PP15 The experiences of homeless individuals accessing healthcare through ambulance services: a narrative literature review

<h3>Background</h3> Homeless individuals are some of the most vulnerable in society and have a higher burden of illness compared to non-homeless groups. Barriers exist to obtaining optimal care from healthcare providers and overall experiences are often negative. This may lead to worse outcomes and contribute to higher rates of morbidity and mortality. The experiences of homeless individuals accessing healthcare through ambulance services is hitherto underexplored. This study aims to investigate why homeless individuals access healthcare through ambulance services and identify the lived experience of both homeless populations and paramedics. Objectives include exploring any barriers and enablers that exist for homeless individuals to receive optimal care and for paramedics to deliver the best care. <h3>Methods</h3> PRISMA reporting methodology was utilised to undertake a systematic search for available literature relating to homeless populations and EMS. The quality of literature was assessed using CASP checklists before thematic synthesis was undertaken. <h3>Results</h3> Twenty-three studies were included for further synthesis and discussion. Six themes were identified including the frequency and clinical characteristics of homeless patients, why homeless individuals access or do not access healthcare through ambulance services and the experiences of homeless individuals and paramedics. <h3>Conclusion</h3> Evidence relating to homeless individuals accessing healthcare through ambulance services is limited. Quantitative studies provide an insight into the frequency and clinical characteristics of care needs. Homeless individuals use ambulance services comparatively more frequently than non-homeless which likely relates to a disproportionate burden of chronic illness rather than homelessness itself. Studies relating to experiences, barriers, and enablers are lacking. Further research is required in relation to this subject. Priority should particularly be given to qualitative studies that seek to understand the lived experiences of homeless individuals. Limitations exist including, the study being undertaken by a single reviewer, variability of paramedic roles internationally, and different definitions of homelessness.