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Background
The past decades Emergency Medical Services (EMS) have changed from conveyance providers into providers of advanced pre-hospital care [1]. Along with this change the demand for emergency care has increased due to a variety of reasons e.g., population growth, aging of the population, changing triage systems, changes in the accessibility in general practitioner (GP) care and an increasing demand for patient self-management with a decrease in social support [1, 2–3]. Within these developments non-conveyance has become a substantial and increasing part of ambulance care [4]. ‘Non-conveyance’ is defined as an appropriate ambulance deployment where the patient after on-scene assessment and/or treatment does not require transportation to a healthcare facility with medical personnel and equipment [5]. Non-conveyed patients are assessed, treated and discharged at the scene and can also be referred to other primary care facilities, such as the GP [6]. International non-conveyance rates vary between 3.7 and 93.7% in the general population [5]. For EMSs in the Netherlands the rate is approximately 25% [7]. Ambulance professionals perceive the non-conveyance decision as complex due to many influencing factors and patient safety may be compromised [8, 9]. Non-conveyed patients have been shown to have an increased risk for subsequent events compared with patients who had been conveyed and discharged from emergency departments (ED’s), such as EMS re-contacts (6.1% vs. 1.8%,), ED visits (4.6% vs. 1.4%,), hospital admission (3.3% vs. 0.8%) and even death (0.2% vs. 0.1%) [10]. In contrast, several studies indicate that non-conveyance is relatively safe and an appropriate triaged decision that leads to appropriate use of limited ambulance sources and reduces ED overcrowding [11, 12–13].
Non-conveyance assessment and decision making requires guidance through guidelines and protocols, which are currently being developed [14, 15–16]. To develop these guiding instruments insight into the non-conveyed patient population is needed. Previous studies showed that non-conveyed patients are generally younger and more often have reasons for care related to mental, behavioural and neurodevelopmental disorders in comparison with conveyed patients [13, 17, 18–19]. Older age was found to be a risk factor for subsequent and adverse events [20, 21]. Although these studies give insight in the non-conveyed population, more insight is needed in that part of the non-conveyed population which has an ambulance care re-contact. Especially as re-contacts are frequently...