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

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.

National Characteristics of Emergency Medical Services in Frontier and Remote Areas.

Although much is known about EMS care in urban, suburban, and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions, and on-scene death between EMS responses in FAR and non-FAR areas. There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3-10] vs. 5 [3-8] min), scene (14 [10-20] vs. 14 [10-20] min), and transport times (11 [5.,24] vs. 12 [7,19] min). Air medical (1.51% vs. 0.42%; OR 4.15 [95% CI: 4.03-4.27]) and Advanced Life Support care (62.4% vs. 57.9%; OR 1.25 [1.24-1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs. 0.70%; OR 5.04, 95% CI: 4.97-5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25-1.30). Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.

Pediatric Out-of-Hospital Critical Procedures in the United States.

OBJECTIVE: Regular clinical application is important for maintenance of difficult resuscitation skills. Although emergency medical services must provide life-saving care for critically ill and injured children, the frequency with which these procedures are performed is unknown. We sought to characterize critical pediatric procedures performed by emergency medical service personnel in the United States. DESIGN: We performed a retrospective, descriptive study of emergency medical service responses. SETTING AND PATIENTS: We included patients less than 18 years old in the 2011 National Emergency Medical Services Information Systems national data set. We identified emergency medical service cases receiving critical procedures, including intubation, cricothyroidotomy, cardiac pacing, cardioversion, defibrillation, needle decompression, pericardiocentesis, and intraosseous or central venous catheter placement. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed the data to determine the number and prevalence of procedures, success rates, and factors associated with success. Of the 14,371,941 emergency medical service responses, 865,591 (6.8%) involved children. Emergency medical service responses to pediatric patients most often involved traumatic injuries (35.7%) or respiratory complications (13.2%). Emergency medical service performed a total of 616,913 procedures on 246,016 pediatric cases. Critical procedures were infrequently performed (n = 11,026, 10 per 1,000 pediatric cases). The most common critical procedures performed were intubation (n = 3,599, 6.7 per 1,000 pediatric cases) and intraosseous access (n = 2,618, 5 per 1,000 pediatric cases). Overall, 81% of critical procedures were successful. Increasing age and interfacility transfers were associated with greater odds of procedural success (p < 0.01). CONCLUSION: Despite the broad range of pediatric conditions seen in the prehospital setting, pediatric critical procedures are infrequently performed. These data highlight factors that are associated with successful completion of critical pediatric procedures.

National characteristics of emergency medical services responses in the United States.

OBJECTIVE: Despite its long history and current prominence in U.S. communities, only limited data describe the national characteristics of emergency medical services (EMS) care in the United States. We sought to characterize out-of-hospital EMS care in the United States. METHODS: We conducted an analysis of the 2010 National Emergency Medical Services Information System (NEMSIS) research data set, encompassing EMS emergency response data from 29 states. From these data, we estimated the national number and incidence of EMS responses. We also characterized EMS responses and the patients receiving care. RESULTS: There were 7,563,843 submitted EMS responses, corresponding to an estimated national incidence of 17.4 million EMS emergency responses per year (56 per 1,000 person-years). The EMS response incidence varied by U.S. Census region (South 137.4 per 1,000 population per year, Northeast 85.2, West 39.7, and Midwest 33.3). The use of lights and sirens varied across Census regions (Northeast 90.3%, South 76.7%, West 68.8%, and Midwest 67.5%). The percentage of responses resulting in patient contact varied across Census regions (range 78.4% to 95.7%). The EMS time intervals were similar between Census regions; response median 5 minutes (interquartile range [IQR] 3-9), scene 14 minutes (10-20), and transport 11 minutes (7-19). Underserved populations (the elderly, minorities, rural residents, and the uninsured) were large users of EMS resources. CONCLUSION: These data highlight the breadth and diversity of EMS demand and care in the United States.