© Borgis - New Medicine 4/2003, s. 100-103
Radoslaw Owczuk, Magdalena A. Wujtewicz, Wioletta Sawicka, Maria Wujtewicz, Maria Szlyk-Augustyn, Anna Wadrzyk
Analysis of causes of Emergency Medical Service resuscitation teams being called to elderly patients
Department of Anaesthesia and Intensive Care,Medical University of Gdansk, Poland
Head: Maria Wujtewicz, MD, PhD
In this study we have analysed the causes of Emergency Medical Service resuscitation teams being called to persons aged over 70 years during the year of 2001 in the city of Gdańsk. A total of 2016 call constituted 18.22% of all prehospital emergency medical interventions during the period. More female (60.81%) than male patients required aid. Medical and neurological problems predominated among the causes of EMS calls. Chest pain was the call reason in 20.88% of patients, and dyspnoea and simple fainting in 16.17% and 15.53% of cases respectively. Unconsciousness was recorded in 14.88%, brain stroke in 4.56% of patients. The number of EMS visits to persons with injuries was much lower, and constituted only 4.38% of all calls. During the period 22 effective CPRs were provided and 135 deceases occurred before EMS arrival. In 88.6% of cases the cause of calling was consistent with the actual situation found at the site.
Constant medical progress results in the acceleration of population ageing. In the USA during a five-year period an increase in the number of admissions of elderly patients to emergency departments was observed (1). It is believed that in an emergency medical intervention in a person over 65 years old, probability of his/her admission to hospital is five times higher than in a younger persons; similarly, the chance of admission of an elderly patient to the intensive care department is five times greater (2). Similar problems are observed in Poland, but there is a lack of publications about the use of Emergency Medical Service (EMS) by elderly patients in our country.
MATERIAL AND METHODS
All Emergency Medical Service resuscitation team calls to persons over 70 years of age during 2001 in Gdańsk were subject to this analysis. Analysed data included: patient age, cause of the call, and consistency of the causes for calling and the actual findings at the site. In 2001, the emergency resuscitation service was supplied in Gdańsk and area by 5 teams. In the year, there were approx. 400,000 persons registered in the area covered by the Gdańsk EMS Station.
The fact of a patient´s admission was considered the measure of efficacy of cardiopulmonary resuscitation. Consistency of the cause for calling and the actual event was noted positive when the reason for calling was part of the clinical diagnosis, and patient´s state or symptoms might have changed before the arrival of the EMS team.
In 2001 the 5 teams at the EMS Station in Gdańsk supplied medical services in 31 930 cases, of which 11 063 interventions were effected by resuscitation teams. In 2016 cases services concerned persons over 70 years, which made up 18.22% of the resuscitation teams (R) interventions. Women constituted 60.81% of patients and men 39.19%.
The age of patients ranged from 70 to 100 years (mean age 77.3 years; SD 5.72). The percentages of respective age groups are presented in table 1.
Table 1. Characteristics of patients´ age in the analysed group.
|Age group||70-74 yrs||75-79 yrs||80-84 yrs||85-89 yrs||90-94 yrs||95-99 yrs||100 yrs|
|Number of patients (%)||748 (37.1%)||600 (29.8%)||404 (20.0%)||188 (9.3%)||65 (3.2%)||10 (0.5%)||1 (0.05%)|
Distribution of the R teams´ callings in subsequent months is shown in figure 1.
Fig 1. Number of calls for EMS by month.
Causes of calls are listed by quantity in table 2.
Table 2. Cause of calling for EMS in view of mean patient age, standard deviation of age, and sex.
|Cause of calling||Number of patients||% of patients||Mean age
(incl. cardiac pain, retrosternal pain)||421||20.88||76.82 (5.26)||268 / 153|
|Dyspnoea||326||16.17||77.60 (5.66)||178 / 148|
|Fainting||313||15.53||77.29 (6.05)||213 / 100|
|Unconsciousness||300||14.88||77.49 (6.01)||177 / 123|
of stroke, paresis)||92||4.56||78.52 (5.85)||58 / 34|
|Asthma||91||4.51||75.25 (4.37)||55 / 36|
|Digestive tract haemorrhage||44||2.18||77.59 (5.86)||21 / 23|
|Loss of contact
with a person||43||2.13||78.37 (6.56)||29 / 14|
|Arrhythmia||42||2.08||76.40 (4.33)||28 / 14|
|Hit by a vehicle||27||1.34||76.50 (4.67)||13 / 14|
|Head injury||26||1.29||78.40 (6.57)||10 / 16|
|Coma||23||1.14||79.70 (7.21)||13 / 10|
|Hypertension||22||1.09||77.23 (5.73)||18 / 4|
(incl. epileptic fit)||21||1.04||77.00 (6.21)||10 / 11|
|Fall from height||17||0.84||77.65 (6.61)||12 / 5|
|Decease?||16||0.79||79.63 (5.2)||7 / 9|
|Lying in the street||12||0.59||76.58 (6.35)||5 / 7|
|Pulmonary oedema||11||0.55||80.09 (5.92)||6 / 5|
|Traffic accident||11||0.55||77.45 (4.37)||6 / 5|
|Rattling breath||8||0.4||80.25 (7.54)||2 / 6|
|Beaten person||7||0.35||72.1 (3.52)||4 / 3|
|Cyanosed person||6||0.3||81.33 (3.89)||3 / 3|
|Dying||6||0.3||79.33 (3.88)||4 / 2|
|Agony||4||0.2||79.75 (8.42)||3 / 1|
|Does not breathe||3||0.15||76.00 (4.58)||2 / 1|
|Others||124||6.16||77.86 (5.66)||81 / 43|
The specificity of the R team tasks in the emergency medical system is indicated by the gravity of the cause for a call. The teams are sent to persons in whom the Despatch Manager at the EMS station suspects a direct life– and health-threatening incident. Among these are priority situations, for which the knowledge, skills and medical supplies of the R team may determine the patient´s survival. To our belief, the causes presented below are such priorities. Together with the causes for call and their numbers, diagnoses made at the event sites are noted as well as numbers of patients with given diagnoses (in brackets):
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