Columns, Mobile Integrated Healthcare

Older Adults Who Repeatedly Request EMS Transport

Issue 10 and Volume 42.

Frequent Flyers

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 geriatric patients.

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.

Bottom Line

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.