Characteristics of Responses from an Australian Emergency Medical Service that Resulted in Non-Conveyance A Retrospective Cross-Sectional Study
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Abstract
Rates of non-conveyance (referred to as a patient refusal or non-transport in areas outside of Australia), defined as paramedic discharge of a patient in the community rather than transporting them to hospital, are increasing. These episodes of care require complex decision-making from paramedics to ensure patients’ needs are appropriately addressed in a timely manner. Knowledge of non-conveyance case characteristics may be useful to direct the focus of research that aims to inform and design effective, patient-centric models of ambulance healthcare delivery.
A retrospective, observational cross-sectional study describing characteristics of non-conveyance cases occurring within an Australian ambulance service setting between 1 January 2019 and 31 December 2020.
Of 1,533,453 adults attended and assessed, n=193,970 (12.6%) were not conveyed to the hospital. Dispatch initially prioritized 43.7% of non-conveyed cases as requiring an emergency (lights and sirens) response. Older people, aged 65 years and above, accounted for 44% of all non-conveyed patients. Pain was the most frequently recorded diagnosis, and less than 1% of all patients not conveyed were recorded as being referred to an alternative form of healthcare service.
This study provides insight into characteristics of ambulance cases in an Australian jurisdictional ambulance service setting which resulted in non-conveyance during the impacts of the COVID-19 epidemic. These findings can be used to focus future investigations that aim to understand how evolving models of ambulance healthcare delivery can safely meet the needs of patients requesting ambulance services and enhance operational efficiency.
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References
Andrew, E., Jones, C., Stephenson, M., Walker, T., Bernard, S., Cameron, P., & Smith, K. (2018). Aligning ambulance dispatch priority to patient acuity: A methodology. Emergency Medicine Australasia, 31(3), 405–410. https://doi.org/10.1111/1742-6723.13181
Andrew, E., Nehme, Z., Cameron, P., & Smith, K. (2019). Drivers of increasing emergency ambulance demand. Prehospital Emergency Care, 24(3), 385–393. https://doi.org/10.1080/10903127.2019.1635670
Australian Institute of Health and Welfare. (2026). Report on government services, part E, section 11 Ambulance Services. https://www.pc.gov.au/ongoing/report-on-government-services/health/ambulance-services
Australian Institute of Health and Welfare. Older Australians. (2024). Older Australians, Summary - Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/older-people/older-australians/contents/summary
Ball, S. J., Williams, T. A., Smith, K., Cameron, P., Fatovich, D., O’Halloran, K. L., Hendrie, D., Whiteside, A., Inoue, M., Brink, D., Langridge, I., Pereira, G., Tohira, H., Chinnery, S., Bray, J. E., Bailey, P., & Finn, J. (2016). Association between ambulance dispatch priority and patient condition. Emergency Medicine Australasia, 28(6), 716–724. https://doi.org/10.1111/1742-6723.12656
Blodgett, J. M., Robertson, D. J., Pennington, E., Ratcliffe, D., & Rockwood, K. (2021). Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1). https://doi.org/10.1186/s13049-020-00821-x
Bloomer, K., Scott, J., Smyth, R., & Wolfe, J. (2024). Paramedic perceptions of barriers and facilitators to the use of ambulance service appropriate care-referral pathways in Northern Ireland: A qualitative study. British Paramedic Journal, 9(3), 13–20. https://doi.org/10.29045/14784726.2024.12.9.3.13
Bohm, K., & Kurland, L. (2018). The accuracy of medical dispatch - A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1). https://doi.org/10.1186/s13049-018-0528-8
Booker, M. J., Purdy, S., & Shaw, A. R. G. (2017). Seeking ambulance treatment for ‘primary care’ problems: A qualitative systematic review of patient, carer and professional perspectives. BMJ Open, 7(8), e016832. https://doi.org/10.1136/bmjopen-2017-016832
Carnicelli, A., Williams, A.-M. M., & Edwards, D. G. (2024). Paramedic education and training for the management of patients presenting with low-acuity clinical conditions: A scoping review. Healthcare, 12(2), 176. https://doi.org/10.3390/healthcare12020176
Cook, B., Evenden, J., Genborg, R., Stretton, B., Kovoor, J., Gibson, K., Tan, S., Gupta, A., Chan, W. O., Bacchi, C., Ittimani, M., Cusack, M., Maddison, J., Gluck, S., Gilbert, T., McNeill, K., & Bacchi, S. (2024). A brief history of ramping. Internal Medicine Journal, 54(9), 1577–1580. https://doi.org/10.1111/imj.16466
Cormack M. (2024). Unleashing the potential of our health workforce scope of practice review final report. Australian Government Department of Health and Aged Care. Accessed January 23, 2026. https://www.health.gov.au/sites/default/files/2024-11/unleashing-the-potential-of-our-health-workforce-scope-of-practice-review-final-report_0.pdf
Corman, M. K., Phillips, P., & McCann, L. (2025). The future of paramedic education: Problematizing the translucent curriculum in paramedicine. Paramedicine. https://doi.org/10.1177/27536386251338525
Dahoud, S., Simpson, P., & Naidoo, N. (2024). The influence of patient sex on paramedic administration of analgesia for acute abdominal pain in an Australian ambulance service. Paramedicine, 21(6), 263–274. https://doi.org/10.1177/27536386241253145
Delardes, B., Gooley, M., Bowles, K.-A., & Chakraborty, S. (2025). Paramedic to general practitioner referral pathways within Australian jurisdictional ambulance clinical practice guidelines: A document analysis. Australian Health Review, 49(2). https://doi.org/10.1071/ah24335
Delardes, B., Powell, M., Bowles, K.-A., Chakraborty, S., Smith, K., & Olaussen, A. (2024). Paramedic perceptions of conveying patients to an emergency department who were suitable for primary care: A cross-sectional survey. Australian Journal of Primary Health, 30(5). https://doi.org/10.1071/py23204
Dinh, M. M., Berendsen Russell, S., Bein, K. J., Chalkley, D. R., Muscatello, D., Paoloni, R., & Ivers, R. (2016). Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: Who, what, where and why? BMJ Open, 6(5), e010964. https://doi.org/10.1136/bmjopen-2015-010964
Eastwood, K., Morgans, A., Smith, K., Hodgkinson, A., Becker, G., & Stoelwinder, J. (2015). A novel approach for managing the growing demand for ambulance services by low-acuity patients. Australian Health Review, 40(4), 378–384. https://doi.org/10.1071/ah15134
Ebben, R. H. A., Castelijns, M., Frenken, J., & Vloet, L. C. M. (2019). Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands. World Journal of Emergency Medicine, 10(4), 239. https://doi.org/10.5847/wjem.j.1920-8642.2019.04.008
Ebben, R. H. A., Vloet, L. C. M., Speijers, R. F., Tönjes, N. W., Loef, J., Pelgrim, T., Hoogeveen, M., & Berben, S. A. A. (2017). A patient-safety and professional perspective on non-conveyance in ambulance care: A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25(1). https://doi.org/10.1186/s13049-017-0409-6
Fogg, C., England, T., Daniels, H., & Walsh, B. (2025). Prevalence and severity of frailty amongst middle-aged and older adults conveyed to hospital by ambulance between 2010 and 2017 in Wales. Age and Ageing, 54(5). https://doi.org/10.1093/ageing/afaf124
Granlund, L., Brännström, I., & Lindström, V. (2024). Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - A qualitative study. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01899-9
Höglund, E., Schröder, A., Andersson-Hagiwara, M., Möller, M., & Ohlsson-Nevo, E. (2022). Outcomes in patients not conveyed by emergency medical services (EMS): A one-year prospective study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1). https://doi.org/10.1186/s13049-022-01023-3
Höglund, E., Schröder, A., Möller, M., Andersson-Hagiwara, M., & Ohlsson-Nevo, E. (2018). The ambulance nurse experiences of non-conveying patients. Journal of Clinical Nursing, 28(1-2), 235–244. https://doi.org/10.1111/jocn.14626
King, R. (2024). Exploring patients’ experiences of non-conveyance after receiving an emergency ambulance service response. University of the Sunshine Coast, Queensland. https://doi.org/10.25907/00808
King, R., Oprescu, F. I., Lord, B., Flanagan, B., & Downer, T. (2023). Patients’ experiences of non-conveyance following an Australian ambulance service paramedic response: A constructivist grounded theory exploration. Paramedicine, 20(3), 63–78. https://doi.org/10.1177/27536386231163721
Krohn, J.-N., & Singler, K. (2025). Frailty and prehospital emergency care: Implications for paramedic education. Age and Ageing, 54(5). https://doi.org/10.1093/ageing/afaf126
Lederman, J., Lindström, V., Elmqvist, C., Löfvenmark, C., & Djärv, T. (2020). Non-conveyance in the ambulance service: A population-based cohort study in Stockholm, Sweden. BMJ Open, 10(7), e036659. https://doi.org/10.1136/bmjopen-2019-036659
Lederman, J., Lindström, V., Elmqvist, C., Löfvenmark, C., Ljunggren, G., & Djärv, T. (2021). Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: A cohort analysis. BMC Emergency Medicine, 21(1). https://doi.org/10.1186/s12873-021-00548-7
Leyenaar, M. S., McLeod, B., Jones, A., Brousseau, A.-A., Mercier, E., Strum, R. P., Nolan, M., Sinha, S. K., Agarwal, G., Tavares, W., & Costa, A. P. (2021). Paramedics assessing patients with complex comorbidities in community settings: Results from the CARPE study. Canadian Journal of Emergency Medicine, 23(6), 828–836. https://doi.org/10.1007/s43678-021-00153-4
Li, M., Vanberkel, P., & Carter, A. J. E. (2018). A review on ambulance offload delay literature. Health Care Management Science, 22(4), 658–675. https://doi.org/10.1007/s10729-018-9450-x
Long, J., Knowles, E., Bishop-Edwards, L., & O’Cathain, A. (2021). Understanding young adults’ reasons for seeking ‘clinically unnecessary’ urgent and emergency care: A qualitative interview study. Health Expectations, 24(4), 1535–1544. https://doi.org/10.1111/hex.13301
Lunn, T. M., Bolster, J. L., & Batt, A. M. (2024). Community paramedicine supporting community needs: A scoping review. Health & Social Care in the Community, 2024(1). https://doi.org/10.1155/2024/4079061
McCann, T. V., Savic, M., Ferguson, N., Bosley, E., Smith, K., Roberts, L., Emond, K., & Lubman, D. I. (2018). Paramedics’ perceptions of their scope of practice in caring for patients with non-medical emergency-related mental health and/or alcohol and other drug problems: A qualitative study. Plos One, 13(12), e0208391. https://doi.org/10.1371/journal.pone.0208391
McManamny, T. E., Dwyer, R., Cantwell, K., Boyd, L., Sheen, J., Smith, K., & Lowthian, J. A. (2021). Emergency ambulance demand by older adults from rural and regional Victoria, Australia. Australasian Journal on Ageing, 41(1). https://doi.org/10.1111/ajag.12960
Morrison, A., Craswell, A., Bogossian, F., & Lord, B. (2025). The tensions between organisational culture and professionalisation and their influence on paramedic conveyance decision-making: A constructivist grounded theory framework. Paramedicine, 22(5), 225–236. https://doi.org/10.1177/27536386251335406
Møller, F. A., Gude, M. F., Nielsen, R. Ø., & Gehrt, T. B. (2025). Patient safety in non-conveyance within prehospital emergency medical services: A register-based study. Internal and Emergency Medicine, 21(2), 673–683. https://doi.org/10.1007/s11739-025-03980-w
Nehme, E., Smith, K., Jones, C., Cox, S., Cameron, P., & Nehme, Z. (2024). Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations. Emergency Medicine Australasia, 36(4), 609–615. https://doi.org/10.1111/1742-6723.14406
NSW Ambulance. (2025). NSW Ambulance Overview. Accessed January 23, 2026. https://www.ambulance.nsw.gov.au/about-us/nsw-ambulance-overview
NSW Ambulance Clinical Systems. (2023). Clinical Services Plan 2024-2029. Accessed January 23, 2026. https://www.ambulance.nsw.gov.au/__data/assets/pdf_file/0011/924509/Clinical-Services-Plan-2024-2029.pdf
Oosterwold, J., Sagel, D., Berben, S., Roodbol, P., & Broekhuis, M. (2018). Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: A systematic mixed studies review. BMJ Open, 8(8), e021732. https://doi.org/10.1136/bmjopen-2018-021732
O’Cathain, A., Connell, J., Long, J., & Coster, J. (2019). ‘Clinically unnecessary’ use of emergency and urgent care: A realist review of patients’ decision making. Health Expectations, 23(1), 19–40. https://doi.org/10.1111/hex.12995
O’Cathain, A., Knowles, E., Bishop-Edwards, L., Coster, J., Crum, A., Jacques, R., James, C., Lawson, R., Marsh, M., O’Hara, R., Siriwardena, A. N., Stone, T., Turner, J., & Williams, J. (2018). Understanding variation in ambulance service non-conveyance rates: A mixed methods study. Health Services and Delivery Research, 6(19), 1–192. https://doi.org/10.3310/hsdr06190
O’Hara, R., Johnson, M., Siriwardena, A. N., Weyman, A., Turner, J., Shaw, D., Mortimer, P., Newman, C., Hirst, E., Storey, M., Mason, S., Quinn, T., & Shewan, J. (2014). A qualitative study of systemic influences on paramedic decision making: Care transitions and patient safety. Journal of Health Services Research & Policy, 20(1_suppl), 45–53. https://doi.org/10.1177/1355819614558472
Pap, R., Barr, N., Hutchison, A., O’Meara, P., Simpson, P., Reardon, M., Reeves, H., Reynolds, L., Thomson, M., & Ross, L. (2024). Research agenda and priorities for Australian and New Zealand paramedicine: A Delphi consensus study. Paramedicine, 21(3), 94–107. https://doi.org/10.1177/27536386241231666
Paramedicine Board of Australia. (2021). Professional capabilities for registered paramedics. Accessed January 23, 2026. https://www.paramedicineboard.gov.au/Professional-standards/Professional-capabilities-for-registered-paramedics.aspx
Paulin, J., Kurola, J., Koivisto, M., & Iirola, T. (2021). EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? BMC Emergency Medicine, 21(1). https://doi.org/10.1186/s12873-021-00508-1
Paulin, J., Kurola, J., Koivisto, M., & Iirola, T. (2021). EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? BMC Emergency Medicine, 21(1). https://doi.org/10.1186/s12873-021-00508-1
Peacock, L., Lewandowsky, R., Bowles, K.-A., Lord, B., & Andrews, T. (2023). Chronic pain in the paramedic practice setting – A qualitative study of patients’ perspective. Paramedicine, 21(2), 79–88. https://doi.org/10.1177/27536386231220966
Shannon, B., Eaton, G., Lanos, C., Leyenaar, M., Nolan, M., Bowles, K.-A., Williams, B., O’Meara, P., Wingrove, G., Heffern, J., & Batt, A. (2022). The development of community paramedicine: A restricted review. Health & Social Care in the Community, 30(6). https://doi.org/10.1111/hsc.13985
Speijers, R. F., Ebben, R. H. A., Eikendal, T., Ruijs, L., Cuppen, F. G. M. H. M., & de Vos, R. (2025). An analysis of characteristics and associated factors for re-contacts after EMS non-conveyance: A retrospective cohort study in the Netherlands. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1). https://doi.org/10.1186/s13049-025-01365-8
Swain, A. H., Al-Salami, M., Hoyle, S. R., & Larsen, P. D. (2012). Patient satisfaction and outcome using emergency care practitioners in New Zealand. Emergency Medicine Australasia, 24(2), 175–180. https://doi.org/10.1111/j.1742-6723.2011.01525.x
Vella, S. P., Simpson, P., Bendall, J. C., Pickles, K., Copp, T., Swain, M. S., Maher, C. G., & Machado, G. C. (2024). Perceptions and experiences of paramedics managing people with non-traumatic low back pain: A qualitative study of Australian paramedics. BMJ Open, 14(3), e084060. https://doi.org/10.1136/bmjopen-2024-084060
Vloet, L. C. M., de Kreek, A., van der Linden, E. M. C., van Spijk, J. J. A., Theunissen, V. A. H., van Wanrooij, M., van Grunsven, P. M., & Ebben, R. H. A. (2018). A retrospective comparison between non-conveyed and conveyed patients in ambulance care. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1). https://doi.org/10.1186/s13049-018-0557-3
Weber, A., Devenish, S., & Lam, L. (2025). Exploring paramedicine models of care: A novel macro analysis using the RESPIGHT framework. Australian Journal of Rural Health, 33(1). https://doi.org/10.1111/ajr.13215
Yardley, I. E., & Donaldson, L. J. (2016). Deaths following prehospital safety incidents: An analysis of a national database. Emergency Medicine Journal, 33(10), 716–721. https://doi.org/10.1136/emermed-2015-204724
Yeung, T., Shannon, B., Perillo, S., Nehme, Z., Jennings, P., & Olaussen, A. (2019). Review article: Outcomes of patients who are not transported following ambulance attendance: A systematic review and meta-analysis. Emergency Medicine Australasia, 31(3), 321–331. https://doi.org/10.1111/1742-6723.13288