• Christopher S Evans, Timothy F Platts-Mills, Antonio R Fernandez, Joseph M Grover, Jose G Cabanas, Mehul D Patel, Gary M Vilke, and Jane H Brice.
• Department of Emergency Medicine and School of Medicine, University of California-San Diego, San Diego, CA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC. Electronic address: csevans@ucsd.edu.
• Ann Emerg Med. 2017 Oct 1; 70 (4): 506-515.e3.

Study ObjectiveThe objective of this study is to characterize repeated emergency medical services (EMS) transports among older adults across a large and socioeconomically diverse region.MethodsUsing the North Carolina Prehospital Medical Information System, we analyzed the frequency of repeated EMS transports within 30 days of an index EMS transport among adults aged 65 years and older from 2010 to 2015. We used multivariable logistic regressions to determine characteristics associated with repeated EMS transport.ResultsDuring the 6-year period, EMS performed 1,711,669 transports for 689,664 unique older adults in North Carolina. Of these, 303,099 transports (17.7%) were followed by another transport of the same patient within 30 days. The key characteristics associated with an increased adjusted odds ratio of repeated transport within 30 days include transport from an institutionalized setting (odds ratio [OR] 1.42; 95% confidence interval [CI] 1.38 to 1.47), blacks compared with whites (OR 1.29; 95% CI 1.24 to 1.33), a dispatch complaint of psychiatric problems (OR 1.38; 95% CI 1.25 to 1.52), back pain (OR 1.35; 95% CI 1.26 to 1.45), breathing problems (OR 1.21; 95% CI 1.15 to 1.30), and diabetic problems (OR 1.14; 95% CI 1.06 to 1.22). Falls accounted for 15.6% of all transports and had a modest association with repeated transports (OR 1.07; 95% CI 1.00 to 1.14).ConclusionMore than 1 in 6 EMS transports of older adults in North Carolina are followed by a repeated transport of the same patient within 30 days. Patient characteristics and chief complaints may identify increased risk for repeated transport and suggest the potential for targeted interventions to improve outcomes and manage EMS use.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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