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Joiner A, Fernandez AR, Van Vleet L, Cabañas JG, Grover J, Godfrey A, Crowe R, Staton C, Pavon J. Predictors of Non-Transport for Older Adult EMS Patients Encountered for Falls. PREHOSP EMERG CARE 2022; 27:859-865. [PMID: 36251394 DOI: 10.1080/10903127.2022.2137744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Emergency medical services (EMS) encounters for falls among older adults have been linked to poor outcomes when the patient is not transported by EMS to a hospital. However, little is known regarding characteristics of this patient population. Our primary objective was to describe characteristics associated with non-transport among older adult EMS patients encountered for falls. METHODS We performed a national retrospective cross-sectional study of 9-1-1 patient contacts from the 2019 ESO Data Collaborative. We included patients who had 9-1-1 encounters for ground-level falls and were aged 60 years or older. Patients residing in congregate living facilities, interfacility transports, cardiac arrests, and suspected drowning patients were excluded. Potential predictors of non-transport included patient demographics, initial vital signs, who requested 9-1-1 service, incident location, alcohol/substance use, and urbanicity. We used multivariable logistic regression to determine associations between non-transport and potential predictors. RESULTS We identified 195,204 EMS encounters for older adults who fell in 2019, including 27,563 (14.1%) non-transports. Most patients were female (62.4%), non-Hispanic White (85.4%), and fell at a home or residence (80.4%). Greater odds of non-transport were identified among males (OR 1.37, 95% CI 1.32-1.42) and Hispanic/Latino patients (OR 1.24, 95% CI 1.14-1.35). Older age was associated with greater odds of non-transport compared to patients aged 60-69 years (70-79 [OR 1.42, 95% CI 1.35-1.49], 80-89 [OR 1.51, 95% CI 1.42-1.59], ≥90 [OR 1.45, 95% CI 1.35-1.55]). Patients residing in Census tracts with larger percentages of the population living in poverty had lower odds of non-transport compared to those in areas with ≤5% in poverty (6-15% poverty [OR 0.82, 95% CI 0.78-0.84), 15-25% poverty [OR 0.78, 95% CI 0.73-0.82], and >25% poverty [OR 0.78, 95% CI 0.72-0.84]). CONCLUSION Males, older age groups, and Hispanic/Latino patients had higher odds of non-transport among this population of community-dwelling adults age 60 or greater. These findings may inform development of future targeted falls-related mobile integrated health or community paramedic services and referrals to community intervention programs. Future work is needed to understand underlying patient and clinician perspectives driving non-transport decisions among these patients to better equip EMS clinicians with tools and information on tailored risk/benefit discussions.
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Affiliation(s)
- Anjni Joiner
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Durham County Emergency Medical Services, Durham, NC, USA
| | | | - Lee Van Vleet
- Durham County Emergency Medical Services, Durham, NC, USA
| | - José G Cabañas
- Wake County Emergency Medical Services, Raleigh, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph Grover
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Godfrey
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Wake County Emergency Medical Services, Raleigh, NC, USA
| | | | - Catherine Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Juliessa Pavon
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Ball SJ, Williams TA, Smith K, Cameron P, Fatovich D, O'Halloran KL, Hendrie D, Whiteside A, Inoue M, Brink D, Langridge I, Pereira G, Tohira H, Chinnery S, Bray JE, Bailey P, Finn J. Association between ambulance dispatch priority and patient condition. Emerg Med Australas 2016; 28:716-724. [PMID: 27592247 DOI: 10.1111/1742-6723.12656] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/03/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition. METHODS This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The χ2 statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity. RESULTS There were 211 473 cases of dispatch. Of 99 988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (time-critical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected from the overall positive predictive value. CONCLUSION Scope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance.
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Affiliation(s)
- Stephen J Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.,Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Fatovich
- Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Perth, Western Australia, Australia
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Deon Brink
- St John Ambulance (WA), Perth, Western Australia, Australia
| | - Iain Langridge
- St John Ambulance (WA), Perth, Western Australia, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Sean Chinnery
- St John Ambulance (WA), Perth, Western Australia, Australia
| | - Janet E Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Bailey
- St John Ambulance (WA), Perth, Western Australia, Australia.,Emergency Medicine, St John of God Hospital Murdoch, Perth, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
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