Geriatric "lift-assist" EMS calls with transport refusal: Characteristics of short-term repeat calls and hospitalizations.

Emily A Moore, David W Schoenfeld, Christie L Fritz, Matthew J Bivens, Shan W Liu, Stephen H Thomas

The American journal of emergency medicine · 2025-05-22 · Observational study

Read at publisher · PubMed

Abstract

BACKGROUND: Older patients who fall may call Emergency Medical Services (EMS) for assistance, then refuse transport to the Emergency Department (ED). We sought to describe the characteristics of such patients, and to identify predictors of the need within 30 days for a repeat EMS call, ambulance transport and/or hospitalization. METHODS: The records of a single urban EMS service were reviewed for one year concluding in October 2024 to identify cases where a geriatric patient (age > 64) refused transport after a fall. Multivariable logistic regression was used to evaluate dichotomous endpoints of repeat EMS call and hospitalization. RESULTS: Of 19,694 overall calls, there were 7329 for geriatric patients, 931 of whom refused transport. Of these 931 geriatric refusals, 433 were refusals after a fall. 142 (32.8 %, 95 % CI 28.4-37.4 %) had at least one same-month repeat EMS call and 101 of those (71.1 %, 95 % CI 62.9-78.4 %) were transported, with 65.9 % of transports resulting in hospitalization. Multivariable analysis identified no patient factors predictive of repeat EMS call. Admission was predicted by advancing age (OR 1.08 for each year, with 95 % CI 1.01-1.14, p = .016). CONCLUSION: Nearly a third of falls with transport refusals are associated with a same-month repeat EMS call, a majority (71.1 %) of which result in transport to the ED, usually followed by hospital admission. We identified no predictors of repeat EMS call or hospitalization. Geriatric patients who refuse transport after a fall are at high risk for repeat EMS calls and hospitalizations, but predictors of such needs are elusive.

Abstract © the authors or publisher, via PubMed. Reuse and removal

Tags

Older adults · Urban

Related articles

• Retrospective Validation of a Protocol to Limit Unnecessary Transport of Assisted-living Residents Who Fall. (Prehosp Emerg Care, 2015)
• Follow-up of elderly patients who refuse transport after accessing 9-1-1. (Prehosp Emerg Care, 2002)
• Predictors of Non-Transport for Older Adult EMS Patients Encountered for Falls. (Prehosp Emerg Care, 2023)
• Prehospital Care of Older Adults Following Perceived Low-Acuity Falls and Related "Lift Assist" Encounters: An NAEMSP Position Statement and Resource Document. (Prehosp Emerg Care, 2026)
• Systematic review of non-transportation rates and outcomes for older people who have fallen after ambulance service call-out. (Australas J Ageing, 2013)
• Evaluation of ambulance calls for patients over 65 years of age in İzmir, Turkey: a two- year retrospective analysis. (Turk J Med Sci, 2021)