• Sarah Purdy, Matthew Booker, and Ali Rg Shaw.
• University of Bristol, Bristol, UK.
• Emerg Med J. 2015 Jun 1;32(6):503.

BackgroundMembers of the public are increasingly turning to ambulance services for help with urgent problems that could successfully be managed in primary care. The reasons for this are complex, and it is unclear whether variation exists across different global settings and between ambulance systems.MethodsA systematic mapping review is a type of systematic literature review used to summarise diverse and heterogeneous evidence, with the aim of focusing a more in-depth study. We conducted a comprehensive search of published and grey literature, in accordance with a prospectively published protocol. Inclusion criteria were any study from 1980 onwards that explored ambulance use for conditions amenable to primary care management. Perspectives of patients, families, carers, bystanders, health professionals (pre-hospital, in-hospital and primary care) and health service management were included. The 'Phenomena of Interest' (P-C) model underpinned the approach, therefore qualitative, quantitative, mixed-methods and interpretative reviews were all included as relevant. A total of 31 studies met inclusion criteria.ResultsWe developed a literature map summarising the evidence under five broad categories. Ambulance use for 'primary care problems' appears associated with individual patient-factors, including personal anxieties and risk management strategies, level of health education, and several socio-demographic factors. The link with specific clinical conditions is weaker. Bystanders, carers and family members consistently exhibit strong influence on decision making across the variety of global pre-hospital systems. Health professionals determine 'inappropriate' ambulance use in inconsistent ways.ConclusionThere is evidence to suggest socioeconomic and demographic characteristics traditionally associated with minority status and deprivation are associated with ambulance use for primary care problems. The role of formal and informal care-givers in influencing risk management warrants deeper exploration. There is a lack of consensus in the literature on what defines 'inappropriate' ambulance use, and from who's perspective this should be determined. Further work needs to explore these conflicts.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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