CONVERSATIONS ABOUT EMS RESEARCH
NOT ANOTHER LIFT ASSIST!
Are lift assists an early indicator of bigger problems?
By Keith Wesley, MD, FACEP, FAEMS & Karen Wesley, NREMT-P
Leggatt L, Van Aarsen K, Columbus M, et
al. Morbidity and mortality associated with
pre-hospital “Lift-Assist.” Prehosp Emerg Care.
2017; 21( 5):556–562.
This paper comes from our esteemed col-
leagues in London, Ontario, Canada, who
explored the outcome of patients that received
a lift assist by EMS. They defined lift assist as,
“When an individual is assisted up to a more
mobile position from the ground by paramed-
ics, but not treated or brought to hospital for
further medical attention.”
During the 2013 calendar year, their ser-
vice responded to 42,055 EMS calls, of which
804 ( 1.9%) were lift assists for 414 individual
patients. Additionally, 298 (72%) had only
one lift assist, and 116 (28%) had more than
one lift assist.
During the following 14 days, 169 (21%)
lift assist patients visited the ED, resulting
in 93 ( 11.6%) of them being admitted and 9
( 1.1%) dying within 14 days of their lift assist
encounter. Advancing age and failing to obtain
a full set of vital signs significantly predicted
this short-term morbidity and mortality.
They concluded that lift assist calls “may
be an early indicator of problems requiring
comprehensive medical evaluation and thus
further factors associated with poor outcomes
should be determined.”
DOC WESLEY COMMENTS
I congratulate the authors for attacking this
very important issue. I suspect a large number,
if not the majority, of EMS agencies treat lift
assists as a public service, when in fact these
are patients with real medical and social issues
that require attention. If a person is unable to
get off the floor or out of bed to their bedside
commode, there’s something wrong.
As members of public health/safety, it’s
our responsibility to determine if they are safe
enough to be left alone. Failing to do so is
tantamount to neglecting the needs of a vul-
I suspect this service’s numbers are conser-
vative. There could have been lift assists that
were marked as some other provider impres-
sion—or worse, marked as “no patient contact.”
To truly assess the prevalence of lift assists,
services must review all non-transport calls
where a squad has arrived on scene.
Although it makes sense that advanc-
ing age predicts worsening outcomes, I’m
not so sure about the missing vital signs.
This service requires that a tempera-
ture be taken on all patients, and it was
the most commonly missing vital sign.
However, 25% of cases had more than one
missing vital sign. In cases where patients had
diabetes, 27% didn’t include a blood glucose
measurement. Even though a blood glucose
is clearly required, it would be unlikely that a
temperature would have changed the decision
What needs to occur with these patients is
a thorough assessment for illness and injury
along with an assessment of their safety. This
should include demonstration that they can
ambulate and/or transfer at their baseline.
Contacts for social services should be provided and a referral provided if it’s felt they
are at significant risk.
At the end of the call, it should be the
patient’s own decision not to be transported, and that should be supported by
documentation of the patient’s medical capacity to refuse care and that the patient has been
advised of any possible risks that may arise as
a result of refusing transport.
MEDIC WESLEY COMMENTS
Lift Assist calls are a large portion of responses
in EMS. We all have them—and we have a
handful of patients who we visit frequently
to provide this service. We know their life-
styles, their habits, and usually after a response
or two, we have a sense for their aversion to
being transported. The fear of not being
able to return home haunts these vulnerable
patients—and often, the decision to not trans-
port them haunts EMS providers.
This study did an excellent job of highlighting the liability the lift assist call represents.
If, according to the authors, a full set of
vital signs and patient assessment were performed, more patients may have been transported. However, I believe that many of these
patients would still refuse transport and opt to
remain at home. This would change the status of the patient to a refusal, and may clear
some of the liability in cases where there was
increased morbidity and mortality following
the EMS visit.
I can’t speak for Canada, but in the U.S.,
there are many services that could be provided to a patient who has ambulatory issues
or other home care needs. Often, the patient
or family isn’t aware of the services provided
by the county or state.
No matter what the reason, EMS providers are usually the ones in the middle of this
dilemma, and the best insurance for minimizing liability is to always be a patient advocate
and perform a full patient assessment every
time we’re called to a lift assist. JEMS
Keith Wesley, MD, FACEP, FAEMS is the
medical director for HealthEast Medical
Transportation in St. Paul, Minn., and United
EMS in Wisconsin Rapids, Wis. He can be
reached at dr email@example.com.
Karen Wesley, NREMT-P, is a paramedic
and educator for Mayo Clinic Medical Trans-
port and is the medic team leader for
the Eau Claire County (Wis.) Regional
Learn more from Keith Wesley at the
EMS Today Conference, Feb. 21–23, in
Charlotte, N.C. EMS Today.com