EMERGENCY MEDICAL SERVICES USE BY THE ELDERLY: ANALYSIS OF A STATEWIDE DATABASE

Background. Elderly patients use emergency medical services (EMS) at a high rate. Objectives. To test the hypothesis that EMS use for emergency department (ED) transports increases across the life span and to estimate changes in the EMS volume in North Carolina (NC) during the next 20 years due to the aging of the population. Methods. We conducted a retrospective observational study of EMS transports to EDs in the state of NC in 2007. Data were obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), which records data for all visits to 105 of the 112 EDs in the state. The association between EMS use and age was assessed using the chi-square test for trend. State demographic projections (U.S. Census Bureau) were used to estimate the increase in EMS use over the next 20 years due to population aging. Results. There were 3,853,866 NC ED visits recorded in 2007. Complete arrival and disposition data were available for 2,743,221 visits (71.2%). Patient visits with and without complete data were similar in mean age (37.4 vs. 37.8 years), percentage female (55.4% vs. 56.1%), and use of EMS (16.9% vs. 16.8%). Visits with complete data were used in the analyses. The proportion of ED visits in which the patient was brought by EMS increased steadily across the life span (p < 0.001). Visits by individuals 65 years of age or older accounted for 14.7% of all visits and 38.3% of all EMS transports to the ED. For those patients aged 85 years and older, EMS was the most common mode of ED arrival (60.6%). We estimate that by 2030, total EMS transports to NC EDs will increase by 47%. Patients 65 years of age and older are projected to account for 70% of this increase and to compose 49% of all EMS transports by 2030. Conclusions. The proportion of patients using EMS to reach NC EDs increases steadily with age. By 2030, older patients will account for approximately half of EMS transports to NC EDs. The changes likely exemplify national trends and highlight the growth of EMS service needs for the elderly and the importance of emphasizing geriatric care in EMS training.