Non-conveyance rates for general and specific patient populations vary. 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. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction. We included all types of peer-reviewed designs on the five topics. We systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process. This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives.
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