Association of Ambulance Chief Executives. Taking healthcare to the patient 2. 2011. https// (accessed 6 December 2023)

Aveyard H. How do I search for literature?, 4th edn. In: Massara T (ed). London: Open University Press; 2019

Brady M. UK Paramedics confidence in identifying child sexual abuse: a mixed-methods investigation. J Child Sex Abus. 2018; 27:(4)439-458

Brown S, Kumar D, James C, Mark J. JRCALC clinical guidelines, 5th edn. Bridgewater: Class Professional Publishing; 2021

Critical Appraisal Skills Programme. Systematic review checklist. 2018. http// (accessed 6 December 2023)

Curtis F, Laparidou D, Whitley GA. Chapter 3: systematic reviews. In: Siriwardena AN, Whitley GA (eds). Bridgwater: Class Professional Publishing; 2022

Fowler J, Beovich B, Williams B. Improving paramedic confidence with paediatric patients: a scoping review. Australasian Journal of Paramedicine. 2017; 15:(1)

Fratta KA, Fishe JN, Schenk E, Anders JF. Emergency medical services clinicians' pediatric destination decision-making: a qualitative study. Cureus. 2021; 13:(8)

Gunnvall K, Augustsson D, Lindström V, Vicente V. Specialist nurses' experiences when caring for preverbal children in pain in the prehospital context in Sweden. Int Emerg Nurs. 2018; 36:39-45

Health and Care Professions Council. New threshold for paramedic registration. 2023. https// (accessed 6 December 2023)

Hetherington J, Jones I. What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?. Br Paramed J. 2021; 6:(1)15-22

Houston R, Pearson GA. Ambulance provision for children: a UK national survey. Emerg Med J. 2010; 27:(8)631-636

Methodology for JBI scoping reviews.Adelaide: Joanna Briggs Institute; 2015

Mooney GP. Conducting a critial literature review in paramedic practice. In: Griffiths P, Mooney GP (eds). Maidenhead: Open University Press; 2012

Murdoch University. PICO/PICo framework. 2023. https// (accessed 6 December 2023)

O'Cathain A, Knowles E, Bishop-Edwards L Understanding variation in ambulance service non-conveyance rates: a mixed methods study.Southampton (UK): NIHR Journals Library; 2018

O'Connor L, Leonard K. Decision making in children and families social work: the practioner's voice. Br J Soc Work. 2014; 7:1805-1822

O'Hara R, Johnson M, Siriwardena AN A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. J Health Serv Res Policy. 2014; 20:45-53

Chapter 11: Scoping Reviews (2020 version). 2020. https// (accessed 29 January 2024)

PRISMA. PRISMA transparent reporting of systematic reviews and meta-analyses. 2020. https// (accessed 6 December 2023)

Ruzangi J, Blair M, Cecil E, Greenfield G, Bottle A, Hargreaves DS, Saxena S. Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017. BMJ Open. 2020; 10:(5)

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008; 8:(45)

Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet. 2010; 375:(9717)834-845

Ward CE, Singletary J, Hatcliffe RE, Colson CD, Simpson JN, Brown KM, Chamberlain JM. Emergency medical services clinicians' perspectives on pediatric non-transport. Prehosp Emerg Care. 2022; 27:(8)993-1003

Whitley GA, Hemingway P, Law GR, Wilson C, Siriwardena AN. Predictors of effective management of acute pain in children within a UK ambulance service: a cross-sectional study. Am J Emerg Med. 2020; 38:(7)1424-1430

Williams DM, Rindal KE, Cushman JT, Shah MN. Barriers to and enablers for prehospital analgesia for pediatric patients. Prehosp Emerg Care. 2012; 16:(4)519-526

Factors that influence child conveyance decisions made by prehospital clinicians

02 February 2024
Volume 16 · Issue 2



The decision to convey children to emergency departments is complex. This study aimed to identify barriers and enablers to making appropriate decisions, along with areas of disparity in this decision-making process by ambulance clinicians.


A rapid evidence review was conducted. MEDLINE, CINAHL and PubMed were searched from 2012 to July 2023. Critical appraisal and thematic synthesis were performed.


Three studies were identified, which highlights the lack of research in this area. Five themes were identified: provision of care; equipment and protocols; exposure, experience and confidence; emotional and social circumstances; and education or skill set.


Enhanced paediatric education is required before and after registration to ensure appropriate conveyance and address clinicians' lack of exposure, experience and confidence. Protocols and guidelines should be drawn up to support decision-making for lower-acuity child patients. Specialist paediatric roles are required in ambulance services to support clinicians and provide advanced patient-centred care.


The findings of this review provide a basis for discussion and clinical practice improvement. Research to determine the clinical and cost effectiveness of implementing prehospital specialist paediatric roles is required.

As the first responders to cases of child trauma or acute illness, prehospital clinicians must have an appropriate knowledge base and the skills and confidence to provide effective and appropriate management (Fowler et al, 2017). Previous studies have noted that ‘management of the prehospital paediatric patient is inherently stressful’ (Fowler et al, 2017), with pre-arrival preparation for such individuals causing ‘extreme anxiety and discomfort for ambulance personnel’ (Houston and Pearson, 2010).

Strict conveyance protocols (Hetherington and Jones, 2021) conflict with both the ambulance services' growing autonomy and the current discourse of hospital avoidance (Hetherington and Jones, 2021), and often result in the unnecessary and avoidable transportation of children.

A cohort study discovered that a significant 15–80% of children visiting accident and emergency departments between 2007 and 2017 presented with conditions that were appropriate for primary care and were discharged with no treatment given (Ruzangi et al, 2020). Nonetheless, it has been recognised that discharging patients at scene is a complex process for prehospital clinicians to undertake and one that is seldom used (O'Hara et al, 2014; O'Cathain et al, 2018).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed