EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Abstract

Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

“…Whites (OR 1.29 95% CI 1.24–1.33); Table 3). Appendix 1 shows the characteristics of transports associated with repeat or frequent EMS transport using the definition of 5 or more EMS transports in a calendar year as has been used in prior studies by Hall et al 34 Characteristics associated with this alternate outcome were similar to the associations observed for patients with repeat transports within 30 days (Appendix 1). …”

“…Previously published definitions of repeat or frequent EMS use differ 37 including: five or more EMS encounters in one year, 34,38 six or more EMS encounters in a 23 month period, 26 ten or more EMS transports in one year, 39 and three or more EMS transports in one year. 40 We chose to focus on repeat use of EMS within 30 days because 30 days is a commonly used outcome for decision instruments in emergency medicine, 41,42 and is the time frame used by the Centers for Medicare and Medicaid Services as a quality measure for hospital readmissions.…”

“…For example, if a patient has only two transports within the study period, separated by two weeks, the first transport would count as having had a repeat transport within 30 days and the second transport would not count as having had a repeat transport within 30 days. For comparison to prior work by Hall et al, 34 older adults with five or more EMS transports in a calender year were also examined. Lastly, a separate analysis was also performed to estimate the frequency of transport in the 30 days following an initial EMS transport refusal.…”

On-Premise Alcohol Establishments and Ambulance Calls for Trauma, Assault, and Intoxication

“…EMS personnel typically deal with serious injuries and medical conditions arising outside of hospital, some of which are related to alcohol consumption. 37 As shown herein, 2.3% of EMS ambulance calls were for intoxication. One proposed strategy to better deal with the latter is the use of a checklist by EMS personnel, to triage intact individuals directly to a detoxification center.…”

Patient Perspectives on EMS Alternate Destination Models

“…Accordingly, after an extensive literature review, 3,15,18,20,[24][25][26] we developed draft statements describing proposed elements of a more integrated, patient-centered emergency response system. 23 We piloted these statements with patients and staff for clarity and understanding.…”