Abstract
BackgroundNot all patients where an ambulance is dispatched are conveyed to an emergency department. Although non-conveyance is a substantial part of ambulance care, there is limited insight in the non-conveyance patient population. Therefore, the study aim was to compare demographics, initial on-scene reasons for care, and vital signs between conveyed and non-conveyed patients attended by an ambulance.MethodsA retrospective study of ambulance runs from 2 EMS regions in the Netherlands in 2016 was performed. For each ambulance run demographics (age, gender and geographical location), initial reasons for care categorised into the ICD-10 classification system, and vital functions or observational scales (according to the national ambulance care protocol) were collected and analyzed.Results54.797 ambulance runs met the inclusion criteria, of which 14.383/54.797 (26.2%) resulted in non-conveyance. There was no significant difference in gender, but the non-conveyance group was significantly younger (48.5 (±26.4) years) compared to the conveyance group (60.7 (±22.2) years) (p = .000). The most common initial reasons for care for the conveyance group could be classified into chapter-9 diseases of the circulatory system, chapter-19 injury, poisoning and certain other consequences of external causes, and chapter-10 diseases of the respiratory system. The most common reasons for care in the non-conveyance group could be classified into the chapter-9 diseases of the circulatory system, chapter-19 injury, poisoning and certain other consequences of external causes, and -chapter-5 mental, behavioral and neurodevelopmental disorders. The total percentage abnormal vital functions/observation scales between the conveyance (69.5%) and non-conveyance group (58.6%) was significantly different (p = .000). 15 out of 17 vital functions/observation scales are significantly different between the conveyance and non-conveyance group.ConclusionsThis study shows that non-conveyed patients are younger, are more likely to be in (highly) rural areas, and more often have initial reasons for care related to mental, behavioral and neurodevelopmental disorders (ICD-10 chapter 5). Although abnormal vital functions/observation scale were more prevalent in the conveyance group, 58.6% of the non-conveyed patients had at least one abnormal vital function/observation scale.
Highlights
Not all patients where an ambulance is dispatched are conveyed to an emergency department
The within-group distribution of location was comparable for the conveyance and non-conveyance group, with no patients in highly urban areas, and one third of the patients in urban, average urban and rural areas
The average age was significantly different between the non-conveyance and conveyance group: 48.5 (±26.4) years for the non-conveyance group, compared to 60.7 (±22.2) years for the conveyance group
Summary
Emergency Medical Service (EMS) systems have changed substantially throughout the last century [1]. Due to the improvement of healthcare and the changing population structure, EMS-systems developed from being just a conveyance provider for patients to an advanced emergency care provider. The last years, EMS-systems are developing into mobile integrated health care systems where EMS-professionals perform assessments and interventions without conveyance to an ED [2] Within these developing EMS-systems, ambulance staff increasingly make critical decisions about patient care in complex environments [3]. One of these critical decisions considers conveyance decision-making. Non-conveyance can be initiated by the ambulance professional (sometimes after consultation of a general practitioner or medical specialist) and the patient and/or his relatives [7]
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