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Ambulance services in sparsely populated circumpolar regions operate over large distances with limited access to alternative care, potentially expanding their role beyond transport to assessment, decision-making, and healthcare navigation. In such settings, conveyance decisions involving children and young people (CYP) may be complex for ambulance clinicians. This retrospective study examined factors associated with non-conveyance and subsequent healthcare contacts among CYP assessed by ambulance clinicians in northern Sweden and compared characteristics of conveyed and non-conveyed patients. Assessments of patients aged 0–17 during 2020–2023 were included. Logistic regression identified factors associated with non-conveyance, and unscheduled healthcare contacts within 72 hours were examined. Non-conveyance occurred in 39% of assignments. Non-conveyed patients were younger and more often assessed for respiratory conditions and infections, whereas conveyed patients more commonly presented with trauma and neurological conditions. Younger age, assignments outside office hours, and rural location were associated with non-conveyance. One quarter of non-conveyed patients had an unscheduled healthcare contact within 72 hours. The findings suggest that non-conveyance is part of a broader healthcare pathway rather than solely the end of an ambulance assignment. Child-specific guidance for assessment, referral, and follow-up, alongside strengthened decision support for ambulance clinicians, may contribute to safe non-conveyance decision-making in remote regions.