Predictors of Non-Transport for Older Adult EMS Patients Encountered for Falls

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.