Analysis of the Interventions of Medical Emergency Teams in Older Patients in Selected Polish Cities with County Status: A Retrospective Cohort Study

Abstract

Introduction: Geriatric patients account for a large proportion of interventions of medical emergency teams (METs). The aim of this study was to analyse medical emergency interventions in the Biała Podlaska and Chełm (Poland) between 2016 and 2018 in a group of patients ≥ 65 years of age. Materials and Methods: We analysed medical records of 1200 older patients treated by METs in Biała Podlaska and Chełm (Lublin Province, Poland). The research was conducted from June 2019 to March 2020 at the Emergency Medical Service Station in Biała Podlaska and the Medical Rescue Station in Chełm (Independent Public Complex of Health Care Facilities). Results: A total of 92.5% of medical emergency service interventions took place at the patient’s home. The mean time of stay at the scene was 20 min. The highest number of interventions occurred between 8:00 p.m. and 8:59 p.m. There were no statistically significant differences in the type of ambulance used depending on the patient’s sex, while there was a statistically significant relationship between priority code and sex. Cardiovascular diseases were diagnosed in 40% of patients, and the symptoms were not precisely classified in almost the same percentage of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the hospital emergency department in 69.1% of cases. Conclusions: METs were called for a variety of diseases due to the fact that geriatric patients are not able to distinguish a life-threatening condition. Medical procedures performed by METs from Biała Podlaska and Chełm were closely related to the initial diagnoses made by these teams. It was irrelevant whether a specialist or non-specialist medical emergency service was used. Paramedics are very well trained to practice their profession and are able to provide treatment to older patients in a state of sudden life threat.

Patients From Nursing and Residential Care Facilities In the Practice of Emergency Medical Teams: Two-Year Study

“…A group of geriatric patients was observed by Celinski et al [20]. This analysis focused on home interventions, but the results are similar to our own study once the disorder group is included as a reason for intervention.…”

ICD-10 Classification in the Practice of Emergency Medical Teams: New Insights

“…Calls to patients under 50 years old were caused by injuries, external causes of illness, and death, and calls to patients in the 15-59 age group were caused by mental and behavioural disorders ( Table 4 ). These results and the relationship between disease entities and the patient's age were also confirmed by studies conducted in other centres [ 3 , 15 – 18 , 27 , 29 , 30 ]. Attention should be paid to the instructions of EMTs to middle-aged patients who were diagnosed in the group F00-F99-Mental and behavioural disorders ( Table 4 ).…”

“…This is due to too many variables influencing the occurrence and diagnosis of the disease ( Table 1 ). Celiński et al [ 15 ] showed in their research that the most common reasons for EMT calls from Eastern Poland (Biała Podlaska, Chełm) in 2016-2018 to patients aged 65 included the following groups of diagnoses: I00-I99-Diseases of the circulatory system (40.2%); R00-R99-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (37.7%); and S00-T98-Injury, poisoning, and certain other consequences of external causes (12.6%). However, the results of studies by Timler et al on the dispatch of EMTs in 2009 to people over 65 in Otwock county (Poland) indicate that EMTs are most often dispatched to patients with cardiovascular diseases (19%) and injuries (18%) [ 16 ].…”

“…Although ambulance medical staff were competent in diagnosing and treating various diseases [ 20 , 21 ], as the research shows, imprecise diagnoses were made based on ICD-10 diagnoses from the group R00-R99-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified. Imprecise diagnoses made by EMTs may result from, among others, the limitations of diagnostics available at the scene and the ambiguity of symptoms [ 15 , 18 , 22 , 23 ]. This group of diagnoses includes, among others, diagnoses R07-Pain in throat and chest, R10-Abdominal and pelvic pain, or R55-Syncope and collapse, which may be symptoms in many diseases of various physiological systems, and only wider imaging and laboratory diagnostics performed in hospital conditions allow for a more precise diagnosis.…”