An evaluation of paramedics' ability to screen older adults during emergency responses.

OBJECTIVES: This study evaluated the feasibility of using the emergency medical services (EMS) system as a public health provider by having paramedics screen older adults (age >or= 65 years) for influenza immunization status during emergency responses. It also determined the proportion of older-adult EMS patients who lacked an influenza vaccination. METHODS: A retrospective descriptive study was performed, with medical-record review for patients treated between January 2003 and April 2003. Patients were included if they were age 65 years and older, requested assistance via a 9-1-1 call, and were treated by one of 13 paramedics using a directed medical record. The authors calculated the proportion of patients successfully screened and the proportion who reported being nonimmunized. They also compared the patients screened and not screened by the EMS providers and patients who reported being immunized and reported being nonimmunized. RESULTS: Two hundred eighty-eight patients were eligible; the median age was 80 years, 53% were women, 73% were white, and 59% required advanced life support care. Paramedics successfully screened 177 patients (61%; 95% CI, 56-67%). Sixty-five patients (37%; 95% CI, 30-44%) reported being nonimmunized. Failure to screen was associated with a Glasgow Coma Scale score of 13 or less. Lack of immunization was associated with younger age and female gender. CONCLUSION: Paramedics can screen a majority of older adults for influenza immunization status during emergency responses. Older adult users of EMS reported lacking influenza vaccination at levels similar to national estimates. An EMS-based, paramedic-implemented screening program has the potential to identify older adults at risk for preventable illnesses and to augment traditional screening programs, but additional measures are needed to enhance screening rates.

Family perspective of medical care and grief support after field termination by emergency medical services personnel: a preliminary report.

OBJECTIVE: To determine the acceptance by family members regarding nontransport of patients in cardiac arrest following unsuccessful resuscitation occurring in private residences. METHODS: This was a survey with a structured telephone interview. Inclusion criteria included adult patients in asystolic nontraumatic cardiac arrest. The setting was an urban multitiered emergency medical services (EMS) system. Termination of field resuscitation efforts was authorized by an emergency medicine physician at a medical control base station after set protocol criteria. Support services were provided by trained personnel. RESULTS: Thirty-three follow-up interviews were completed with a family member. Thirty-two (97%) of the contacted family members expressed satisfaction with the services provided by EMS personnel. Twenty-one (64%) patients were not transported to the hospital. All 21 family members of the nontransported were satisfied with both the medical care and the emotional support provided by EMS. Additionally, family members of three of the 12 (25%) transported patients stated they would have preferred to have the patient die at home instead of being transported. CONCLUSIONS: In this small sample, family members accept the nontransport of patients by trained EMS personnel after asystolic nontraumatic cardiac arrest occurring in private residences. This may positively impact emergency department resources for other critically ill patients.