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Background Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. Methods Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011–2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. Results The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly ( p  = 0.16) over the study period, 90-days ( p  = 0.03) and 180-days ( p  = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). Conclusions Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.

Introduction Early recognition of an acute myocardial infarction (AMI) can increase the patient's likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender. Hypothesis/Problem No studies currently exist that describe the EMD's ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers. The retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah. Overall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels. Acute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick Person and Unconscious/Fainting. The 35-year age cutoff for assignment to higher priority levels is strongly supported. The Falls and Sick Person Protocols offer opportunities to capture atypical AMI presentations. Clawson JJ , Gardett I , Scott G , Fivaz C , Barron T , Broadbent M , Olola C . Hospital-confirmed acute myocardial infarction: prehospital identification using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29-35.

Background and Purpose: Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire. Methods: We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression. Results: Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21). Conclusions: These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions.

Research into the health impacts of heat has proliferated since 2000. Temperature increases could exacerbate the increased heat already experienced by urban populations due to urbanization. Heat-related mortality studies have found that hot southern cities in North America have not experienced the summer increases in mortality found in their more northern counterparts. Heat-related morbidity studies have not assessed this possible regional difference. This comparison study uses data from emergency 911 dispatches [referred to as heat-related dispatches (HRD)] identified by responders as heat-related for two United States cities located in different regions with very different climates: Chicago, Illinois in the upper midwest and Phoenix, Arizona in the southwest. Phoenix’s climate is hot and arid. Chicago’s climate is more temperate, but can also experience days with unusually high temperatures combined with high humidity. This study examines the relationships between rising HRD and daily temperatures: maximum (Tmax); apparent (ATmax): minimum (Tmin) and two energy balance indices (PET and UTCI). Phoenix had more HRD cumulatively, over a longer warm weather season, but did not experience the large spikes in HRD that occurred in Chicago, even though it was routinely subjected to much hotter weather conditions. Statistical analyses showed the strongest relationships to daily ATmax for both cities. Phoenix’s lack of HRD spikes, similar to the summer mortality patterns for southern cities, suggests an avenue for future research to better understand the dynamics of possible physiological or behavioral adaption that seems to reduce residents’ vulnerability to heat.

[...]natural disasters themselves can damage mobile phone networks, limiting their coverage, data utility, and data availability, while damage to power grids limit users' ability to recharge their handsets. [...]the density of masts is usually tightly correlated with residential population density, meaning that displacements into rural areas, where masts are often hundreds of kilometres apart, are difficult to track accurately. [...]the representativeness of mobile phone data remains an important question both in disaster situations and more generally.

Aims Ambulance services in England receive around 8 million calls a year, and no known studies have explored characteristics of frequent callers. This study aimed to identify the characteristics of the most frequent callers to Yorkshire Ambulance Service (YAS) between April 2010 and March 2011. Methods Top 100 frequent callers to YAS were analysed using population comparison, case control and multiple regression methods. 7808 calls were made by the frequent callers, and data were analysed to predict total number of calls made, and explore characteristics of frequent callers. Results Six call codes were associated with a higher number of calls. Frequent callers were assigned slower response levels, or often no call code. Calls increased during the times of 4:00–9:00, 16:00–20:00 and 22:00–2:00, and in the months of December, January and February. Men and patients with all but the very highest conveyance rates had a higher number of different reasons for calling. Patients with a medical diagnosis were more likely to be conveyed, while patients with a psychiatric classification had a higher number of different reasons for calling, were older and were more likely to call for ‘assault/sexual assault’ or ‘haemorrhage/laceration’. Conclusions Frequent callers to YAS were a heterogeneous group that differed from the overall population served, resulting in numerous implications for the delivery of services for this group of patients. Further research is required to determine if and how frequent callers differ from frequent attenders at emergency departments.

The aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs. Our model is based on initial telephone triage of potential candidates for an intravenous thrombolysis by an emergency physician before a 3-party conference including basic life support team on scene and a stroke neurologist. We performed a time series analysis for a period of 5 years and a half, comparing the number of emergency telephone calls with that of intravenous thrombolysis treatment realized. In our organizational model, repeated awareness public campaigns increased both the number of emergency calls for suspected stroke and the selection of potential candidates for intravenous thrombolysis. Results from the time series analysis suggest that educational campaigns are a major factor influencing our emergency medical service activity. This result is correlated with the number of performed intravenous thrombolyses by the stroke center especially within a 3-hour delay (Spearman ρ, P = .621, P = .000 and P = .439, P = .000, respectively). Educational programs repeated each year are useful to the population for learning how to recognize stroke symptoms and send straight away an emergency call. Combining the emergency action with an early remote evaluation by the stroke center team and a direct admission in imaging department shortens the time-to-treatment delay. This model is reproducible in different health care systems.

Effective communication during a medical emergency is crucial for an appropriate emergency medical services (EMS) response. This exploratory qualitative study explored intentions to use 9-1-1 in a Chinese speaking community and the barriers and facilitators to accessing EMS. Focus groups with Chinese adults who self-reported limited English proficiency were conducted. An inductive iterative approach was used to categorize and connect themes identified in the discussions. Language difficulties, negative perceptions of EMS, perceived costs of using emergency services, and no previous experience with 9-1-1 were commonly described as barriers to calling EMS during emergencies. Positive past experiences with EMS and encountering an emergency situation perceived as too great to manage alone are common facilitators for calling 9-1-1. Further exploration is necessary to assess barriers to calling 9-1-1 unique to specific communities, test findings, and tailor interventions to improve EMS communication.

IntroductionThe increasing demands made on emergency ambulance services contribute to inefficient, clinically inappropriate health care, and may delay the provision of emergency care to life-threatening cases. The hypothesis of this study was that the activity for the first year of operation of an emergency telephone consultation service contributed to a reduction in ambulance use in non-urgent cases and a decrease in the cost associated with despatching ambulances.MethodsThe numbers of ambulance use and the emergency hospitalisation of ambulance cases were compared before and after the introduction of the Tokyo Emergency Telephone Consultation Centre (the #7119 centre). Public awareness of the #7119 centre in each region of Tokyo and the cost related to despatching ambulances were also investigated.ResultsA total of 26 138 consultations was performed in the initial year. Compared with the previous year, the number of ambulance uses per 1 million people decreased (before 46 846, after 44689, p<0.0001). The emergency hospitalisation rate (EHR) of ambulance cases increased significantly because of the decreased proportion of non-urgent cases (before 36.5%, after 37.8%, p<0.0001). There was a statistical correlation between the awareness rate in each region and the change of after-hours EHR in adults (R=0.333, p=0.025). The total cost related to despatching ambulances was reduced by approximately ¥678 000 000 (£4 520 000) in the initial year.ConclusionTo date, the emergency telephone consultation service has contributed to the appropriate use of ambulances and a reduction of its cost in Tokyo.

Background As the demographic of older people continues to grow, health services that support independence among community-dwelling seniors have become increasingly important. Personal Emergency Response Systems (PERS) are medical alert systems, designed to serve as a safety net for seniors living alone. Health care professionals often recommend that seniors in danger of falls or other medical emergencies obtain a PERS. The purpose of the study was to investigate the experience of seniors living with and using a PERS in their daily lives, using a qualitative grounded theory approach. Methods Five focus groups and 10 semi-structured interviews, with a total of 30 participants, were completed using a grounded theory approach. All participants were PERS subscribers over the age of 80, living alone in a naturally occurring retirement community (NORC) with high health service utilization in a major urban centre in Ontario. Constant comparative analysis was used to develop themes and ultimately a model of why and how seniors obtain and use the PERS. Results Two core themes, unpredictability and decision-making around PERS activation, emerged as major features of the theoretical model. Being able to get help and the psychological value of PERS informed the context of living with a PERS. Conclusions A number of theoretical conclusions related to unpredictability and the decision-making process around activating PERS were generated.