A Novel Emergency Medical Services–Based Program to Identify and Assist Older Adults in a Rural Community

Abstract

Rural-dwelling older adults experience unique issues related to accessing medical and social services. We describe the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs. The program leveraged the existing emergency medical services (EMS) system. The program specifically included: 1) geriatrics training for EMS providers; 2) screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; 3) communication of EMS findings to community-based case managers; 4) in-home evaluation by case managers; 5) referral to community resources for medical and social interventions. Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. 1231 of 1444 visits to older patients (85%) were screened by EMS. Of those receiving specific screens, 45% had fall-related, 69% had medication management-related, and 20% had depression-related needs identified. 171 of eligible EMS patients who could be contacted accepted the in-home assessment. For the 153 individuals completing the assessment, 91% of patients had identified needs and received referrals or interventions. This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services.

A Culture in Transition: Paramedic Experiences with Community Referral Programs

“…Indeed, others have identified limited education in this area at the entry to practice and ongoing professional development levels, 11 and the need for further or better training to improve accuracy or appropriateness in referral programs 3 and screening. 5 Another salient theme emerging from the data was the strong desire by paramedics to receive meaningful feedback and improve communication regarding referrals made. In cases where feedback lacked detail or was delayed it did little to improve paramedics' use or understanding of the CREMS program.…”

“…3 Paramedics have demonstrated capacity in identifying individuals at risk of deterioration in the home. 4,5 As such, the paramedic community has developed, implemented, and continues to expand programs involving paramedics initiating referrals to community services (referred to as "community referrals by EMS (Emergency Medical Services)" or "CREMS"). Referral programs aim to promote the health and quality-of-life of seniors, improve their access to resources, and reduce 911-system activations and hospital visits.…”

Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate

“…Our review of titles and abstracts suggested that 138 articles might be eligible. After studying full texts, we confirmed that 13 papers 61,62,66,80,[89][90][91][92][93][94][95][96][97] reporting 12 studies met our inclusion criteria, as detailed in Figure 1. Table 4 summarises the 12 included studies; Tables 5 and 6 describe them in more detail and Table 7 assesses their quality.…”

“…Of the 12 studies, six 61,62,66,80,89,94 came from the UK, four [90][91][92][93] came from the USA, one 97 came from Australia and one 95 came from New Zealand. Study designs comprised two RCTs 61,66 (one of which 61 published a separate paper evaluating cost-effectiveness element of the study), 62 nine cohort studies (of which six did not include a comparator arm 89,[91][92][93]95,97 and three included intervention and control arms 80,90,96 ) and one qualitative study.…”

“…Study designs comprised two RCTs 61,66 (one of which 61 published a separate paper evaluating cost-effectiveness element of the study), 62 nine cohort studies (of which six did not include a comparator arm 89,[91][92][93]95,97 and three included intervention and control arms 80,90,96 ) and one qualitative study. 94 Of the nine cohort studies, three were retrospective, 92,95,96 five were prospective 80,[89][90][91]97 and one had both prospective (screening) and retrospective (referral) elements.…”