Başak BAYRAM, Erkan GÜVENÇ, Ahu PAKDEMİRLİ

Evaluation of ambulance calls for patients over 65 years of age in İzmir, Turkey: a twoyear retrospective analysis

Background/aim: Analysis of interventions for special patient groups is important for the planning of health services, especially emergency medical services. In this study, we aimed to evaluate emergency medical service (EMS) interventions for the elderly and determine the decisive factors affecting transfer to the hospital of EMS team over 2 years (2017 and 2018) in İzmir. Materials and methods: Records of 112 emergency calls that were made between 2017 and 2018 followed up with interventions for patients aged 65 years and older were obtained from the 112 system. The reasons for the calls, outcomes, possible diagnoses of the patients, differences in time intervals and seasons, characteristics of the patients transferred to the hospital, and factors affecting the need for transfer to the hospital were investigated. Results: A total of 176,104 elderly patients with a mean age of 78.02 ± 8.0 years required ambulance services, and out of them, 66% were transferred to the hospital. Transfer to the hospital was significantly associated with the event location, sex, time interval, international classification of diseases (ICD) codes, and physical examination findings. Conclusion: Ambulance interventions are more frequently required in urban areas than in the countryside, and calls are mostly made during daytime hours and during winter months. The decision to transfer a patient to the hospital is based on the patient’s respiratory status, skin examination, state of consciousness, pulse, systolic blood pressure, call time, and the preliminary diagnosis of the crew.Key words: Ambulance, aged, emergency medical services, geriatrics

PDF

___

1. Karadas B, Çat H, Ozturk AO, Basat O, Altuntaş Y. Patients admitted to emergency outpatient clinic and kept under observation: a survey of three years. Akad Geriatri 2010; 2: 176-185.
2. Çığşar G, Akkuş Y, Elnare G, Erdemir Öztürk E, Palas MB. Aetiology of emergency department admission of the elderly: a retrospective study in Kars. Turkish Journal of Geriatrics 2016; 19 (1): 19-26.
3. Yenal S, Keser G, Mandıracıoğlu A, Yalçın M, Bayram B et al. The determination of the status of emergency department use by elderly patients and of the indicators for ambulance use. Turkish Journal of Geriatrics 2018; 21 (2): 109-117. doi: 10.31086/tjgeri.2018240412
4. Dinh MM, Muecke S, Russell SB, Chalkley D, Bein KJ et al. Demand for emergency services trends in New South Wales years 2010–2014 (DESTINY): age and clinical factors associated with ambulance transportation to emergency departments. Prehospital Emergency Care 2016; 20 (6): 776- 782. doi: 10.1080/10903127.2016.1182603
5. Noergaard Bech CL, Brabrand M, Mikkelsen S, Lassen A. Patients in prehospital transport to the emergency department: a cohort study of risk factors for 7-day mortality. European Journal of Emergency Medicine 2018; 25 (5): 341-347. doi: 10.1097/mej.0000000000000470
6. Kıdak L, Keskinoğlu P, Sofuoğlu T, Ölmezoğlu Z. The evaluation of 112 emergency ambulance service uses in İzmir. Genel Tıp Dergisi 2009; 19 (3): 113-119 (in Turkish).
7. Keskinoglu P, Sofuoglu T, Özmen O, Gündüz M, Ozkan M. Older people’s use of pre-hospital emergency medical services in Izmir, Turkey. Archives of Gerontology and Geriatrics 2010; 50 (3): 356-360. doi: 10.1016/j.archger.2009.05.019
8. Kahraman Ş. One year analysis and geospatical mapping of 112 emergency health services in İzmir, Turkey. Thesis for specialization in medicine, Dokuz Eylül University, İzmir, Turkey, 2019.
9. Dundar C, Sunter AT, Canbaz S, Cetinoglu E. Emergency service use by older people in Samsun, Turkey. Advances in Therapy 2006; 23 (1): 47-53. doi: 10.1007/BF02850346
10. Unsal A, Ayranci U, Alper Cevik A, Metintas S, Arslantas D et al. Use of emergency departments by elderly patients in a city of Western Turkey. European Journal of Emergency Medicine 2007; 14 (3): 125-129. doi: 10.1097/MEJ.0b013e3280111f99
11. Dundar ZD, Ayranci MK. Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey. Acta Clinica Belgica 2020; 75 (6):405-410. doi: 10.1080/17843286.2019.1655215
12. Sariyer G, Ataman MG, Sofuoğlu T, Sofuoğlu Z. Does ambulance utilization differ between urban and rural regions: a study of 112 services in a populated city, Izmir. Journal of Public Health 2017; 25: 379-385. doi: 10.1007/s10389-017- 0802-7
13. Newgard CD, Fu R, Bulger E, Hedges JR, Mann NC et al. Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services. JAMA Surgery 2017; 152 (1):11- 18. doi: 10.1001/jamasurg.2016.3329
14. Alanazy ARM, Wark S, Fraser J, Nagle A. factors impacting patient outcomes associated with use of emergency medical services operating in urban versus rural areas: a systematic review. International Journal of Environmental Research and Public Health 2019; 16 (10):1728. doi: 10.3390/ijerph16101728
15. Richards JR, Ferrall SJ. Inappropriate use of emergency medical services transport: comparison of provider and patient perspectives. Academic Emergency Medicine 1999; 6 (1):14- 20. doi: 10.1111/j.1553-2712.1999.tb00088.x
16. Jones CMC, Wasserman EB, Li T, Amidon A, Abbott M et al. The effect of older age on ems use for transportation to an emergency department. Prehospital and Disaster Medicine 2017; 32 (3):261-268. doi: 10.1017/S1049023X17000036
17. Wong HT, Lin TK, Lin JJ. Identifying rural-urban differences in the predictors of emergency ambulance service demand and misuse. Journal of the Formosan Medical Association 2019; 118: 324-331. doi: 10.1016/j.jfma.2018.05.013
18. Davis RE, Markle ES, Windoloski S, Houck ME, Enfield KB et al. A comparison of the effect of weather and climate on emergency department visitation in Roanoke and Charlottesville, Virginia. Environmental Research 2020; 191: 110065
19. Bunker A. Wildenhain J, Vandenbergh A, Henschke N, Rocklv J et al. Effects of air temperature on climate-sensitive mortality and morbidity outcomes in the elderly; a systematic review and meta-analysis of epidemiological evidence. EBioMedicine 2016; 6: 258-268.
20. Dwyer R, Gabbe B, Tran TD, Smith K, Lowthian JA. Patterns of emergency ambulance use, 2009–13: a comparison of older people living in residential aged care facilities and the Community. Age and Ageing 2018; 47 (4): 615-619. doi:10.1093/ageing/afy056
21. Cantwell K, Burgess S, Morgans A, Smith K, Livingston M et al. Temporal trends in falls cases seen by EMS in Melbourne: the effect of residence on time of day and day of week patterns. Injury 2016; 47 (1): 266-271. doi: 10.1016/j. injury.2015.10.073
22. Cox S, Roggenkamp R, Bernard S, Smith K. The epidemiology of elderly falls attended by emergency medical services in Victoria, Australia. Injury 2018; 49 (9): 1712-1719. doi: 10.1016/j.injury.2018.06.038
23. Faul M, Stevens JA, Sasser SM, Alee L, Deokar AJ et al. Older adult falls seen by emergency medical service providers: a prevention opportunity. American Journal of Preventive Medicine 2016; 50 (6): 719-726. doi: 10.1016/j.amepre.2015.12.011
24. Mikolaizak AS, Simpson PM, Tiedemann A, Lord SR, Close JC. Systematic review of non‐transportation rates and outcomes for older people who have fallen after ambulance service callout. Australasian Journal on Ageing 2013; 32 (3): 147-157. doi: 10.1111/ajag.12023
25. Snooks HA, Halter M, Close JC, Cheung WY, Moore F et al. Emergency care of older people who fall: a missed opportunity. Quality and Safety in Health Care 2006; 15 (6): 390-392. doi: 10.1136/qshc.2006.018697
26. Dickinson ET, Verdile VP, Kostyun CT, Salluzzo RF. Geriatric use of emergency medical services. Annals of Emergency Medicine 1996; 27 (2): 199-203. doi: 10.1016/s0196-0644 (96)70323-2
27. Bass RR, Alcorta RL, Beachley M, Chang DC. Undertriage of elderly trauma patients to state-designated trauma centers. Archives of Surgery 2009; 144 (1): 91. doi: 10.1001/ archsurg.143.8.776
28. Shenvi C, Platts-Mills T. Managing the Elderly Emergency Department Patient. Annals of Emergency Medicine 2019; 73 (3): 302-307. doi: 10.1016/j.annemergmed.2018.08.426