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Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study.

Duncan, Edward; Best, Catherine; Dougall, Nadine; Skar, Silje; Evans, Josie; Corfield, Alasdair; Fitzpatrick, David; Goldie, Isabella; Maxwell, Margaret; Snooks, Helen; Stark, Cameron; White, Chris; Wojcik, Wojtek


Edward Duncan

Catherine Best

Silje Skar

Josie Evans

Alasdair Corfield

David Fitzpatrick

Isabella Goldie

Margaret Maxwell

Helen Snooks

Cameron Stark

Chris White

Wojtek Wojcik


Background: People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental health and self-harm emergencies attended by ambulance services, and subsequent all-cause mortality, including deaths by suicide. This is the first national epidemiological analysis of the processes and outcomes of people attended by an ambulance due to a mental health or self-harm emergency. The study aimed to
describe patient characteristics, volume, case-mix, outcomes and care pathways following ambulance attendance in this patient population.
Methods: A linked data study of Scottish ambulance service, emergency department, acute inpatient and death records for adults aged ≥16 for one full year following index ambulance attendance in 2011.
Results: The ambulance service attended 6802 mental health or self harm coded patients on 9014 occasions. This represents 11% of all calls attended that year. Various pathways resulted from these attendances. Most frequent were those that resulted in transportation to and discharge from the emergency department (n =
4566/9014; 51%). Some patients were left at home (n = 1003/9014 attendances, 11%). Others were admitted to hospital (n = 2043/9014, 23%). Within 12 months of initial attendance, 279 (4%) patients had died, 97 of these were recorded as suicide.
Conclusions: This unique study finds that ambulance service and emergency departments are missing opportunities to provide better care to this population and in potentially avoidable mortality, morbidity and service burden. Developing and testing interventions for this patient group in pre-hospital and emergency department settings could lead to reductions in suicide, patient distress, and service usage

Journal Article Type Article
Acceptance Date Mar 10, 2019
Online Publication Date Mar 20, 2019
Publication Date 2019-03
Deposit Date Mar 25, 2019
Publicly Available Date Mar 25, 2019
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 27
Issue 34
Keywords Mental health, Emergency department, Pre-hospital,
Public URL
Contract Date Mar 25, 2019


Epidemiology of emergency ambulance service calls... (603 Kb)

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© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated

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