Conceptualisations of the roles and competencies of ambulance drivers in emergency medical services: A scoping review

Background The ambulance-driving function is essential to safe and timely emergency medical services (EMS). However, competencies associated with ambulance driving remain fragmented and vary across EMS workforce models, in which driving may be performed by dedicated ambulance drivers or incorporated into broader roles such as emergency medical technicians and paramedics. Aim This scoping review aimed to map and synthesise how the roles and competencies associated with ambulance driving are conceptualised across EMS systems. Method The review followed the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, ScienceDirect, GARUDA and Google Scholar were searched. Studies involving ambulance drivers or other prehospital personnel were included when ambulance driving or emergency vehicle operation was explicitly addressed. Data were synthesised using descriptive mapping, thematic synthesis, conceptual framework mapping and gap analysis. Results Nineteen studies published between 2007 and 2026 were included from Europe, Asia, the Middle East and South America. Seven competency domains were identified: technical driving; safety and risk management; cognitive and decision-making; communication and teamwork; stress and emotional management; professional and personal attributes and work ability and fitness. Additional competencies included first aid, basic life support, emergency response and patient-related responsibilities, although these varied across workforce models. Overall, ambulance-driving competency was conceptualised as a multidimensional and context-dependent construct extending beyond vehicle-handling skills to include non-technical skills, human factors and adaptive performance. No comprehensive and standardised competency framework specific to the ambulance-driving function was identified. Conclusions Ambulance driving involves multiple competency domains, while the capability to adapt and apply these competencies is influenced by professional role and EMS context. The seven domains identified provide an evidence-derived conceptual structure rather than a definitive competency framework. Future research should explore how capability, adaptive expertise, human factors and system context can inform competency framework development, education, assessment, workforce development and safety.