Are lift assists an early indicator of bigger problems?
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 colleagues 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 paramedics, but not treated or brought to hospital for further medical attention.”
During the 2013 calendar year, their service 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 vulnerable adult.
I suspect this service’s numbers are conservative. There could have been lift assists that were marked as some other provider impression-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 advancing age predicts worsening outcomes, I’m not so sure about the missing vital signs. This service requires that a temperature 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 of non-transport.
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 lifestyles, 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 transport 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.
Learn more from Keith Wesley at the EMS Today Conference, Feb. 21-23, in Charlotte, N.C. EMSToday.com