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Background: Patient participation is considered to promote well- being and is, there-fore, central in care contexts. Care- dependent older persons living at home constitute a vulnerable  population  with  increased  ambulance  care  needs.  Care  transfers  risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.

Aim: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.

Method: A  phenomenological  hermeneutical  method  was  used to  analyse  tran-scripts of narrative interviews with 11 ambulance personnel.

Results: The  ambulance personnel's  lived  experience  of  older  persons'  participa-tion includes  passive  and active  dimensions  and  involves  a  balancing  act  between  an exercise of power that impedes participation and equalisation of power that em-powers participation. The main theme ‘Balancing dignity in relation to manipulat-ing the body’ included the themes Providing a safe haven and Complying with bodily expressions, which  means  shouldering  responsibility  for  existential  well-  being  and  being guided by reactions. The main theme ‘Balancing influence in relation to per-ceived health risks’ included the themes Agreeing on a common perspective, Directing decision- making   mandate,  and  Sharing  responsibility  for  well-  being,  which  means shouldering responsibility for health focusing on risks. Influence is conditional and includes  performance  requirements  for  both  the  older  person  and  municipal  care personnel.

Conclusion: Care-  dependent  older  persons'  participation  in  care  from the per-spective of ambulance personnel means recognising passive and active dimensions involving  human  dignity,  the  ability  to  influence  care,  and  optimising  care  efforts through collaboration. This study provides a deepened understanding of the balanc-ing of  power  involved  in  ambulance  care  determining  participation,  where  power  is equalised  or  exercised  depending  on  personal  engagement,  health  risks,  and available care options. The knowledge provided holds the potential to improve am-bulance care to benefit older persons in critical life situations.