The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

Abstract

Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step. RÉSUMÉLa prestation des soins aux personnes âgées occupe une place importante dans les services médicaux d'urgence (SMU). Les systèmes de SMU étaient conçus au départ pour traiter des affections aiguës isolées, ce qui est très différent des pratiques exemplaires en matière de soins aux personnes âgées fragiles. Le repérage précoce des personnes âgées fragiles, fortement prédisposées à des événements défavorables pourrait améliorer la prestation des soins. Les ambulanciers paramédicaux sont bien placés pour jouer un rôle important dans une évaluation approfondie du degré de fragilité (ou de vulnérabilité), et les résultats obtenus peuvent éclairer les décisions prises par les fournisseurs de services préhospitaliers et, par la suite, dans les services d'urgence (SU). Des programmes innovateurs de SMU, de soins dans les SU et de soins de base pourraient réduire la charge de travail dans les SU tout en améliorant l'accès aux soins et, en dernier ressort, les résultats cliniques. Certaines personnes âgées fragiles pourraient profiter des ressources disponibles dans les SU et du bagage cumulé de connaissances spécialisées, tandis que d'autres profiteraient davantage d'autres solutions, habituellement d'une meilleure coordination des soins de base. Toutefois, cela vaudrait la peine de faire davantage de recherche afin de distinguer les deux groupes. Dans un cas comme dans l'autre, il faudrait donner des soins au bon moment, en plus de déterminer la nécessité de fournir des soins d'urgence ou des soins de courte durée; d'évaluer le...

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