Compensation for emotional distress is claimed due to the patient's suffering, fear, risk of death, permanent disability, intensive care period, decreased quality of life, and psychological trauma. If the patient has passed away, their relatives may claim compensation for loss of support, funeral expenses, and compensation for emotional distress.

Can a criminal investigation be opened?

If negligence or faulty intervention in ambulance services results in serious injury or death, a criminal investigation may be initiated. Depending on the nature of the incident, the crimes of negligent injury or negligent homicide will be discussed. Article 89 of the Turkish Penal Code regulates causing pain to another person's body or causing impairment of their health or sensory abilities through negligence; Article 85 of the Turkish Penal Code considers causing the death of a person through negligence as a crime.

In a criminal investigation, it is examined whether the ambulance crew, call center personnel, command and control center managers, private ambulance company, or driver violated their duty of care and diligence. However, a criminal investigation and a civil lawsuit are different. In a criminal case, the aim is to establish the criminal liability of the individuals; in a civil lawsuit, the aim is to compensate the patient or their relatives for their material and moral damages.

Expert or forensic reports obtained in a criminal case can also be important evidence in a compensation lawsuit. However, the absence of fault in a criminal case does not always mean that a compensation lawsuit will be dismissed; organizational faults in public service, in particular, may be evaluated separately in administrative courts.

How should evidence be collected?

In cases of ambulance delays or malpractice, it is necessary to quickly gather evidence. Call records, camera footage, vehicle tracking data, and medical records can become difficult to access over time. Patients or their relatives should primarily request 112 call records, voice recordings, ambulance case report forms, ASOS records, vehicle tracking system data, dispatch and arrival times, hospital emergency room records, and discharge summary reports.

The Patient Rights Regulation stipulates that a patient may directly review and obtain copies of their health records and files, either through their legal representative or proxy. The regulation also states that these records may only be viewed by individuals directly involved in the patient's treatment.

The following are particularly important pieces of evidence: 112 call time, call audio recording, case assessment note, team assignment time, ambulance departure time, vehicle tracking system, arrival time at the scene, interventions performed at the scene, medications administered, patient's vital signs, hospital arrival time, patient handover form, emergency room triage record, intensive care unit records, death certificate, autopsy report, witness statements, camera recordings, and private ambulance invoice, if applicable.

The Importance of Expert Reports

In cases of malpractice in ambulance services, the expert report determines the outcome of the case. The expert panel should include an emergency medicine specialist, an anesthesiology and resuscitation specialist, a physician from a relevant specialty, experts in ambulance/paramedic practices, and, depending on the nature of the incident, a forensic medicine specialist.

The expert must answer the following questions: Was the call properly assessed? Was the ambulance dispatched within a reasonable time? Did the team arrive at the scene within a reasonable time? Was the necessary intervention performed at the scene? Was the type of ambulance used appropriate for the patient's condition? Was the patient monitored during transport? Was the patient transferred to an appropriate hospital? Were records kept properly? Could the harm have been prevented or reduced if there had been no delay or faulty intervention?

Incomplete expert reports must be challenged. In particular, closing a case simply by saying "there was traffic" or "the patient was already seriously ill" is insufficient. The report should concretely examine the entire timeline from the call to patient delivery, electronic records, medical interventions, and causal links.

What should the patient or their relatives do?

If there is suspicion of ambulance delay or faulty intervention, the first thing to do is to create a chronology of events. At what time was 112 called? What complaint was reported? When was the ambulance dispatched? When did it arrive at the scene? What intervention was performed? Which hospital was the patient taken to? When was the patient delivered to the hospital? When did the damage occur?

The second step is to request the records in writing. For public ambulance services, records can be requested from the Provincial Health Directorate, the 112 Provincial Ambulance Service Chief Physician's Office, and the relevant hospital. For private ambulance services, record and inspection information can be requested from the private ambulance company, the private hospital organizing the service, and the Provincial Health Directorate.

The third step is to correctly distinguish between public and private sectors. If it's a public 112 ambulance, you can file an appeal with the administration and pursue a full judicial review; if it's a private ambulance, you can consider private law, consumer law, tort law, and breach of contract.

The fourth step is to identify the damages. If the patient is alive, these should include medical expenses, disability, care needs, and emotional distress; if the patient has passed away, these should include loss of support, funeral expenses, and claims for compensation for emotional distress by relatives.

Conclusion: Ambulance service is a vital public and health service

Ambulance service is one of the most critical stages of the emergency medical system. Accurate call reception, proper assessment of the situation, timely dispatch of the ambulance, necessary intervention at the scene, safe transport of the patient, and delivery to an appropriate healthcare facility are vital for patient survival.

Not every ambulance delay is grounds for compensation. However, if the damage occurs due to an error in call assessment, delayed dispatch, incorrect address, inappropriate ambulance type, lack of equipment or personnel, incorrect medical intervention, referral to the wrong hospital, lack of follow-up during transport, or improper record keeping, a claim for material and moral damages may arise.

In public ambulance services, administrative negligence and full judicial review cases should be considered; in private ambulance services, private law, consumer law, breach of contract, and tort liability should be evaluated. If there is serious injury or death, a criminal investigation may also be initiated.

Therefore, in cases where there is suspicion of delay or faulty intervention in ambulance services, 112 call records, ASOS records, vehicle tracking data, ambulance case record form, patient handover report, and hospital records should be collected without delay. A strong legal process is possible not only with the claim that "the ambulance arrived late," but also by presenting the records of the time elapsed from the call to the hospital handover, evaluating the conformity of the medical intervention to standards, and proving the causal link between the damage and the delay/error with concrete evidence.