National Characteristics of Emergency Medical Services Responses for Older Adults in the United States

Hieu V. Duong; Lauren Nicholas Herrera; Justin Xavier Moore; John Donnelly; Karen E. Jacobson; Jestin N. Carlson; N. Clay Mann; Henry E. Wang

doi:10.1080/10903127.2017.1347223

National Characteristics of Emergency Medical Services Responses for Older Adults in the United States

Hieu V. Duong
, Lauren Nicholas Herrera
, Justin Xavier Moore
, John Donnelly
, Karen E. Jacobson
, Jestin N. Carlson
, N. Clay Mann
, Henry E. Wang

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Objective: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. Methods: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. Results: During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71–1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96–1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96–3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00–2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. Conclusion: One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.

Original language	English
Pages (from-to)	7-14
Number of pages	8
Journal	Prehospital Emergency Care
Volume	22
Issue number	1
DOIs	https://doi.org/10.1080/10903127.2017.1347223
State	Published - Jan 2 2018

Bibliographical note

Publisher Copyright:
© 2017 National Association of EMS Physicians.

Funding

The NEMSIS project is a national effort to standardize EMS data collected by EMS personnel. The database is managed by the NEMSIS Technical Assistance Center (currently located at the University of Utah School of Medicine, Salt Lake City, UT) and supported by the Office of Emergency Medical Services of the National Highway Traffic Safety Administration. Local EMS agencies submit data to their State database for computation, of which a subset of data is then exported to the national database. Greater than 90% of the United States and its territories have a NEMSIS data system implemented. For this study, we used the 2014 NEM-SIS Public Release Dataset (Version 2.2.1), which contained data on almost 26 million EMS activations in 46 states and territories. The percentage of EMS agencies providing data ranged between 42 and 100%, with a few states (Arizona, Kentucky, and Louisiana) providing less than 18%. The requirements for NEMSIS data reporting vary by state (Figure 1).

Funders	Funder number
NEMSIS Technical Assistance Center
Office of Emergency Medical Services
National Childhood Cancer Registry – National Cancer Institute	R25CA047888
City, University of London	UT
Jikei University School of Medicine
National Highway Traffic Safety Administration

Keywords

emergency medical services
geriatric
older adults
prehospital intervention

ASJC Scopus subject areas

Emergency Medicine
Emergency

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10.1080/10903127.2017.1347223

Cite this

@article{87c852d03edb486b8243025fed328fbc,

title = "National Characteristics of Emergency Medical Services Responses for Older Adults in the United States",

abstract = "Objective: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. Methods: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. Results: During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76\%) older and 9,547,155 (59.24\%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68\% vs. 3.40\%; OR 1.71; CI: 1.71–1.72), cardiac arrest/rhythm disturbance (3.27\% vs. 1.69\%; OR 1.97; CI: 1.96–1.98), stroke (2.18\% vs. 0.74\%; OR 2.99; CI: 2.96–3.02) and shock (0.77\% vs. 0.38\%; OR 2.02; CI: 2.00–2.04). Common EMS interventions performed on older persons included intravenous access (32.02\%), 12-lead ECG (14.37\%), CPR (0.87\%), and intubation (2.00\%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. Conclusion: One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.",

keywords = "emergency medical services, geriatric, older adults, prehospital intervention",

author = "Duong, \{Hieu V.\} and Herrera, \{Lauren Nicholas\} and Moore, \{Justin Xavier\} and John Donnelly and Jacobson, \{Karen E.\} and Carlson, \{Jestin N.\} and Mann, \{N. Clay\} and Wang, \{Henry E.\}",

note = "Publisher Copyright: {\textcopyright} 2017 National Association of EMS Physicians.",

year = "2018",

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doi = "10.1080/10903127.2017.1347223",

language = "English",

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AU - Duong, Hieu V.

AU - Herrera, Lauren Nicholas

AU - Moore, Justin Xavier

AU - Donnelly, John

AU - Jacobson, Karen E.

AU - Carlson, Jestin N.

AU - Mann, N. Clay

AU - Wang, Henry E.

PY - 2018/1/2

Y1 - 2018/1/2

N2 - Objective: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. Methods: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. Results: During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71–1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96–1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96–3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00–2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. Conclusion: One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.

AB - Objective: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. Methods: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. Results: During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71–1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96–1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96–3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00–2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. Conclusion: One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.

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KW - geriatric

KW - older adults

KW - prehospital intervention

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National Characteristics of Emergency Medical Services Responses for Older Adults in the United States

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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