OBJECTIVE Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provide to older adults in the United States. METHODS We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals) and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency “911” responses. RESULTS During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71–1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96–1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96–3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00–2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%) and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. CONCLUSION One of every three US EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.

Abstract:The ultimate goal of this multi-article series is to develop a methodology to generate continuous fields of tree height and biomass. The first paper demonstrated the need for Allometric Scaling and Resource Limitation (ASRL) model optimization and its ability to generate spatially continuous fields of tree heights over the continental USA at coarse (1 km) spatial resolution. The objective of this second paper is to provide an assessment of that approach at site scale, specifically at 12 FLUXNET sites where more accurate data are available. Estimates of tree heights from the Geoscience Laser Altimeter System (GLAS) waveform data are used for model optimization. Amongst the five possible GLAS metrics that are representative of tree heights, the best metric is selected based on how closely the metric resembles field-measured and Laser Vegetation Imaging Sensor tree heights. In the optimization process, three parameters of the ASRL model (area of single leaf, α; exponent for canopy radius, η; and root absorption efficiency, γ) are simultaneously adjusted to minimize the difference between model predictions and observations at the study sites (distances to valid GLAS footprints ≤ 10 km). Performance of the optimized ASRL model was evaluated through comparisons to the best GLAS metric of tree height using a two-fold cross validation approach (R 2 = 0.85; RMSE = 1.81 m) and a bootstrapping approach (R 2 = 0.66; RMSE = 2.60 m). The optimized model satisfactorily performed at the site scale, thus corroborating results presented in part one of this series. Future investigations will focus on generalizing these results and extending the model formulation using similar allometric concepts for the estimation of woody biomass.

A methodology to generate spatially continuous fields of tree heights with an optimized Allometric Scaling and Resource Limitations (ASRL) model is reported in this first of a multi-part series of articles. Model optimization is performed with the Geoscience Laser Altimeter System (GLAS) waveform data. This methodology is demonstrated by mapping tree heights over forested lands in the continental USA (CONUS) at 1 km spatial resolution. The study area is divided into 841 eco-climatic zones based on three forest types, annual total precipitation classes (30 mm intervals) and annual average temperature classes (2 °C intervals). Three model parameters (area of single leaf, α, exponent for canopy radius, η, and root absorption efficiency, γ) were selected for optimization, that is, to minimize the difference between actual and potential tree heights in each of the eco-climatic zones over the CONUS. Tree heights predicted by the optimized model were evaluated against GLAS heights using a two-fold cross validation approach (R 2 = 0.59; RMSE = 3.31 m). Comparison at the pixel level between GLAS heights (mean = 30.6 m; standard deviation = 10.7) and model predictions (mean = 30.8 m; std. = 8.4) were also performed. Further, the model predictions were compared to existing satellite-based forest height maps. The optimized ASRL model satisfactorily reproduced the pattern of tree heights over the CONUS. Subsequent articles in this series will document further improvements with the ultimate goal of mapping tree heights and forest biomass globally.

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