Timeline for Repeat EMS Encounters Resulting in Transport Following "Lift Assist" in a Suburban EMS System.

Abstract

Objective: When emergency medical services (EMS) clinicians provide mobilization assistance to geriatric fall patients without transport, this is often coded as a "lift assist." Previous research has shown many of these patients are subsequently transported, suggesting the "lift assist" may signal the presence of underlying medical illness or decline in functional condition. Understanding the timeline for repeat visits requiring transport is critical to improvement initiatives seeking to reduce diagnostic delays for this population. The primary objective of this study was to describe the timeline and factors associated with subsequent transport following an index EMS encounter for lift assist.

Methods: This was a retrospective analysis of one year (2022) of patient encounters in a suburban EMS system with ∼120K dispatches per year. Patients ≥ 60 years of age were included if they had at least one repeat EMS encounter within 7 days of a non-transport with a primary impression of lift assist. The population was described using descriptive statistics. Associations between assessment completeness and abnormal vital signs with odds of subsequent transport versus non-transport were evaluated using logistic regression analysis.

Results: In total, 1054 EMS encounters were analyzed, accounting for 574 repeat encounters involving 428 unique patients and 480 patient clusters. Number of repeat encounters within 7 days ranged from one to six, with 84% (n = 406) having only one. Of initial EMS encounters, 14% were missing at least one vital sign, and abnormal vital signs were observed (HR > 100:10% (n = 459), SBP < 110:8% (n = 448), SpO₂ < 90%:4% (n = 425)). On repeat encounter, patients were transported in 76% of cases. The primary impression indicated a medical etiology in 61% of repeat encounters and 1% were for cardiac arrest. Median time to first repeat encounter resulting in transport was 1.13 days (IQR 0.33 to 3.33 days). No association was found between abnormal vital signs or ambulation assessment with odds of transport on subsequent encounter.

Conclusions: Most repeat patient encounters following index lift assist occur within 72 h and result in transport, most commonly for presumed medical etiology. Ambulation assessment, abnormal or missing vital signs were not associated with increased odds of transport on repeat visits in this limited patient sample.