ABSTRACTS
Evaluation of EMS Transport for Out-of-Hospital Falls Among Older Adults in Washington, DCAuthor: Antonio R. Fernandez, PhD, NRP | | Associate Authors: Daniel P. Burke, Remle P. Crowe, Alison Treichel, J. Brent Myers, Scott S Bourn
Introduction Joiner et al. (2022) identified age, racial, and gender disparities in nontransport patterns following EMS activations for older adults who fell in the United States. Initiatives to reduce care disparities begin at the local level. Demographics in Washington, DC (DC) are notably different from the rest of the United States. Objective To describe characteristics associated with transport among older EMS patients who fell in DC. Methods This retrospective study analyzed all 9-1-1 responses submitted to the DC Department of Health with a provider impression or primary injury consistent with a fall and patient age ≥ 60 years from January 1 through December 31, 2022. The study outcome was EMS transport. Patient demographics included gender, age, and race/ethnicity. Rapid Emergency Medicine Scores (REMS) were calculated. Blood glucose measurement (BGL) documentation was evaluated. Incident characteristics included location type and percent poverty by zip code. Descriptive statistics, adjusted odds ratios (aOR), and 95% confidence intervals (95% CI) were calculated. Results A total of 261,996 responses were evaluated, and 2% (4,892) were older adults who fell. Of those, 58% (2,819) were female. Median age was 74 years (IQR: 66–83 years). Most patients were Black (55%, n = 2,700), followed by White (37%, n = 1,799), Hispanic/Latino (5%, n = 185), and other (4%, n = 184). Most incidents occurred in a home/residence (51%, n = 2,516), followed by outdoor/public (40%, n = 1,945), and communal living (9%, n = 426). BGL was documented on 53% (2,606) of records. 51% (n = 3,470) of responses occurred in communities with poverty levels ≥ 15%. Overall, 12% (576) of patients were not transported. There was no statistically significant difference in the odds of transport for gender (male: aOR = 1.04, 95% CI: 0.86–1.25), age (60–69 years: referent; 70–79 years: aOR = 0.82, 95% CI: 0.64–1.03; 80–89 years: aOR = 0.89, 95% CI: 0.87–1.20; ≥90 years: aOR=0.99, 95% CI: 0.67–1.48), race/ethnicity (White: referent; Black: aOR = 0.99, 95% CI: 0.80–1.23; Hispanic/Latino: aOR = 1.24, 95% CI: 0.73–2.07; other: aOR = 0.97, 95% CI: 0.59–1.59), or percent poverty (≥ 5%: referent, 6–15%: aOR = 0.83, 95% CI: 0.57–1.27; 16–25%: aOR = 0.77, 95% CI: 0.47–1.27; ≥ 26%: aOR = 0.86, 95% CI: 0.56–1.31). REMS (aOR = 1.12, 95% CI: 1.05–1.18), and incident location (Home/Residence: referent; Communal Living Facilities: aOR = 2.23, 95% CI: 1.35–3.65; Outdoor/Public: aOR = 0.63, 95% CI: 0.52–0.78) had increased odds of EMS transport. The regression model demonstrated good fit (p = 0.5684). Conclusion In contrast to national trends, there were no disparities in EMS transport among older patients who experienced an out-of-hospital fall in DC with respect to patient demographics or socioeconomic status.
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