Background Ambulance clinicians increasingly refer patients to self-care, positioning the ambulance service within a complex gatekeeping role. Clinicians must assess whether self-care is a safe option or if further support is needed. Unlike referrals to primary healthcare centers (PHCs), structured follow-up after self-care referrals is often lacking, and the consequences of these decisions remain largely unexplored. This study investigates outcomes and predictors of subsequent healthcare contact and mortality among patients referred to self-care by ambulance services in three Swedish regions. Methods We conducted a retrospective cohort study of 6,496 ambulance assignments in 2023 that resulted in self-care referrals (970 children, 5,526 adults). The primary outcome was subsequent healthcare contact (including recontact, PHC visits, new ambulance calls, emergency department visits, and hospitalizations) and all-cause mortality within 72 hours and 30 days. Bayesian multilevel logistic regression models were used to estimate the probability of recontact and mortality. Results Of the 6,496 self-care referrals, 30% resulted in subsequent healthcare contact (adults: 29,2%; children: 23,7%), most commonly to PHCs (adults: 55,8%; children: 60,3%). Observed mortality was 0,9% within 72 hours and 2,9% within 30 days (adults: 0,9%, 2,9%; children: 0%). Among children, respiratory, infectious, and general medical symptoms were most common; among adults medical, surgical, and neurological symptoms dominated. Predictors of recontact included older age, longer on-scene time, use of Advisory decision support system (ADSS), and distance to hospital. The strongest predictor was the type of complaint, with orthopedic cases showing the highest recontact rates. Conclusion Nearly one-third (30%) of patients sought additional care within 72 hours of a self-care referral. While this does not necessarily indicate negative outcomes, the lack information follow-up and patient-reported data limits interpretation. Future research should explore patients’ perspectives to better understand re-attendance and improve the safety of self-care referrals.