The ambulance process is situated within this context. In addition to this growing demand, frequent overcrowding of the ED occurs. Together, these developments put a growing demand on ambulance systems and ambulance capacity, the emergency departments (ED) and the wider healthcare system, and this may compromise patient safety, healthcare quality, and access. At the same time, the utilization of ambulance care has increased throughout the developed world, with various underlying reasons such as ageing of the population, changes in social support, accessibility and costs. The past decades, ambulance care has evolved from a health care facility that conveys patients to the hospital, into emergency medical services (EMS) that provide advanced out-of-hospital care for (non-) life-threatening conditions.
#Alternate conveyance professional
Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card). A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. Within 24 h–48 h after non-conveyance, 2.5%–6.1% of the patients have EMS representations, and 4.6–19.0% present themselves at the ED. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Non-conveyance rates for general patient populations ranged from 3.7%–93.7%. We included 67 studies with low to moderate quality.
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