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Beyond the Emergency Department, Part 2: What the World Is Already Doing

Alex Aste
Sep 8
18 min read
Around the world, EMS systems are developing additional pathways—including telephone assessment, community-based care, virtual consultation, treatment at the scene, and alternative destinations—while preserving emergency-department access for patients who need it.
Around the world, EMS systems are developing additional pathways—including telephone assessment, community-based care, virtual consultation, treatment at the scene, and alternative destinations—while preserving emergency-department access for patients who need it.

International models of telephone resolution, community paramedicine, virtual emergency care, and non-conveyance—and what the United States can realistically learn from them.


An ambulance can take a patient almost anywhere.


The harder question is whether the healthcare system has built anywhere else for that patient to go.

Part 1 of this series examined why emergency departments have become the default destination for so many patients whose needs may be better addressed elsewhere. It explored community paramedicine, telehealth, alternative destinations, and the structural forces that continue to make the ED the only dependable door.


Part 2 looks beyond the United States.


Healthcare systems in England, Canada, Australia, New Zealand, Sweden, the Netherlands, Germany, and other countries have developed different ways to provide care without automatically transporting every patient to an emergency department.


Some resolve calls by telephone.

Some send specially trained paramedics into patients’ homes.

Some connect field clinicians with emergency physicians by video.

Some allow ambulance clinicians to treat and discharge patients at the scene.

Some refer patients directly to primary care, urgent community services, mental health teams, or other destinations.

Others attempt to prevent the emergency call from occurring in the first place.


These models are worth studying.

They are not, however, interchangeable.


Importing another country’s program without its financing, workforce, legal authority, and receiving network would be like importing a train without the tracks. It may look impressive, but it is unlikely to get anyone where they need to go.


The purpose of international comparison should not be imitation.

It should be informed adaptation.


Compare the Function, Not the Name


The phrase “community paramedicine” is widely used in the United States and Canada, but other countries may perform similar functions without using that label.


A 2026 international scoping review identified five broad categories of alternative care pathways:

Hear and treat: A clinician assesses the patient by telephone or video and provides advice or treatment without an ambulance response.


Hear and refer: The call is clinically assessed and directed to another service, such as primary care, mental health, pharmacy, or an urgent community team.

See and treat: An ambulance clinician assesses and treats the patient at the scene without transportation.

See and refer: The clinician evaluates the patient in person and arranges follow-up with another healthcare service.

See and convey elsewhere: The patient is transported, but the destination is somewhere other than an emergency department.


A 2026 international scoping review organized alternative-care pathways into five functions: hear and treat, hear and refer, see and treat, see and refer, and convey to a suitable non-ED destination.
A 2026 international scoping review organized alternative-care pathways into five functions: hear and treat, hear and refer, see and treat, see and refer, and convey to a suitable non-ED destination.


Community paramedicine adds another important category: proactive care delivered before a 911 or equivalent emergency call occurs.

That may include scheduled home visits, chronic-disease monitoring, fall-risk assessments, medication support, post-discharge follow-up, connections to social services, and care for patients waiting for long-term-care placement.


The distinctions matter.


A telephone advice line is not the same as an advanced paramedic assessing a patient in the home. A referral is not the same as confirmed acceptance by another provider. Treatment at the scene is not the same as leaving a patient without a plan.


Most importantly, “low acuity” should describe a conclusion reached after an appropriate assessment. It should not become a dismissive label applied to a caller before the patient’s actual needs are understood.


England: Building a Menu of Pathways


England provides one of the most developed examples of an ambulance system moving beyond automatic transportation.


This development did not begin with a single national announcement.

It evolved through extended-care roles, paramedic-practitioner programs, clinical telephone assessment, referral pathways, urgent community services, and greater integration between ambulance trusts and the rest of the National Health Service.


Early Paramedic-Practitioner Programs


In the early 2000s, England began developing paramedic-practitioner roles for patients with minor illnesses and injuries.


These clinicians received additional education in assessment, treatment, and discharge. The intention was to give selected patients safe care in the community instead of making emergency-department transportation the only available option.


A 2007 cluster-randomized trial included 3,018 patients over the age of 60 who called 999 with minor acute conditions.

Patients in the paramedic-practitioner group were less likely to attend an emergency department or require hospital admission within 28 days. They experienced shorter overall episodes of care and reported greater satisfaction. The study found no significant difference in 28-day mortality.


The trial did not prove that every paramedic should independently discharge every older patient.

It demonstrated that appropriately selected patients could be managed differently when the system invested in advanced education, defined clinical authority, and a structured model of care.


From Pilot Programs to Routine Dispositions


England now reports ambulance incidents using dispositions that include:

Hear and treat.

See and treat.

Conveyance to an emergency department.

Conveyance to another destination.


In May 2026, NHS England reported that 19.5% of ambulance incidents were closed by telephone through hear-and-treat processes. Another 28.8% were closed at the scene, 47.2% resulted in conveyance to an emergency department, and 4.4% resulted in conveyance elsewhere.


Percentages are affected by rounding. These figures describe system dispositions, not a claim that every non-ED outcome represented a preventable ED visit. NHS England Ambulance Quality Indicators, May 2026


The importance of these data is not that England has discovered a perfect percentage.

It is that the system recognizes several legitimate outcomes after an emergency call.

Transportation to the ED remains available.

It is simply not the only outcome the system is designed to produce.


England formally recognizes several potential outcomes following an ambulance-system contact: clinical resolution by telephone, treatment at the scene, transportation to an emergency department, or transportation to another appropriate destination.
England formally recognizes several potential outcomes following an ambulance-system contact: clinical resolution by telephone, treatment at the scene, transportation to an emergency department, or transportation to another appropriate destination.

Single Points of Access and Urgent Community Response


England has also developed single points of access through which ambulance services, primary care, hospitals, community providers, and social-care partners can coordinate urgent referrals.

The NHS England single-point-of-access model is designed to connect patients with services such as urgent community response, frailty teams, virtual wards, and other community resources.


Urgent community response teams can provide urgent care in patients’ homes, including assessment and treatment intended to prevent avoidable admission or support recovery outside the hospital.


The transferable lesson is not simply that English paramedics have more options.

It is that those options are connected to receiving services.

A paramedic cannot refer a patient to capacity that does not exist. A referral to a closed clinic or an unanswered voicemail is not an alternative care pathway.

It is a scavenger hunt with a stethoscope.


Canada: Preventing the Call Before It Happens


Canada has been especially influential in the development of community paramedicine.

According to an Institute of Health Economics review, community-paramedicine programs began developing in Nova Scotia in 2003 and 2004. In 2005, representatives from Australia, Canada, Scotland, and the United States met in Halifax to discuss how expanded paramedic roles could address isolated older populations, rural healthcare gaps, and overstretched services.

That history helps explain an important feature of the Canadian model.


Community paramedicine is frequently proactive.

Rather than waiting for a patient to call 911 and then deciding whether the ED is necessary, many programs attempt to identify and address health risks earlier.


Community Paramedicine at Clinic


Community Paramedicine at Clinic, or CP@clinic, uses specially trained paramedics to provide scheduled health-promotion and disease-prevention services in subsidized senior housing.

Services may include:

Blood-pressure assessment.

Diabetes-risk assessment.

Fall-risk screening.

Health education.

Referral to primary and community care.

Communication with the patient’s physician.


A 2018 cluster-randomized trial involving six subsidized-housing buildings found fewer building-level ambulance calls in the intervention locations. Participating residents also demonstrated improvements in blood pressure, usual activities, and measured quality of life.

Those findings were encouraging.


A later and larger trial provided a more complicated picture.

A 2024 cluster-randomized trial evaluated 3,695 residents across 30 social-housing buildings in Ontario. It did not find a statistically significant difference in ambulance ED visits between the intervention and control groups.


However, participation in CP@clinic was associated with more primary-care visits, greater access to home care, and lower odds of transfer to long-term care.

These findings should not be forced into a simple success-or-failure headline.

The larger trial did not demonstrate that the program reduced ambulance ED visits.


It did suggest that the program improved connections to other parts of the healthcare system and may have supported some older adults in remaining in the community.

That distinction is important because community paramedicine should not be judged only by how many ED visits it prevents.


A program may create value by identifying hypertension, improving medication access, connecting an isolated patient with primary care, supporting aging at home, or recognizing deterioration before it becomes an emergency.


Ontario’s Long-Term-Care Model


Ontario has expanded Community Paramedicine for Long-Term Care across all 55 certified land-paramedic service areas. The program serves people waiting for long-term care or those who may soon become eligible.


The province describes services that include 24-hour access to non-emergency medical support, routine diagnostic procedures, treatment in the home, and remote care. Ontario Ministry of Long-Term Care


The Canadian lesson is straightforward:

Sometimes the most effective alternative to the emergency department is not a different destination after the ambulance arrives.

It is providing enough support that the emergency call never becomes necessary.


Canadian community-paramedicine programs demonstrate the value of proactive care through screening, chronic-disease support, connection to primary and home care, and planned follow-up. Evidence regarding reductions in ambulance and ED use remains mixed, reinforcing the need to measure broader patient and system outcomes.
Canadian community-paramedicine programs demonstrate the value of proactive care through screening, chronic-disease support, connection to primary and home care, and planned follow-up. Evidence regarding reductions in ambulance and ED use remains mixed, reinforcing the need to measure broader patient and system outcomes.

Australia: Bringing the Emergency Department to the Patient


Australia offers a particularly useful example of virtual care being integrated with ambulance operations.

The Virtual Emergency Department in Victoria began as a pilot at Northern Hospital in October 2020. It was initially developed in response to COVID-19, pressure on physical emergency departments, and the need to assess more patients safely at home. Virtual Emergency Department history


The service has since expanded statewide.

It now provides free, 24-hour video access to emergency physicians and nurses from anywhere in Victoria. Patients can access the service directly, while ambulance clinicians, urgent-care providers, and aged-care facilities can also submit referrals. Virtual Emergency Department

This is not simply a video call added to the side of the healthcare system.


Ambulance Victoria can connect patients with emergency clinicians who assess the patient, provide medical advice, initiate treatment, and arrange referrals to general practitioners, residential in-reach teams, or other services.


Video-Assisted Secondary Triage


Ambulance Victoria has also incorporated video into secondary triage.

During 2024–25, 35,092 cases managed by its triage services used Video Assisted Triage. Of those, 22,122 cases, or 63%, were diverted from emergency ambulance resources and referred to alternative services. Ambulance Victoria Annual Report 2024–25

The wording matters.


Those cases were diverted from emergency ambulance resources.

That statistic should not be reinterpreted as 22,122 proven ED visits prevented. Some patients may still have required in-person evaluation, private transportation, primary care, urgent care, or later escalation.


Even with that caution, the result demonstrates the potential value of allowing clinicians to see the patient rather than relying exclusively on a telephone description.

Video can provide additional information about:

The patient’s appearance.

Work of breathing.

Mobility.

Skin signs.

The home environment.

Medication containers.

Caregiver support.

Potential safety concerns.

It does not replace a complete physical examination.


It can, however, improve the information available to the clinician deciding what should happen next.

The Australian lesson is that telehealth becomes more valuable when it is embedded in emergency operations and connected to real services.


A tablet alone is not a care model.

The clinical authority, referral network, follow-up process, and ability to escalate care are what make the technology useful.


New Zealand: A Public Front Door for Uncertain Patients


New Zealand demonstrates another function: helping patients decide what kind of care they need before they activate the emergency system.


Healthline is a free service available 24 hours a day, seven days a week. Experienced nurses and paramedics provide telephone advice, help patients determine what to do next, and direct them toward self-care, general practitioners, pharmacies, after-hours services, hospitals, or other resources. Patients can also share images or video from a mobile device. Health New Zealand Healthline


Healthline is not a replacement for New Zealand’s 111 emergency number.

It is a parallel front door for people who are worried, uncertain, unable to reach a general practitioner, or unsure whether their condition requires emergency care.

That distinction is valuable.


The United States often asks dispatch centers and field clinicians to solve a problem that begins earlier: many people simply do not know whom else to call.

A healthcare system cannot criticize patients for choosing the wrong door if it has not made the other doors visible, understandable, and reliably available.


Victoria integrates video consultation into ambulance and secondary-triage workflows, while New Zealand’s Healthline offers free, 24-hour guidance from nurses and paramedics. Both create additional entry points without replacing emergency response when in-person care is required.
Victoria integrates video consultation into ambulance and secondary-triage workflows, while New Zealand’s Healthline offers free, 24-hour guidance from nurses and paramedics. Both create additional entry points without replacing emergency response when in-person care is required.

Sweden: Non-Conveyance as a Clinical Disposition


In some Swedish regions, non-conveyance is treated as a clinical disposition rather than being documented primarily as a patient refusal.

Ambulance clinicians may assess the patient, apply regional criteria, and recommend:

Self-care.

Primary care.

Emergency-department evaluation using transportation other than an ambulance.

Ambulance conveyance when required.


In one prospective Swedish study, patients who were not conveyed received written information about the assessment, the recommended next level of care, and what to do if their condition worsened. Regional criteria included symptoms, vital signs, triage level, and clinical judgment. Outcomes in patients not conveyed by EMS

This is conceptually different from saying:

“You refused transportation. Sign here.”

A structured non-conveyance process recognizes that remaining at home, seeking primary care, or reaching an ED by another method may be an intentional clinical plan.

It also recognizes that the decision carries risk.


A 2024 study examined 837 non-conveyed trauma patients in southwestern Sweden. Approximately three out of four did not seek additional medical care within 72 hours. Patients who were subsequently admitted were more likely to be older, to have fallen, and to have relevant medical histories. The study reported mortality below 1%, but it did not evaluate every possible morbidity or long-term outcome. Swedish non-conveyed trauma study


The lesson is not that most fall patients should remain home.

The lesson is that age, frailty, comorbidity, anticoagulant use, the cause of the fall, and the reliability of follow-up must influence the decision.

The injury may be minor.

The reason the patient fell may not be.

The Netherlands: Measure What Happens Next

The Netherlands also uses non-conveyance as a meaningful part of ambulance care.


A 2025 retrospective study examined 13,879 non-conveyance cases in one Dutch EMS region. Of those, 585, or 4.2%, had another ambulance contact within 72 hours. Dutch ambulance recontact study


The investigators made an important point: the recontact percentage alone has limited value.

A patient may call again because the original problem worsened.

The patient may develop a new and unrelated problem.

The initial disposition may have been appropriate, but the patient may have been unable to access the recommended service.

A planned safety-net instruction may have correctly told the patient to call again if symptoms changed.

Or the first assessment may have missed something important.

Those situations should not be treated as equivalent.

Recontact is an important safety signal.

It is not automatically proof of failure.

This is one of the most useful lessons for American programs. It is not enough to count non-transports or avoided ED visits. Systems need linked follow-up that helps explain what occurred afterward.


Did the patient reach the referred service?

Was treatment completed?

Did the patient call 911 again?

Was the patient hospitalized?

Was a diagnosis delayed?

Did the patient experience harm?


Without those answers, a high non-conveyance rate may reflect innovation, inadequate access, unsafe triage, or some combination of all three.


Germany: A Separate Door Does Not Eliminate the Challenge


Germany maintains separate access points for emergency and urgent non-emergency care.

The 112 number is intended for life-threatening emergencies or situations involving the risk of permanent injury.


The national 116117 patient service is available 24 hours a day for non-life-threatening medical needs, particularly when regular practices are closed. It can provide guidance, identify an on-call practice, connect the caller with a physician, or arrange a home visit when appropriate. Germany’s 116117 patient service


This creates a clearer alternative for patients who know which number to call.

It does not completely solve the problem of redirecting patients who have already entered the emergency pathway.


A 2025 multicenter study in Berlin examined 358 patients transported by EMS who ultimately received ambulatory treatment in an emergency department.

EMS clinicians considered 37% of the patients potentially treatable in primary care.

Meanwhile, 44.5% of the patients said they would have been open to primary-care management.

Those groups did not consistently include the same people.


When both patient acceptance and EMS assessment were considered, only 24.4% of cases met the study’s criteria for potentially realistic diversion. Agreement between the patient and clinician assessments was low, and the investigators noted that no validated prehospital system could reliably identify every patient appropriate for safe redirection.


That finding provides a necessary counterweight to overly optimistic estimates.

A patient may be clinically suitable but unwilling to accept another destination.

A patient may prefer primary care while the paramedic remains concerned about an undifferentiated symptom.

The nearest clinic may be appropriate on paper but unable to accept the patient.

A destination may be open when the program is announced and unavailable when the patient actually needs it.


Redirection is not simply a clinical decision.

It is a clinical, operational, legal, logistical, and human decision.


What the International Models Show

System

Primary mechanism

Major strength

Important caution

England

Hear and treat, see and treat, urgent community response, and alternative conveyance

Multiple formal dispositions connected to a national health system

Community capacity and access can vary locally

Canada

Proactive community paramedicine in homes, social housing, and long-term-care populations

Addresses health risks before they become 911 calls

Effects on ambulance use and ED utilization are mixed across studies

Victoria, Australia

Video-assisted triage and a statewide virtual emergency department

Real-time access to emergency clinicians and referral options

Diversion from an emergency ambulance does not automatically equal an avoided ED visit

New Zealand

A national telephone advice service staffed by nurses and paramedics

Gives uncertain patients a visible alternative entry point

A parallel advice line does not replace emergency assessment

Sweden and the Netherlands

Clinician-directed non-conveyance, self-care, or referral

Treats non-conveyance as a clinical disposition and tracks subsequent care

Under-triage, older patients, falls, and vague symptoms require particular caution

Germany

Separate emergency and medical on-call access, with proposed primary-care redirection

Gives the public another route for same-day medical help

Patient preference, clinician judgment, and primary-care capacity may not align

The table shows a shared direction, not a shared model.


Each system is attempting to answer the same question:

How can we provide emergency access without making emergency-department transportation the automatic response to every unscheduled healthcare need?

The answer depends heavily on local conditions.


Seven Differences That Determine Whether a Model Transfers


  1. Where the patient enters the system

Some models begin when the patient calls an advice line.

Others begin during emergency dispatch.

Others require an ambulance clinician to evaluate the patient in person.

Community-paramedicine programs may begin days or weeks before an emergency occurs.

Moving the decision earlier may preserve more resources, but it also means that clinicians have less physical information about the patient.


  1. Who makes the decision

The decision-maker may be:

A nurse.

A paramedic.

An advanced or specialist paramedic.

A physician.

A multidisciplinary team.

A computer-supported triage process.

Different countries educate and regulate these professionals differently. A model built around specialist ambulance nurses or advanced paramedics cannot be copied into a system without comparable education, clinical governance, and legal authority.


  1. Who pays for the care

Publicly funded systems may be able to transfer cost and responsibility between ambulance, hospital, primary-care, and community services more easily than fragmented systems.

In the United States, the organization paying for a community-paramedicine visit may not be the organization receiving the financial benefit from an avoided hospitalization.

If payment rewards transportation while community treatment remains unpaid, the system should not be surprised when transportation remains the dominant service.

Financial design is clinical design.


  1. Whether an alternative service can actually receive the patient

A safe referral requires more than a telephone number.

The receiving service must:

Be open.

Have capacity.

Know why the patient is being referred.

Accept responsibility.

Receive relevant clinical information.

Communicate the outcome.

Provide a clear escalation pathway.

Without those components, “refer elsewhere” may become “leave the patient to solve it.”


  1. How liability and clinical governance are structured

Clinicians need clear protocols, consultation support, medical oversight, documentation standards, education, and a fair quality-review process.

They also need permission to use judgment.

If every non-conveyance decision creates fear of punishment, clinicians will understandably choose the legally familiar destination.

That destination will usually be the ED.


  1. Whether the data follow the patient

Ambulance services often know that a referral was placed.

They may not know whether the patient received care.

A mature system should connect ambulance, primary-care, hospital, telehealth, and community data sufficiently to evaluate outcomes while respecting privacy requirements.

Without closed-loop information, the system measures activity instead of care.


  1. Whether the pathway is equitable

Virtual care may fail patients without internet access, devices, digital confidence, privacy, language support, or a safe home environment.

Self-care instructions may be unrealistic for someone who is unhoused, cognitively impaired, socially isolated, or unable to purchase medication.

A clinic referral is not useful if the patient lacks transportation.

A model can reduce average utilization while making access worse for the people with the greatest needs.


Equity must be designed into the pathway, not added after implementation.


International programs succeed when the patient is supported by an interconnected system of clinical assessment, field care, virtual consultation, primary care, community services, social support, and emergency care—not through redirection alone.
International programs succeed when the patient is supported by an interconnected system of clinical assessment, field care, virtual consultation, primary care, community services, social support, and emergency care—not through redirection alone.

What Should the United States Borrow?


The United States should not attempt to reproduce another country’s system in full.

It should borrow the functions that address specific local gaps.


From England:

Create a formal menu of ambulance dispositions rather than treating transport and refusal as the only meaningful outcomes.

Develop single access points through which field clinicians can reach urgent community, frailty, behavioral-health, and other services.


From Canada:

Invest in proactive care for patients with chronic disease, mobility limitations, repeated emergency use, or risk of institutionalization.

Measure access, prevention, and patient stability—not only ED avoidance.


From Australia:

Embed telehealth clinicians directly into dispatch and field workflows.

Use video when it materially improves assessment, but preserve a low threshold for in-person care when needed.


From New Zealand and Germany:

Give the public a well-known, dependable source of clinical advice for urgent but non-life-threatening concerns.

Teach people when and how to use it.


From Sweden and the Netherlands:

Treat non-conveyance as a clinical disposition requiring assessment, documentation, safety-net instructions, referral, and outcome monitoring.

Do not hide it inside refusal statistics.


From every country:

Build the receiving network before increasing redirection targets.

Track what happens to the patient after the ambulance leaves.


The Evidence Still Requires Humility


International experience supports the potential of alternative care pathways.

It does not support careless expansion.


A 2021 scoping review of 41 studies found evidence of potential improvements in patient-centered care and operational efficiency. It also identified recurring concerns involving incorrect triage, inadequate training, weak partnerships, and insufficient measurement of patient-safety outcomes.

The more recent 2026 international review found growing use of hear-and-treat, referral, treatment at the scene, and alternative-destination models.


The evidence base is expanding.

It remains heterogeneous.

Programs serve different populations, use different clinicians, apply different definitions, and measure different outcomes. A reduction in ED transportation in one system cannot automatically be reproduced in another.


Even within the same country, a pathway that works in a dense city with extensive community services may not work in a rural community with long travel distances and limited primary-care capacity.


The appropriate conclusion is not that alternatives are unsafe.

It is that safety must be demonstrated, monitored, and continuously improved.


The Most Important International Lesson


No country has solved the problem simply by telling ambulance clinicians to transport fewer people.

The stronger systems changed more than the ambulance.


They changed:

How calls are assessed.

Who can provide care.

Where patients can be referred.

How community services receive patients.

How clinicians communicate.

How care is funded.

How patients are followed.

How outcomes are measured.

That is the central international lesson.

Redirection is not an ambulance project.

It is a healthcare-system project.


The destination decision may happen in a dispatch center, an ambulance, or a patient’s living room.

But the safety of that decision depends on everything the healthcare system has built around it.


Coming in Part 3


Part 1 examined why the emergency department remains the default destination.


Part 2 examined what other countries are doing differently.


Part 3 will focus on implementation.


It will present a practical framework for building a safe alternative-care system, including:

Governance and medical oversight.

Patient inclusion and exclusion criteria.

Clinical education and competency.

Telehealth integration.

Receiving-service agreements.

Payment and reimbursement.

Documentation and data exchange.

Equity protections.

Safety-net instructions.

Outcome measures and a practical performance scorecard.


The objective will not be to create the highest possible non-conveyance rate.

The objective will be to create a system in which the right patient can receive the right care, in the right place, at the right time—with a dependable way back into emergency care when needed.


A Call to Action


If you lead an EMS agency, health system, fire department, government program, or payer, begin with three questions:

Which patients are repeatedly entering emergency care because another service is unavailable?

Which alternative services already exist but remain disconnected from EMS?

What information would you need to prove that a new pathway is safe, equitable, and valuable?

Do not begin by selecting a diversion target.


Begin by mapping the patient journey.


Astera Global Solutions works with EMS and healthcare organizations in the United States and internationally to evaluate clinical pathways, community-paramedicine programs, telehealth integration, quality measures, education, governance, and system performance.

If your organization is developing an alternative-destination, community-paramedicine, nurse-navigation, telehealth, or non-conveyance program, we welcome the opportunity to continue the conversation.



What international model offers the most useful lesson for your community—and what would need to change before it could work safely where you are?


References


Agarwal, G., et al. Community Paramedicine Program in Social Housing and Health Service Utilization: A Cluster Randomized Clinical Trial. JAMA Network Open, 2024.https://pubmed.ncbi.nlm.nih.gov/39466243/

Agarwal, G., et al. Evaluation of a Community Paramedicine Health Promotion and Lifestyle Risk Assessment Program for Older Adults Who Live in Social Housing. CMAJ, 2018.https://pubmed.ncbi.nlm.nih.gov/29807936/

Ambulance Victoria. Right Care, Right Patient, Right Time. Annual Report 2024–25.https://www.ambulance.vic.gov.au/annual-report-2024-25/right-care-right-patient-right-time

Blodgett, J. M., et al. Alternatives to Direct Emergency Department Conveyance of Ambulance Patients: A Scoping Review of the Evidence. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2021.https://link.springer.com/article/10.1186/s13049-020-00821-x

de Loor, S. E., et al. An Analysis of Ambulance Recontacts After Non-Conveyance. International Journal of Emergency Medicine, 2025.https://pubmed.ncbi.nlm.nih.gov/39893492/

Government of Ontario. Ontario Investing $89 Million to Help People Age Safely at Home, 2025.https://news.ontario.ca/en/release/1006273/ontario-investing-89-million-to-help-people-age-safely-at-home

Guo, B., et al. Community Paramedicine: Program Characteristics and Evaluation. Institute of Health Economics, 2017.https://www.ncbi.nlm.nih.gov/books/NBK549088/

Holzinger, F., et al. Could Low-Acuity Emergency Medical Services Patients Be Redirected to Primary Care? Findings From a Multicenter Survey in Berlin, Germany. BMC Emergency Medicine, 2025.https://pubmed.ncbi.nlm.nih.gov/40739617/

Larsson, G., et al. The Non-Conveyance of Trauma Patients in Swedish Emergency Medical Services. BMC Emergency Medicine, 2024.https://link.springer.com/article/10.1186/s12873-024-00952-9

Mason, S., et al. Effectiveness of Paramedic Practitioners in Attending 999 Calls From Elderly People in the Community. BMJ, 2007.https://pubmed.ncbi.nlm.nih.gov/17916813/

Nadarajan, G. D., et al. Scoping Review on Alternative Care Options for Patients Calling the Ambulance. BMC Emergency Medicine, 2026.https://link.springer.com/article/10.1186/s12873-026-01672-y

NHS England. Urgent Community Response and Ambulance Referral Resource.https://www.england.nhs.uk/long-read/urgent-community-response-and-ambulance-referral-resource/

Northern Health. Virtual Emergency Department.https://ved.vic.gov.au/

Kassenärztliche Bundesvereinigung. Dial 116117 for Medical Help.https://www.116117.de/de/englisch.php

 
 
 

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