EMS World

AUG 2016

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54 AUGUST 2016 | EMSWORLD.com Tr a i n i n g R e a l i t i e s In the early 1990s, Acadian Ambulance in Louisiana analyzed its customer base and took the initiative to develop a highly interactive course known as "Carpe Diem," which focuses on the geriatric patient's distinct social, physical and cognitive needs. Class participants utilize training aids to mimic hearing loss, vision loss and even muscular degeneration and then have classmates assist them in daily functions such as walking and eating. Similarly, the National Association of Emergency Medical Technicians (NAEMT) offers the Geriatric Education for Emergency Medical Services (GEMS) course. While maintaining a scenario-based approach with emphasis on the uniqueness of the geriatric popula- tion, GEMS lectures include slides that highlight geriatric- specific content that EMS providers must know, such as fall prevention, epidemiology, polypharmacy and more. According to NAEMT, future geriatric-specific initiatives include an all-scenario-based class to supplement the one-day GEMS class, a lecture on unique geriatric chal- lenges in a disaster, and a lecture on mobile integrated healthcare-community paramedicine (MIH-CP) and the opportunity to make a difference with older patients. EMS agencies should ensure classes like these are mandatory for personnel. A merica is aging. Between 2010 and 2030, the number of older Americans is expected to dou- ble, to 72.1 million. This will mean that for the first time in history, people over 65 will outnumber children under the age of 5. The geriatric population, defined as persons 65 years or older, numbered 44.7 million in 2013 (the latest year for which data is available). This represents 14.1% of the population, or about one in every seven Americans. This will grow to 21.7% of the population by 2040. 1 This means by 2040, one out of every five persons in the U.S. will be over 65. The older population itself is also increas - ingly older—we are seeing more adults in the age categories above 65, specifically the 65–74, 75–84 and 85+ age groups. EMS Specifics Is your EMS agency ready for this paradig- matic shift and what it means for utilization of your service, the types of calls you will see, the need for greater interaction with social services and even potential changes to clinical protocols? Patients 65 and older utilize EMS twice as often as younger populations. 2 Americans over 85 use it three times as much. 3 That both these population groups are increasing will have significant impact on your call volume. The increasing geriatric population will also translate into a need for geriatric- specific training programs, understand- ing how the facilities that typically house geriatric patients operate and even studying utilization patterns for geriatric residents. One study called attention to the minimal training EMS providers receive specific to geriatrics and revealed that many EMS pro- viders do not understand geriatric-specific needs regarding communication and psy- chosocial issues. 4 The aforementioned increase in over- all population numbers could potentially impact the number of calls received and amount of time your units spend on scene, as these calls for chronic medical issues are more clinically intricate. One statewide study showed the proportion of patients using EMS to reach emergency departments increased steadily with age and estimated, by the year 2030, older patients will account for approximately half of all EMS transports to North Carolina's EDs. 5 These trends were further confirmed by the CDC's National Hospital Ambulatory Medical Care Sur- vey from 2009–2010, which showed the percentage of ED visits made by nursing home residents, patients arriving by ambu- lance and patients admitted to the hospital increased with age. Most Common Emergencies Elders report using EMS because of immo- bility, perceived medical needs or requests by others. Similarly, the presence of acute illness symptoms, older age and poor social and physical function, rather than health beliefs, predicts EMS use among elders. These factors must be considered when managing the demand for EMS services. A review of the most common traumatic and medical emergencies this population encounters is in order. Per the National EMS Information Systems (NEMSIS), in 2014, 45% of all calls for EMS were from patients 65 or older, and females comprised 54% of these patients. NEMSIS also identified the most common geriatric emergencies, based on provider impression, that year as follows: » Traumatic injury 10%; » Respiratory distress 8%; » Syncope/fainting 6%; » Abdominal pain/problems 6%; » Altered level of consciousness 5%. Geriatric patients are at increased risk of morbidity and mortality when experi- encing trauma. Although they currently account for just 12.5% of the population, they account for one-third of all traumatic deaths. 6 The types of trauma seen most fre- quently in the elderly are blunt trauma from falls, motor vehicle crashes and pedestrians struck by automobiles. Falls are responsible for half of all accidental deaths in the elderly and are a common cause of head injuries. There are various reasons why the elderly fall. Envi- ronmental factors may include stairways without handrails, slippery bathtubs, slip- ping rugs, steep steps or improperly fitting footwear. There are also a number of medi- cal reasons why the elderly fall. The most common are dizziness, side effects from The increa sing geriatric population will al so translate into a need for geriatric-specific training programs.

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