Patient safety in non-conveyance within prehospital emergency medical services: a register-based study

This study investigated the patient safety of prehospital Emergency Medical Service (EMS) non-conveyance decisions by examining EMS reassessments on-scene, hospital admission, and mortality within 48 h among non-conveyed patients. Secondarily, we described proportions of patients within each dispatch code needing reassessment and hospital admission and explored predictors of these outcomes.

This register-based study included all EMS assignments in the Central Denmark Region from January 1st, 2022, to December 31st, 2023, resulting in EMS-initiated non-conveyance. We estimated the proportion of patients reassessed on-scene by EMS providers, admitted to hospital or deceased within 48 h. Predictors of reassessment and hospital admission were explored using regression models.

During the 2-year period, 17.402 patients were non-conveyed. Among these, 4.70% (95% CI: 4.40-5.03%) were reassessed by EMS providers, 4.92% (95% CI: 4.60-5.25%) were admitted to the hospital within 48 h, and 14 patients died within 48 h (0.08%, 95% CI: 0.04-0.13%). Patients with 'ear, nose and throat' complaints had a high risk of needing EMS reassessment (17.6%, 95% CI: 11.5-25.2%) and hospital admission (16.0%, 95% CI: 10.2-23.5%). Furthermore, the risk was high in patients with 'seizures', 'non-traumatic bleeding' and 'psychiatry/suicidal ideation'. Male sex, older age, and abnormal vital signs were identified as predictors.

Within 48 h, mortality was low and few non-conveyed patients were reassessed by the EMS and admitted to the hospital. This suggests that non-conveyance is generally a safe practice. However, caution is needed when considering males, older patients, those with specific complaints, and abnormal vital signs.