Emergency Medical Care Committee Facilitated Workshops

272 Pages·2012·7.51 MB·English

Contra Costa Emergency Medical Services
EMS System Modernization Study conducted by 
Fitch and Associates 
EMCC Workshop Literature  
October, 2013 
A compilation of evidence‐based and best 
practice literature on Emergency Medical 
Services
A D S “L -A ” C
ESCRIPTIVE TUDY OF THE IFT SSIST ALL
DavidC.Cone,MD,JohnAhern,ChristopherH.Lee,MD,MS,DorothyBaker,PhD,
TerrenceMurphy,PhD,SandyBogucki,MD,PhD
ABSTRACT evaluation.Keywords: emergencymedicalservices;geri-
atrics;accidentalfalls
Introduction.Responsesfor“liftassists”(LAs)arecommon
PREHOSPITALEMERGENCYCARE2013;17:51–56
in many emergency medical services (EMS) systems, and
result when a person dials 9-1-1 because of an inability to
get up, is subsequently determined to be uninjured, and INTRODUCTION
is not transported for further medical attention. Although
LAsofteninvolverecurrentcallsandaregenerallynotreim- When elderly or disabled persons fall or are unable
13 bursable,littleisknownoftheiroperationaleffectsonEMS to move from an undesirable position to a preferred
05/ systems.WehypothesizedthatLAspresentanopportunity one, they may call 9-1-1 for assistance. Often there is
on 09/ finojruerayrlpierervterenatitomnenintteorfvseunbttiloen-osninseatmpoepduiclaalticoonnadtithioignhsarinsdk no perceived injury or illness, so these individuals do
c not want medical treatment or transport to the hospi-
n forfalls.Objectives.ToquantifyLAcallsinonecommunity,
US I describe EMS returns to the same address within 30 days tal. They simply want responders to physically help
ma following an index LA call, and characterize utilization of them back to a bed, chair, or wheelchair. These calls
ar EMS by LA patients.Methods. Data from the computer- arelocallyknownas“liftassists.”
h
s P aideddispatch(CAD)systemofasuburbanfire-basedEMS It is likely that in some percentage of cases, a lift-
a
ell system were retrospectively reviewed. All LAs from 2004 assist call represents a “sentinel event” or a marker
Ast to 2009 were identified using “exit codes” transmitted by ofdeteriorationinfunctionofthepatient.1 Thiscould
by paramedicsaftereachcall.Thenumberandnatureofreturn be due to an unapparent medical condition such as
com nly. visits to the same address within 30 days were examined. a urinary tract infection or pneumonia, or could in-
nformahealthcare.For personal use o RsTttLhopwAeeotsos.hnue-Festlaheotssdsira.rdmd(2F4rs1ree.84oso%asmfodetfsdoh2(frte01heE07seL44MssAeaotShdccrrcaiedonutlrluucresirrgsden(sh7dee2nvs2w6;ti0ss;3i0)i26tt9hst.65,o,i.n%8ti5h%t)33e;w0)5r5ewd6ad3saweifyropfeeseforrtetasehofsnt1eioetb,r0rnlae8eetdt7hu-tdteorhLrneiiAcnrscdodsamreleoelsxs--f. dcAaaolsildcsgzainhsattieeatilinmovacseeesnrcei’oanwsfpdaa(sciocsttrieaitvagyoisetneriegeooslofariotngoefrgsddatedaltaoioulcayakrcltlhhiodvrrfoei)intncisglisioc..ncIeditaicislonesuauplsdpeh,pyaosslsuircotcahhalneoardsr-
m i Anecdotally, emergency medical services (EMS)
o parepatientageandsexwiththoseassociatedwiththeini-
d fr tialLA,revealingthat85%ofreturnvisitswerelikelyforthe providers report frequently returning to the same
de samepatients.Ofthese,38.5%wereforanotherLA/refusal address in the days, weeks, or even hours following
a
o
nl of transport, 8.2% for falls and other injuries, and 47.3% an initial lift assist, either for another lift assist, or for
w
o for medical complaints. Hospital transport was required in a more serious problem such as a fall with injury, or
D
e 55.5% of these return visits. The EMS crews averaged 21.5 a medical emergency, often resulting in transport to
Car minutes out of service per LA call. Conclusion. Lift-assist the emergency department (ED). In the case of older
erg calls are associated with substantial subsequent utilization patients,thereisconsiderableexpenseassociatedwith
m
sp E oinftEerMveSn,taionndss.hBoauselddtornigoguerrdfaaltlap,trheveseentciaolnlsamnadyobteheerarslayfeinty- atriptotheEDbecausethesepatientsreceiveagreater
o number of diagnostic tests, remain in the ED longer,
Preh dicators of medical problems that require more aggressive have higher ED charges,2 and are more likely to be
admitted to acute or intensive care units.3 Perhaps
the lift-assist call can be used to trigger interventions
to help prevent the “next call,” thereby improving
Received January 10, 2012 from the Section of EMS, Department the quality of care and reducing the use of financial
of Emergency Medicine (DCC, JA, CHL, SB) and the Section of
resources. Screening of elders has been advocated
Geriatrics, Department of Internal Medicine (TM, DB), Yale
by national organizations as a key component of
UniversitySchoolofMedicine,NewHaven,Connecticut.Revision
receivedMay29,2012;acceptedforpublicationJune14,2012. high-quality geriatric emergency care;4 perhaps such
screening should begin in the field, at the patient’s
Theauthorsreportnoconflictsofinterest.
home.
Reprintsarenotavailable.
Sinceatleastonevehicleandcrewmustrespondto
each lift-assist call in order to locate and assess the
Address correspondence to: David C. Cone, MD, Yale Univer-
patient and resolve the problem, lift assists consume
sity School of Medicine, Section of Emergency Medicine, 464
Congress Avenue, Suite 260, New Haven, CT 06519. e-mail: EMS resources. In some cases, multiple vehicles and
[email protected] personnel must respond to these calls. Examples in-
doi:10.3109/10903127.2012.717168 cludebariatricpatientswhocannotbesafelyliftedby
51
52 PREHOSPITALEMERGENCYCARE JANUARY/MARCH2013 VOLUME17/NUMBER1
twoproviders,orpatientsbehindlockeddoorsrequir- dence, and describe other characteristics of lift-assist
ing forced entry. There is generally no way for EMS calls.
agenciestorecoverthecostsassociatedwithlift-assist
calls, since with few exceptions, EMS efforts are re-
StudyProtocol
imbursed only when patients are transported to the
hospital. TheCADsystemdatabasewasqueriedfortherecords
While there are published studies of the EMS re- ofall lift-assist calls (as identified byexit code) occur-
sponse to falls,5,6 including analysis of patients who ringbetween2004and2009,inclusive.Thesedatawere
are not transported, no research describing lift-assist exported to the investigators in a single Excel spread-
calls, the patients involved, or the workload for the sheet (Microsoft Inc., Redmond, WA). The system be-
EMS system have been reported to date. We hypoth- gan using ePCRs in July 2007; no PCRs were avail-
esized that lift assists present an opportunity for ear- ableforthestudyperiodpriortoJuly2007.However,
lier treatment of subtle-onset medical conditions and dispatchers sometimes enter free-text “CAD notes”
injurypreventioninterventionsinapopulationathigh such as “80 y/o male unable to get off floor.” The
13 risk for falls. As the first step of a multiphase project, combination of address, age, and sex can be consid-
5/
0 we conducted a descriptive study of lift-assist calls in ered identifying information; therefore, relevant data
9/
n 0 one EMS jurisdiction. Specific objectives were: 1) to privacy practices were followed for the entire study
o
c quantifythefrequencyanddemographicsoflift-assist period.
n
S I callsinonesuburbanEMSsystem,2)todescribeEMS ThespreadsheetswerescannedmanuallyandbyEx-
U
a returns to the same address within 30 days following cel utilities for data inconsistencies, such as calls with
m
ar an index lift-assist call, and 3) to grossly estimate the the lift-assist exit code that also reported transport
h
P resources used by the EMS system by these lift-assist timesanddestinationcodesindicatingthatthepatient
s
a
ell responses. was taken by ambulance to a hospital, or calls with
Ast multiple exit codes. In each case found to have such
by METHODS internalconflicts,theePCRwasreviewedtodetermine
com nly. StudySettingandPopulation whetherthecallwasindeedaliftassist,inwhichcase
mahealthcare.personal use o Ta29hs,e0h0os0rteualdinnydeawtonawsanrceoawnoidtfhuacabteopduotpi2nu2laBstrqiaounnafrooerfdma,piClpeosron(xn5i7emcktaimtceu2l)ty,. totinhhrceauitddnceaeantxlaltpswlwtahaiensareteedoxincciclncuulcudrordenedesddifs.artoetIfnmacadintdehsreeepPssesCteurRssdisoywt.feaIdpnsuauabfdnltiedacrvistraieeoitlvntaii,bnealwgelsl,,
nforFor Thetownhasahigherpopulationofresidentsoverthe such as businesses or parks were excluded from the
m i ageof65years(19.9%)thaneithertherestofthestate study. Thus, all lift-assist calls included in this study
o
d fr (14.2%)ortheUnitedStatesasawhole(13%).7 involvedresponsestoprivateresidences.
de The town has a fire department–based EMS system
a
o
wnl that provides both basic and advanced life support DataAnalysis
o first response and transport, and responds to approx-
D
e imately 4,000 EMS calls and 1,600 fire calls per year. The lift-assist calls for each year and for the entire
ar
C Thepublicsafetyansweringpoint,includingEMSdis- study interval were recorded both as total numbers
g
er patch,ismaintainedbythetown’spolicedepartment, andasproportionsofallEMScalls.Poissonregressions
m
p E usingtheMedicalPriorityDispatchSystem(SaltLake with robust estimation of standard errors were used
s
o City,UT). toassessforlineartrendsincallvolumeandlift-assist
h
e
Pr At the conclusion of each call, in addition to com- volume over time, and the Cochrane-Armitage trend
pletingelectronicpatientcarereport(ePCR)documen- testwasused toassess fortrendsintheproportion of
tation,theEMScrewverballytransmitsan“exitcode” the department’s call volume that consisted of lift as-
tothedispatcherbyradio.Theexitcodeindicatesthe sistsovertime.Theproportionofresponsestounique
natureoftheincidentactuallyfoundbytheproviders addressesforliftassistswasalsocomputed.
onscene,andisdistinctfromthe“complaint”thatwas WeexaminedallEMSresponsestothesameaddress
described by the caller at the time of the 9–1-1 call. within30daysafteranindexlift-assistcalland,where
These codes are included in the permanent record of possible,basedonmanuallyenterednotesintheCAD
each call in the computer-aided dispatch (CAD) sys- file and ePCR data, assessed whether the return visit
tem.“Liftassist”isoneof126possibleEMSexitcodes was for the same patient. In the absence of a criterion
inthissystem. standardintheliterature,30dayswaschosenbycon-
Branford was chosen for the study for two reasons. sensus of the authors as a time frame within which it
First,ithasasingleEMSprovideragency,ratherthan seemed likely that return calls could be related to the
one for first response and another for transport. Sec- indexlift-assistcall.Iftheindexlift-assistcallandsub-
ond, inclusion of the exit codes in the CAD database sequentreturnvisitwithin30dayscontainedmatching
provides a reliable way to identify cases, report inci- names, or in the absence of names (when only CAD
Coneetal. LIFT-ASSISTCALLS 53
notes were available), matching age and sex data, it TABLE1. LiftAssistsandTotalEmergencyMedical
wasanalyzedasbeingforthesamepatient.Forexam- ServicesCallsperYear,2004–2009
ple,intheyearspriortotheuseofePCRs,aCADnote
Percentageof
of“75y/oM”fortheindexcallcombinedwithaCAD CallsThatWere
note of “75 year old male” for the return visit a few Year LiftAssists∗ EMSCalls† LiftAssists‡
days later was considered a return visit for the same
2004 152 3,367 4.5
patient. 2005 175 3,640 4.8
Caseswithconflictingageandsexdata,suchas“78 2006 129 3,829 3.4
2007 195 3,807 5.1
F” and a “69 y/o male,” or incomplete data, such as
2008 218 3,891 5.6
age but no sex, were excluded from the return-visit 2009 218 4,062 5.4
analysis.Acallatthesameaddresswithin30daysaf- TOTAL 1,087 22,596 4.8
teranindexcallwasconsideredareturn-visitcall,not ∗Increaseyeartoyearissignificant,p=0.017.
another index call, and return visits were not them- †Increaseyeartoyearissignificant,p<0.0001.
selvessearchedforadditionalreturncalls.Likethein- ‡Increaseyeartoyearissignificant,p=0.003.
13 dex lift-assist calls, the natures ofall return calls were
5/
0 derived from the exit codes in the CAD file and on
n 09/ theePCR,andrecordedbybroadcategory.Thesecate- Over the study period, there were 563 EMS re-
o sponses to the same address within 30 days after an
c gorieswereformedbygroupingtheexitcodesintoone
S In of the following: cardiac, gastrointestinal, pain with- index lift-assist call. For 214 of these 563 returns to
U the same address (38%), the name or the age and sex
a out history of trauma, respiratory, altered mental sta-
m of the patient for both initial lift assist and return re-
ar tus, miscellaneous medical, cardiac arrest, falls and
h sponse could be determined; CAD notes did not pro-
P other injuries, burns, other, and refusal of treatment/
as videthesedatafortheremaining349(62%)duringthe
ell transport.
Ast Resource use was estimated by examining the years when ePCRs were not yet in use. Of these re-
by CAD database for the vehicles that responded (e.g., sponses to the same address within 30 days after an
mahealthcare.com personal use only. ppatnhmoaluertoisacfiumreenedewntdgtsoihicfwneteaeidmmriecsbeopnumasolpttapcienfihanceentedryotoohnnpfalltttyuhh,tseehorerrdeyesepspwppaouorenantrysmeseeaetcvd(ohfairitcieohlafmae)bmtliatembhnfueedolrattihnatmhecnyeee- istctneoaardmlaqlesuehxfaooplrisrtafpitttl-hieiateeasrnlsastin(as6(mgt56ec8.e3a%[%lpIlQ,aff1tReei8me]m2n7aatr8lel(e–e5t;9;u50mmr.)5n,ee%saddn)wiiaadreennr1seua0ag1algteteeotdr8f8i0bti4hnuyeytetsereaedaarnrsrte,ssot,pIuQtoihrnrRne-t
nforFor othercall). 72–88) (Fig. 1). The 182 returns for the same patients
m i followed157indexliftassists;thenaturesofthese182
ed fro HumanSubjectsApproval rTewtuernntyc-athllrseeariendsehxolwifntaisnsiFstisgu(1r4e.62%, )anredsuvlaterdyiwnimdeolrye.
d
oa than one return for the same patient within 30 days
nl The study was submitted to the Yale University Hu-
w (21 with two return calls and two with three return
o man Investigation Committee, which deemed it ex-
D
e emptfromfullrevieworapproval. calls).
Car Crews averaged 21.5 minutes (standard deviation
Emerg RESULTS [toSDa]n±d1a7rrmiviinnugteosn,rtahnegsec3entoe2o1f8lmifti-nausstiesst)craelslps.onTdhiensge
sp responses totaled over 366 hours of responder out-of-
o There were 1,087 lift-assist calls over the six-year pe-
h
e service time over the duration of the study. One hun-
Pr riod, accounting for 4.8% of all EMS incidents. As
dred twelve (10.3%) of the lift-assist calls required, in
shown in Table 1, both the total number of EMS calls
(p < 0.0001) and the number of lift assists (p = 0.017) additiontotheambulance,additionalfiredepartment
apparatus.Inmost(79%)ofthesecases,theadditional
increasedoverthestudyyears,asdidtheproportionof
thedepartment’scallsthatwereliftassists(p=0.003). unit(s) were dispatched simultaneously with the am-
bulance, suggesting overtriage by the dispatcher. In a
This suggests that lift assists represent a substantial
minorityofthesecases,theadditionalunit(s)weredis-
andgrowingproblemintermsofincidenceinthecom-
patched after arrival of the ambulance on scene, indi-
munityandinrelativeprevalencewithinEMScallvol-
cating that the ambulance crew requested additional
ume.
help, e.g., for lifting a bariatric patient or for forcing
The 1,087 lift assist responses were made to 535
entry.
unique private addresses. One hundred seventy-four
addresses (32.5%) accounted for 726 lift-assist re-
sponses (66.8%). Almost all of these calls were to ad- DISCUSSION
dresseswherethepatientswerelivingindependently;
there were two lift-assist responses to addresses with ThisdescriptivestudyusedCADdatatoevaluatethe
full-timemedicalstaffonduty(hospice). frequency and system burden of lift-assist calls in a
54 PREHOSPITALEMERGENCYCARE JANUARY/MARCH2013 VOLUME17/NUMBER1
Total EMS
calls: 22596
Li(cid:2) assist
calls: 1087
No return
Return visit in
visit in 30
30 days: 563
days: 524
3
1
5/
0
9/
0
on Names or Names or
nc age/sex not age/sex
S I available: 349 available: 214
U
a
m
ar
h
P
s
a
ell Not the same Same
Ast pa(cid:3)ent: 32 pa(cid:3)ent:182
y
b
m y.
conl
mahealthcare.personal use o transN8po1otr ted: Trans1p0o1rted:
nforFor
m i
o FIGURE1. Patientflowdiagramofemergencymedicalservices(EMS)calls.
d fr
e
ad suburban setting. We found that nearly 5% of EMS Our findings are similar to those of the London
o
nl incidents in this jurisdiction are for lift assists, that Ambulance Service, which found that 47% of elderly
w
Do EMS returned to the same address within the next (age ≥65 years) fall patients not transported to the
are 30daysfairlyoften,andthatabouthalfofsubsequent hospital summoned EMS again within two weeks,
g C calls for the same patient were for conditions that re- with47%ofthesepatientscallingmorethanonce.5 In
mer quiredambulancetransporttothehospital.Significant the subset of these repeat-call patients transported to
E
p municipalresourcesarebeingexpendedonthesenon- studyhospitalsinLondon,41%wereadmitted—arate
hos reimbursablecalls. 4.7 times that of the general ≥65-year-old population.
e
Pr
FIGURE 2. Natureof182returncallsconfirmedtobeforthesamepatient.AMS=alteredmentalstatus;GI=gastrointestinal;Misc.Med=
miscellaneousmedical;Resp=respiratory;w/o=without.
Coneetal. LIFT-ASSISTCALLS 55
This London study examined patients to whom EMS of Health Services,” to “ensure that the care provided
was dispatched for an incident (complaint) code by EMS does not occur in isolation, and that positive
of “fall,” and is thus different from our population effectsareenhancedbylinkagewithothercommunity
identifiedonthebasisofaconfirmedliftassist. healthresourcesandintegrationwithinthehealthcare
The similar high rate and varied nature of return system.”14 The Agenda’s authors, specifically citing a
calls we observed in the 30 days following an index role for EMS in prevention of falls, noted that EMS
lift-assistcallsuggestthatneithertheEMSsystemnor must “expand its public health role and develop on-
the patients are best served bysimply returning apa- goingrelationshipswithcommunitypublichealthand
tient to bed or chair without additional medical and socialservicesresources”inordertomaximizetheben-
social services evaluation. Halter et al. in the United efits to patients, both present and future. We believe
Kingdom have recently developed a decision tool to thatitisfeasible,practical,andimportantforfieldper-
assistEMSproviderswhoareconsideringwhetherel- sonneltoserveastheeyesandearsofthecommunity
derlypatientsshouldbetransportedtothehospitalun- healthsysteminapreventiverole.
der these circumstances.8 Likewise, our findings sug-
5/13 gest that lift-assist calls could offer an opportunity to LIMITATIONS
0 screenpatientsandinitiateinterventionstomitigateat
9/
n 0 leastsomefutureclinicalproblems. The study was conducted in a single EMS system,
o
c EMS screening of elderly patients has been shown in a suburban New England town, and may not be
S In to be feasible,9–11 and there are several studies sug- generalizable to other types of systems (e.g., third-
U
a gesting that such intervention can be beneficial. A service) or other types of municipalities (e.g., large
m
ar study conducted in Nottinghamshire, UK, examined citiesorruralareas).Inparticular,thistownhasahigh
h
P patientsovertheageof60yearswhohadsummoned proportion of residents who are 65 years of age and
s
a
ell EMS because of a fall, but were not transported to older.AlloftheEMSagenciesinourarea(covering11
Ast the hospital.12 The patients were randomized to re- other cities and towns) report having lift-assist calls,
by ceive either standard care or an individualized multi- but response patterns differ somewhat from town to
com nly. disciplinaryfall-interventionprograminvolvinghome town, and data analysis would likely reveal different
mahealthcare.personal use o vtnchiieaseelirdtassepebdirysvtrisenc,feueasrr,nsreaasalns,sdspteohscysothmsmiecemanplutrtinhomieftaryhar-ypocemicsnatetsre,ehraapngzhdraoyrousdcipscc,iuaswpneasiottshiiroonsnaoass--l. esaosbAtmliemseradeptleieaesstcdi.reionbntesdm,,aatnnhdueatChlAoresDceonCrdoAitneDsgnwoofetpreeastnitehontattaivwnafeoilrraembalaevtiafooilnr-
nforFor Theincidenceratesofself-reportedfallsperyearwere bythedispatchers.Furthermore,theEMSsystemstud-
m i 3.46 in the intervention group and 7.68 in the control ied did not begin using ePCRs until July 2007. Thus,
o
d fr group(incidencerateratio0.45,95%confidenceinter- age and sex data were available for only a subset of
de val [CI] 0.35 to 0.58, p < 0.001), and the number of patients,somatchinginitialliftassistswithreturncalls
a
o
nl times an ambulance was called because of a fall was was frequently not possible during early study years.
w
o significantly lower among the intervention group (in- We cannot determine whether this subset is represen-
D
e cidencerateratio0.60,95%CI0.40to0.92,p=0.018). tative of the entire sample; the analysis of the return
ar
C The intervention group also demonstrated increased calls must therefore be viewed with caution. How-
g
er levels of activities of daily living and reduced fear of ever, our data seem reasonable given the anecdotal
m
p E falling. reports from the paramedics regarding the frequency
os A similar study from Rochester, New York, found withwhichtheyreturntothesamepatientinthedays
h
e
Pr that volunteer EMS personnel in a rural community and weeks afteralift-assist call.Our dataalso appear
could effectively screen elderly patients for fall risk, reasonable in the context of at least one prior study
depression, and medication-management problems, of patients who summoned EMS at least once in the
andreferthemtocasemanagersforin-homevisitsfor yearafteranindexEMScall,showingthatelderly(age
further assessment and intervention.13 This parallels 65 years or greater) “repeaters” accounted for 18% of
theapproachthatourprogramisnowtaking,withfire elderly EMS patients and 40% of elderly EMS trans-
department paramedics providing their screening in- ports to the ED.15 Similarly, Shah et al. found that in
formation to involve primary care physicians and the astudyofruralEMSuse,25%to30%ofcasesinvolv-
localvisitingnurseservice. ingpatientsaged65yearsandoverwererepeatcallers,
This move away from reflexive, response-based in- suggestingthatafairlyhighproportionofreturnvisits
terventionandtowardproactive,preventivemeasures toelderlyEMSpatientsisnotunusual.16
reflectsgeneralinterestintheEMScommunityinmov- Ourstudydidnotinvolvereviewofhospitalrecords,
ingtowardatrulyintegrated,community-basedhealth so while we know how many of the repeat callers
system, as suggested by the 1998 Emergency Medical weretransportedtothehospital,wedonotknowhow
Services Agenda for the Future.14 The first EMS sys- many of these were admitted to the hospital. Such
tem attribute discussed in the Agenda is “Integration data would have allowed comparison with the 41%
56 PREHOSPITALEMERGENCYCARE JANUARY/MARCH2013 VOLUME17/NUMBER1
admission rate for the repeat-call patients in the Lon- 6. ClawsonJ,OlolaC,ScottG,etal.Associationbetweenpatient
donstudy.17 unconsciousornotalertconditionsandcardiacarrestorhigh-
Finally, while we were able to calculate resource acuityoutcomeswithintheMedicalPriorityDispatchSystem
“Falls”protocol.PrehospDisasterMed.2010;25:302–8.
use in terms of man-hours, we did not conduct a ro-
7. UnitedStatesCensusBureau.Connecticut.Availableat:http://
bustcostanalysisofthefinancialburdenthatlift-assist
quickfacts.census.gov/qfd/states/09000.html.AccessedAugust
calls impose on EMS systems. A cost analysis, using 8,2012.
the methods described by Lerner and colleagues,18,19 8. HalterM,VernonS,SnooksH,etal.Complexityofthedecision-
wouldprovidemoreaccuratedata,butwasbeyondthe making process of ambulance staff for assessment and refer-
ralofolderpeoplewhohavefallen:aqualitativestudy.Emerg
scopeofthisstudy.
MedJ.2011;28:44–50.
9. Weiss SJ, Chong R, Ong M, Ernst AA, Balash M. Emergency
CONCLUSIONS medicalservicesscreeningofelderlyfallsinthehome.Prehosp
EmergCare.2003;7:79–84.
In this descriptive study of a mid-sized EMS system, 10. Shah MN, Caprio TV, Swanson P, et al. A novel emer-
gency medical services-based program to identify and assist
lift-assistcallsarecommon,appeartobeincreasingin
olderadultsinaruralcommunity.JAmGeriatrSoc.2010;58:
5/13 frequency, and create a substantial number of nonre- 2205–11.
0 imbursedresponsesforthemunicipalEMSsystem.We 11. ShahMN,LernerEB,ChiumentoS,DavisEA.Anevaluation
9/
n 0 found that EMS personnel often return to care for the ofparamedics’abilitytoscreenolderadultsduringemergency
c o same patients within 30 days, by which time approx- responses.PrehospEmergCare.2004;8:298–303.
n 12. Logan PA, Coupland CAC, Gladman JRF, et al. Community
US I imately half require transport to an ED. These find- falls prevention for people who call an emergency ambu-
a ingsrequirefurtherstudy;however,theysuggestthat lance after a fall: randomised controlled trial. BMJ. 2010;340:
m
ar it may be feasible to use the lift-assist call as the trig- c2102.
h
P ger for additional assessment and intervention in an 13. Shah MN, Clarkson L, Lerner EB, Fairbanks RJ, McCann
s
Astella etuffronrtEtMoSpcreavllesn,atnmdeadviocaidl dasesteorciioartaetdiosnu,ffienrjiunrgy,,danisdabriel-- Rto, SpcrhomneoidteerthSeMh.eAalnthemoferoglednecryamduedltisc.alJ sAermvicGeseripartorgrSaomc.
com by nly. ity,andcosts. 14. 2FD0ue0tlu6b;rr5ei4d::gw9e5h6Te–Rr6e2,w.BaeilaeryeB..,.CwhhewereJLwJer,weatnatl.toEMbeS.PArgeehnodspafEomrethrge
care.use o References 15. CWaeries.s1S9J9,8E;r2n:1s–t1A2.A,MillerP,RussellS.RepeatEMStransports
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Building the evidence base
in pre-hospital urgent and
emergency care
A review of research evidence
and priorities for future research
by the University of Sheffield
Medical Care Research Unit
Research funded by the Department of Health Policy Research Programme
(cid:1)
Building the evidence base
in pre-hospital urgent and
emergency care
A review of research evidence
and priorities for future research
by the University of Sheffield
Medical Care Research Unit
Janette Turner
Evidence reviewers
Mike Bjarkoy
Patricia Coleman
Steve Goodacre
Emma Knowles
Suzanne Mason
Jon Nichol
Alicia O’Cathain
Colin O’Keeffe
Janette Turner
Richard Wilson