ADESCRIPTIVE STUDY OF THE “LIFT -ASSIST”CALL David C. Cone, MD, John Ahern, Christopher H. Lee, MD, MS, Dorothy Baker, PhD, Terrence Murphy, PhD, Sandy Bogucki, MD, PhD ABSTRACT Introduction. Responses for “lift assists” (LAs) are common in many emergency medical services (EMS) systems, and result when a person dials 9-1-1 because of an inability to get up, is subsequently determined to be uninjured, and is not transported for further medical attention. Although LAs often involve recurrent calls and are generally not reim- bursable, little is known of their operational effects on EMS systems. We hypothesized that LAs present an opportunity for earlier treatment of subtle-onset medical conditions and injury prevention interventions in a population at high risk for falls. Objectives. To quantify LA calls in one community, describe EMS returns to the same address within 30 days following an index LA call, and characterize utilization of EMS by LA patients. Methods. Data from the computer- aided dispatch (CAD) system of a suburban fire-based EMS system were retrospectively reviewed. All LAs from 2004 to 2009 were identified using “exit codes” transmitted by paramedics after each call. The number and nature of return visits to the same address within 30 days were examined. Results. From 2004 through 2009, there were 1,087 LA re- sponses (4.8% of EMS incidents) to 535 different addresses. Two-thirds of the LA calls (726; 66.8%) were to one-third of these addresses (174 addresses; 32.5%); 563 of the return calls to the same address occurred within 30 days after the index LA. For 214 of these return visits, it was possible to com- pare patient age and sex with those associated with the ini- tial LA, revealing that 85% of return visits were likely for the same patients. Of these, 38.5% were for another LA/refusal of transport, 8.2% for falls and other injuries, and 47.3% for medical complaints. Hospital transport was required in 55.5% of these return visits. The EMS crews averaged 21.5 minutes out of service per LA call. Conclusion. Lift-assist calls are associated with substantial subsequent utilization of EMS, and should trigger fall prevention and other safety interventions. Based on our data, these calls may be early in- dicators of medical problems that require more aggressive Received January 10, 2012 from the Section of EMS, Department of Emergency Medicine (DCC, JA, CHL, SB) and the Section of Geriatrics, Department of Internal Medicine (TM, DB), Yale University School of Medicine, New Haven, Connecticut. Revision received May 29, 2012; accepted for publication June 14, 2012. The authors report no conflicts of interest. Reprints are not available. Address correspondence to: David C. Cone, MD, Yale Univer- sity School of Medicine, Section of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519. e-mail: david.cone@yale.edu doi: 10.3109/10903127.2012.717168 evaluation. Key words: emergency medical services; geri- atrics; accidental falls PREHOSPITAL EMERGENCY CARE 2013;Early Online:1–6 INTRODUCTION When elderly or disabled persons fall or are unable to move from an undesirable position to a preferred one, they may call 9-1-1 for assistance. Often there is no perceived injury or illness, so these individuals do not want medical treatment or transport to the hospi- tal. They simply want responders to physically help them back to a bed, chair, or wheelchair. These calls are locally known as “lift assists.” It is likely that in some percentage of cases, a lift- assist call represents a “sentinel event” or a marker of deterioration in function of the patient. 1 This could be due to an unapparent medical condition such as a urinary tract infection or pneumonia, or could in- dicate a new stage of gradual decline in physical or cognitive capacity related to chronic disease, such as Alzheimer’s disease or osteoarthritis. It could also her- ald a loss of (or ongoing lack of) social support and assistance in activities of daily living. Anecdotally, emergency medical services (EMS) providers report frequently returning to the same address in the days, weeks, or even hours following an initial lift assist, either for another lift assist, or for a more serious problem such as a fall with injury, or a medical emergency, often resulting in transport to the emergency department (ED). In the case of older patients, there is considerable expense associated with a trip to the ED because these patients receive a greater number of diagnostic tests, remain in the ED longer, have higher ED charges, 2 and are more likely to be admitted to acute or intensive care units. 3 Perhaps the lift-assist call can be used to trigger interventions to help prevent the “next call,” thereby improving the quality of care and reducing the use of financial resources. Screening of elders has been advocated by national organizations as a key component of high-quality geriatric emergency care; 4 perhaps such screening should begin in the field, at the patient’s home. Since at least one vehicle and crew must respond to each lift-assist call in order to locate and assess the patient and resolve the problem, lift assists consume EMS resources. In some cases, multiple vehicles and personnel must respond to these calls. Examples in- clude bariatric patients who cannot be safely lifted by 1 Prehosp Emerg Care Downloaded from informahealthcare.com by Yale Dermatologic Surgery on 10/01/12 For personal use only.