Duong Hieu V, Herrera Lauren Nicholas, Moore Justin Xavier, Donnelly John, Jacobson Karen E, Carlson Jestin N, Mann N Clay, Wang Henry E
Prehosp Emerg Care. 2018 Jan-Feb;22(1):7-14. doi: 10.1080/10903127.2017.1347223. Epub 2017 Sep 1.
Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States.
We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses.
During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71-1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96-1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96-3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00-2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium.
One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.
65岁及以上的老年人经常需要急诊护理。然而，仅有有限的全国性数据描述了为老年人提供的紧急医疗服务（EMS）。我们试图确定美国为老年人提供的EMS护理的特征。
我们使用了2014年国家紧急医疗服务信息系统（NEMSIS）的数据，其中包括来自46个州和地区的EMS响应数据。我们排除了针对18岁以下儿童的EMS响应、机构间转运、拦截、非紧急医疗转运和待命响应。我们将老年人定义为年龄≥65岁。我们比较了老年和年轻成人EMS紧急9-1-1响应之间的患者人口统计学特征（年龄、性别、种族、主要支付方）、响应特征（调度时间、地点类型、时间间隔）和临床过程（临床印象、损伤、操作、药物）。
在研究期间，共有20,212,245次EMS紧急响应。在16,116,219次成人EMS响应中，有6,569,064名（40.76%）老年人和9,547,155名（59.24%）年轻人。老年EMS患者更有可能是白人，且EMS事件更有可能发生在医疗机构（诊所、医院、养老院）。与年轻患者相比，老年EMS患者更有可能出现晕厥（5.68%对3.40%；OR 1.71；CI：1.71 - 1.72）、心脏骤停/心律失常（3.27%对1.69%；OR 1.97；CI：1.96 - 1.98）、中风（2.18%对0.74%；OR 2.99；CI：2.96 - 3.02）和休克（0.77%对0.38%；OR 2.02；CI：2.00 - 2.04）。对老年人进行的常见EMS干预包括建立静脉通路（32.02%）、12导联心电图检查（14.37%）、心肺复苏（0.87%）和插管（2.00%）。给老年人使用的最常见的EMS药物包括肾上腺素、阿托品、呋塞米、胺碘酮以及沙丁胺醇或异丙托溴铵。
美国每三次EMS紧急响应中就有一次涉及老年人。EMS人员必须做好照顾老年患者的准备。
