Results: The study identified plans for 50/50 States, 29/50 had no EMS specified section, 4/50 had an EMS section 10 % of the total document, the remainder had  10% focused on EMS. SHSPs varied in length from 1 page to 120 pages. EMS representation was not identified on all SHSP development committees. In SHSPs with an EMS section, categories addressed were not consistent across plans. Some focused on EMS training, dispatch and response, others on funding or other issues. One plan in addition to focusing on issues of dispatch and training also had a specific section focused on the safety of EMS providers during transport and on the scene of a highway emergency. No field of EMS focus was common to all plans. Conclusion: The State SHSPs evaluated reflected a varied involvement of EMS representatives, identification of diverse EMS priorities, and varied EMS- related highway safety issues. Although regional variation is expected, involvement of key EMS stakeholders should be standard in the basic development of SHSP. Consideration of uniform recommendations for the core aspects of EMS SHSP components could enhance a more substantive role of EMS in these State plans. 370 National Patterns in Emergency Department Antibiotic Prescribing for Elderly Patients With Urinary Tract Infections, 1996-2005 Weed S, Caterino JM, Espinola JA, Camargo Jr CA/Duke University College of Medicine, Raleigh-Durham, NC; The Ohio State University, Columbus, OH; Massachusetts General Hospital, Boston, MA Study Objectives: Due to the high prevalence of antibiotic resistance in elderly patients with a urinary tract infection (UTI), current practice guidelines recommend treatment with fluoroquinolones and avoidance of trimethoprim-sulfamethoxazole (TMP-SMX) monotherapy in patients 65 and over. To determine the appropriateness of current prescribing practices in emergency department (ED) elders with UTI, we sought to identify rates and trends in prescribing fluoroquinolones and TMP-SMX over the past decade in the elderly as compared to younger adults. Methods: We performed a retrospective analysis utilizing the 1996-2005 National Hospital Ambulatory Medical Care Survey. We included patients aged 18 or older with an ICD-9-CM diagnosis of urinary tract infection or pyelonephritis. Pregnant patients were excluded. Patients were divided in age groups of 18-64 years (“adults”) and 65 years and older (“elders”) for analysis. The primary outcomes were prescription of either TMP-SMX monotherapy or the prescription of a fluoroquinolone. National Drug Code Directory Drug Classes and Codes were used to identify type of antibiotic prescribed. Estimated visit totals and rates with 95% confidence intervals (CIs) of each outcome were calculated for the entire population and by age group. We analyzed trends using weighted linear and logistic regression, with two-tailed p0.05 considered statistically significant. Results: From 1996-2005, there were an estimated 26.3 million (95% CI, 23.9-28.6 million) ED visits diagnosed with a UTI or pyelonephritis, accounting for 3.3% (95% CI, 3.2-3.5%) of all ED visits. 7.5 million (95% CI, 6.7-8.4 million) were =65 years old, an estimated 4.8% (95% CI, 4.5-5.1%) of ED visits by elders. The percentage of ED visits for UTI in both age groups increased during the study period (p for trend 0.001). Overall, an estimated 9.4% (95% CI, 7.9-11%) of elders received TMP-SMX monotherapy as compared to 23% (95% CI, 21-25%) of adults. Both groups demonstrated a trend for decreasing rates of TMP-SMX monotherapy (p for trend in elders =0.031 and in adults 0.001). An estimated 39% of elders (95% CI, 36-42%) and 31% (95% CI, 30-33%) of adults received a fluoroquinolone. Rates in both groups increased over the study period (p for trend 0.001 for both). The percentage of elders receiving a fluoroquinolone increased from 26% (95% CI, 17-36%) in 1996 to 52% (95% CI, 44-61%) in 2005. Conclusion: Elders presenting to the ED with a UTI are less likely to receive TMP-SMX monotherapy than other adults. The percentage of elders receiving TMP- SMX prescriptions has significantly decreased over the past decade. Fluoroquinolone therapy has increased in both elderly and other adult patients; however, elders continue to receive fluoroquinolones more commonly than other adults. ED prescribing trends for elders with UTI are consistent with national guidelines, although complete compliance has not been achieved. 371 Appropriately Screened Geriatric Chest Pain Patients May Be Appropriate for an Emergency Department Observation Unit Bledsoe J, Bossart P, Sugerman, PA-C S, Bernhisel K, Cheng M, Mataoa T, Madsen T/University of Utah, Salt Lake City, UT Study Objective: Observation units may exclude geriatric patients due to the high rate of observation failure (admission to an inpatient unit) among these patients. We evaluated whether geriatric patients (age  65) on a chest pain protocol are admitted to an inpatient unit from an emergency department (ED) observation unit at a higher rate than non-geriatric patients at our 35,000 visits/year ED. Methods: This was a retrospective chart review of all patients admitted to the ED observation unit at the University of Utah Medical Center over the 14-month period from April 2006-June 2007. The observation unit did not exclude geriatric patients, nor did it exclude patients with a history of coronary disease; patients were admitted per the discretion of the attending emergency department physician. Patient information, including age, date of admission, history of coronary disease (defined as a previous myocardial infarction, stent, or coronary artery bypass graft), and admission to an inpatient unit from the observation unit, were recorded. Results were analyzed using chi-square statistics. Results: 134 geriatric patients were admitted to the ED observation unit for chest pain during the study period. 17% of these patients were admitted to an inpatient unit from the observation unit vs. 10.7% of the 394 chest pain patients who were under age 65 (p=0.048). Geriatric patients were more likely to have coronary disease (31.3%) than non-geriatric patients (20.8%, p=0.013). We then performed a subanalysis of the 404 patients (92 geriatric, 312 non-geriatric) who had no history of coronary disease. Geriatric patients without a history of coronary disease had a 12% inpatient admission rate from the observation unit vs. a 7.7% admission rate for non-geriatric patients without a history of coronary disease (p=0.2). Conclusion: Geriatric patients without a history of coronary artery disease were admitted to an inpatient unit at a rate consistent with a generally accepted observation failure rate of 10%. When screened appropriately, these patients may be appropriate for chest pain evaluation in the ED observation unit. 372 Nursing Home-Acquired Pneumonia: Demographics, Outcomes and Antibiotic Usage Kass-Shamoun R, Anderson S, Robinson D, Medado P, Haque N, Zervos MJ, O’Neil BJ/William Beaumont Hospitals, Royal Oak, MI; Henry Ford Hospital, Detroti, MI Study Objectives: Pneumonia is a leading cause of hospitalization and mortality among the elderly in nursing homes with an estimated 1.9 million episodes by 2010. NHAP pathogens are not well defined; however, the IDSA and ATS in 2005 recommend treatment in NHAP like health care-acquired pneumonia. Despite its prevalence, little is known regarding NHAP pts admitted through the ED. Our objective is to investigate the demographics, outcomes and appropriate use of antibiotics (ABX) in NHAP. A retrospective chart review of ED nursing home patients with a final diagnosis of pneumonia was performed at 2 large hospitals. Data was abstracted pre and post the IDSA guidelines. Data abstraction followed the guidelines of Gilbert and Lowenstein. Patient demographics, test results, length of stay, (LOS), treatment and final outcomes were abstracted. Data was analyzed with student t test. Methods: A retrospective chart review of ED nursing home patients with a final diagnosis of pneumonia was performed at 2 large hospitals. Data was abstracted pre and post the IDSA guidelines. Data abstraction followed the guidelines of Gilbert and Lowenstein. Patient demographics, test results, length of stay, (LOS), treatment and final outcomes were abstracted. Data was analyzed with student t test. Results: 302 patients were enrolled with a mean age of 78.3 with 50% males. 16.5% of patients were intubated and 20% died on the initial visit, additionally 7.9% died at 1 yr follow-up. The immunization rate for influenza A was 11.9%, for pneumonia was 15.2% and 27.8% of patients were on ABX at EC visit. Blood cultures were performed on 89% of patients, 17.8% of these had growth and of these 52% were contaminants. Sputum culture was obtained in 27.5% of patients, 85.5% grew bacteria, none of which correlated to blood pathogens. Before and after the IDSA guidelines NHAP was treated 59.4% v 41.3% appropriately, 26.1% v 18.7% as CAP and 46.4% and 33.3% with a single antibiotic, respectively, all had a p  Research Forum Abstracts Volume , .  : October  Annals of Emergency Medicine S155