# Refusal of Emergency Medical Transport After a Fall: Patient Characteristics and Outcomes of Repeat Callers

## TL;DR

This study finds that patients who refuse EMS transport after a fall are more likely to return to the emergency department or be hospitalized, suggesting a need for better follow-up care.

## Contribution

The study identifies repeat EMS callers as a high-risk group for future ED visits and hospitalizations, offering a novel approach to EMS-based patient risk stratification.

## Key findings

- Repeat callers and super-users had significantly higher odds of 30-day and six-month ED visits and hospitalizations.
- No significant differences in one-year mortality were observed between repeat callers and super-users.
- Repeat callers were more likely to be on anticoagulation/antiplatelet therapy and non-ambulatory.

## Abstract

Lift assistance represents a high proportion of emergency medical services (EMS) calls, yet data is limited regarding the long-term outcomes of these patients who subsequently refuse transport. In this study, our objective was to examine the outcomes of patients who require lift assistance but refuse transport and to determine factors associated with repeated EMS utilization.

We conducted a retrospective, observational cohort study of EMS calls in southern New Jersey in patients ≥18 years of age who declined EMS transport after a fall between July 1, 2021–July 1, 2022. Repeat callers were defined as making one additional call within 30 days, and we defined super-users as those making ≥four calls within six months. The primary outcome was repeat emergency department (ED) visits within 30 days from the initial transport refusal visit.

We analyzed 116 of 203 (57%) patients. The mean patient age was 66.3 years, and 53.6% were female. Forty-seven (37.9%) patients were repeat callers, and 27 (21.8%) were super-users. Repeat callers and super-users had increased odds of 30-day ED visits (odds ratio [OR] 17.2, 95% confidence interval [CI] 6.4–47.6, and OR 8.8, 95% CI 3.3–23.7, respectively), and six-month ED visits (OR 4.9, 95% CI 2.2–11.2, and OR 12.9, 95% CI 3.9–56.5). Similarly, there were increased odds of 30-day admission for repeat and super-user callers (OR 6.6, 95% CI 2.5–18.2, and OR 10.8, 95% CI 4.0–29.8, respectively), and six-month admissions (OR 3.0, 95% CI 1.4–6.5,and OR 6.8, 95% CI 2.6–19.9, respectively). No differences in death at one year were observed in either group (repeat callers OR 1.4, 95% CI 0.4–4.5; super-users OR 1.1, 95% CI 0.2–4.1) Repeat callers had higher proportions of anticoagulation/antiplatelet therapy and non-ambulatory status (42.9% vs 61.7%, P=.046 and 29.0% vs 56.8%, P=.006, respectively).

Repeat EMS calls for lift assistance may be used to identify patients at high risk for ED visits and hospitalizations. As patients decline transport, EMS may be their sole healthcare encounter. Future directions would entail training EMS personnel in screening or referring patients for more intensive outpatient interventions.