Non-conveyance of prehospital patients in Denmark a descriptive study of current practices

Non-conveyance is a term used to describe a situation in which a patient who is treated by the ambulance service is not transported to a hospital after assessment and/or treatment at the scene. Non-conveyance may result from finalised treatment at the scene or from a patient being referred to transportation other than an ambulance. Although increasingly used in the ambulance setting, Danish legislation addresses non-conveyance only minimally, and prehospital healthcare providers may need support from local guidelines. This study aimed to describe and compare the different models of care for non-conveyance of prehospital patients in Denmark. Key stakeholders across all five health regions of Denmark provided detailed descriptions and written protocols on all ambulance practices related to non-conveyance. All five health regions in Denmark implement non-conveyance models of care in the prehospital setting. The required prehospital competencies for independent treat-and-release or assess-and-release vary by region. Primarily, ambulance service personnel across all regions must respect patients’ autonomy, but all regions acknowledge the possibility of non-conveyance for suitable patients, usually following consultations between prehospital staff and a physician. For patients with minor injuries that do not require prehospital treatment, emergency medical technicians or paramedics may assess and release them on scene or refer them for alternative transportation. Non-conveyance is applied in practice in emergency medical services protocols in Denmark. Non-conveyance practice is supported from an EMS-administrative perspective by increased educational initiatives and expanded point-of-care testing capabilities. Despite the apparent usefulness of treat-and-release and assess-and-release as concepts, a significant gap remains between legislation and actual practice.