U.S. Metropolitan Municipalities EMS Medical Directors Consortium ( The “Eagles” Coalition)
INTERNATIONAL RESEARCH PERSPEC TIVES
Study examines older adults who repeatedly request EMS transport
By Sean J. Britton, MPA, NRP
Evans CS, Platts-Mills TF, Fernandez AR, et al.
Repeated emergency medical services use
by older adults: Analysis of a comprehensive
statewide database. Ann Emerg Med. May 27,
2017. [Epub ahead of print.]
Have you ever transported the same patient
more than once? The public may assume all
patients requesting 9-1-1 system
response are truly in need of emergency medical care, and very few
would be unfortunate enough to experience repeated life-threatening emergencies within a short time period.
Background: As we know from
firsthand experience, not all patients
require lifesaving interventions, and at
least some of them will utilize EMS
more than once. Kudos to the authors
of this study for performing research
to better understand the factors associated with repeated EMS use among
Methods: The research team reviewed
records entered into North Carolina’s Prehospital Medical Information System (PreMIS)
from 2010 to 2015. Entering data into PreMIS is required by law, therefore all patients
transported by EMS in N.C. during the study
period would have potentially been included.
Researchers focused on emergency/9-1-1
responses where a patient, aged 65 years or older,
was transported to a hospital. This resulted in
1,711,669 EMS transports of 689,664 patients
being included the study.
Results: One key result was, “Among the
689,664 older adults in the study, 20.6%
(141,852 older adults) had a repeated transport within 30 days.” One factor associated with
an increased chance of being transported again
within 30 days was residing within a healthcare
facility vs. a private home (odds ratio, 1. 42; 95%
confidence interval, 1. 38–1. 47), although the
researchers noted the exclusion of interfacility
transfers may have understated this result. Older
adults with dispatch complaints of breathing
problems, back pain and psychiatric issues were
the most likely to have a repeat EMS transport
within 30 days, while those with dispatch complaints of cardiac arrest and traffic accidents
were the least likely.
The researchers also performed an analysis
of the 6,559 older adults who had an encounter with EMS resulting in a patient refusal of
transport. Among this patient population, 1,271
( 19.3%) were transported by EMS to a hospital
within 30 days of the initial transport refusal.
Discussion: This research is incredibly valuable to understanding repeated EMS transports
among older adults since it utilizes a population
within a large and diverse state over a period
of six years. An interesting finding is that the
rates of repeated transport within 30 days are
essentially the same whether the patient initially received or refused transport by EMS.
This research has practical applications
for population health management,
which is increasingly involving participation from EMS. The most frequent reasons identified for repeated
transports—breathing problems, back
pain and psychiatric issues—are all
chronic diseases. A focus within population health is to limit exacerbations
of chronic disease in order to reduce
the clinical and financial burden upon
the healthcare system.
The researchers specifically noted
that mobile integrated healthcare or
community paramedicine referrals for
older adults could be made based on the dispatch complaints associated with higher rates
of repeat EMS transports. JEMS
Sean J. Britton, MPA, NRP, is an EMS practitioner, educator and administrator. He’s a
paramedic with Superior Ambulance Service
in Binghamton, N.Y., a board member of the
Learn more from Sean Britton at the
EMS Today Conference, Feb. 21–23, in
Charlotte, N.C. EMS Today.com
The rates of repeated
transport … are essentially
the same whether the
patient initially received
or refused transport.
What we already know: Geriatric patients
may access EMS repeatedly within a short
period of time.
What this study adds: Understanding
factors behind repeat transports may help
develop and refine innovative approaches to
better managing geriatric healthcare needs.