Multi-occupancy transport

Multi-occupancy transport refers to the practice of conveying one or more patients in the same vehicle.  This was common practice amongst Ambulance Services prior to demarcation of resources into Paramedic and Patient Transport Services (PTS) in the 1980’s.  Since then it has become increasingly accepted that Paramedic Emergency Service (PES) resources should convey via solo occupancy because of the perceived acuity of 999 patients and urgent healthcare professional admissions.  There is a paucity of evidence evaluating the clinical safety of this practice, as it is largely based upon a combination of individual risk assessment and organisational policy. 

We know that multi-occupancy transport continues to be used by PES resources in certain situations and based upon individual risk assessments e.g. multiple patients with minor injuries at a road traffic accident. 

Multi-occupancy transport can be seen to offer a range of benefits to the Ambulance Services and receiving units through more efficient use of resources and better management of system capacity.  However, selection of patients for such transport is often fraught with inconsistency, with decisions by healthcare professionals on the level of Ambulance and skill mix often being based upon perceived risks, habitual behaviours and legacy practices.  This has resulted in some patients waiting for a PES resource where there actual clinical needs during transport could easily have been met by a non-emergency or PTS resource. 

NWAS and the Liverpool Heart & Chest Hospital started a collaborative piece of work in 2012 to promote the use of multi-occupancy transport for suitable non-emergency cardiac in-patients at sending units.  This included establishing consistent multi-occupancy transport screening criteria, booking processes within NWAS Emergency Operations Centres and consistent practice across operational Ambulance staff for these patients.  The process aimed to reduce unnecessary PES transfer of these patients and to assess the clinical safety of multi-occupancy transport for this patient group. 

An evaluation at three years across 3172 patients showed that multi-occupancy transport can be safely used for this patient group providing adequate patient screening processes are in place.  This has highlighted potential for greater efficiency and utility of non-PES transport.

The evaluation has been published in the Journal of Paramedic Practice: (Scholes et al., 2016)

SCHOLES, S., TUNN, E., NEWTON, M., and RATCLIFFE, D., 2016. Stay on the ambulance long enough and you’ll go full circle: an evaluation of the clinical safety and effectiveness of non-emergency and multi-occupancy ambulance conveyance in non-emergency percutaneous coronary intervention patients. Journal of Paramedic Practice. 8 (12), pp. 578–587.