Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 1314 (2015)

Increasing prehospital emergency medical service interventions for nursing home residents

  • Pierre-Nicolas Carron
  • Fabrice Dami
  • Bertrand Yersin
  • Valérie Toppet
  • Bernard Burnand
  • Valérie Pittet
Cite this as:
Swiss Med Wkly. 2015;145:w14126


QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013.

METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories.

RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65–79 (10.2, 95% confidence interval [CI] 6.2–14.2), 80–89 (16.5, 95% CI 14.0–19.0) and over 90 (12.1, 95% CI 5.8–18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton.

CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.


  1. Demographic change in the Euro Area: projections and consequences. In: Monthly Bulletin, European Central Bank (ECB). Frankfurt am Main: European Central Bank, 2006; pp 49–64.
  2. Roberts DC, McKay MP, Shaffer A. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med. 2008;51:769–74.
  3. Vilpert S, Jaccard-Ruedin H, Trueb L, Monod-Zorzi S, Yersin B, Büla C. Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss University hospital. BMC Health Serv Res. 2013;13:344.
  4. Conroy S, Van der Cammen T, Schols J, Van Balen R, Peteroff P, Luxton T. Medical services for older people in nursing homes – comparing service in England and the Netherlands. J Nutr Health Aging. 2009;13:559–63.
  5. NHS England Analytical Service. Improving general practice – a call to action. NHS England August 2013/14.
  6. Wang HE, Shah M, Allman RM, Kilgore M. Emergency department visits by nursing home residents in the United States. J Am Geriatr Soc. 2011;59:1864–72.
  7. Falconer M, O’Neill D. Profiling disability within nursing homes: a census-based approach. Age Ageing. 2007;36:209–13.
  8. Arendts G, Reibel T, Codde J, Frankel J. Can transfers from residential aged care facilities to the Emergency Department be avoided through improved primary care services? Data from qualitative interviews. Austral J Ageing. 2010;29:61–5.
  9. Frank C, Seguin R, Haber S, Godwin M, Stewart GI. Medical directors of long-term care facilities. Preventing another physician shortage? Can Fam Physician. 2006;52:752–3.
  10. Lowthian JA, Cameron PA, Stoelwinder JU, Curtis A, Currel A, Cooke MW, McNeil JJ. Increasing utilization of emergency ambulances. Austral Health Rev. 2011;35:63–9.
  11. Zakariassen E, Burman RA, Hunskaar S. The epidemiology of medical emergency contacts outside hospitals in Norway – a prospective population based study. Scand J Trauma Resusc Emerg Med. 2010;18:9.
  12. Platts-Mills TF, Leacock B, Cabanas JG, Shofer FS, McLean SA. Emergency medical services use by the elderly: analysis of a statewide database. Prehosp Emerg Med. 2010;14:329–33.
  13. Josseaum J, Duchateau FX, Burnod A, Pariente D, Beaune S, Leroy C, et al. Observatory of the elderly over 80 years supported by the mobile emergency and resuscitation service. Ann Fr Anesth Reanim. 2011;30:553–8. Article in French
  14. Pittet V, Burnand B, Yersin B, Carron P-N. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis. BMC health services research. 2014;14(1):380.
  15. Weiss M, Bernoulli L, Zollinger A. The NACA scale. Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients. Der Anaesthesist. 2001;50(3):150–4. German.
  16. Deasy C, Bray JE, Smith K, Harris LR, Bernard SA, Davidson PM, et al. Resuscitation of out-of-hospital cardiac arrests in residential aged care facilities in Melbourne, Australia. Resuscitation. 2012;83:58–62.
  17. Melby V, Ryan A. Caring for older people in prehospital emergency care: can nurses make a difference. J Clin Nursing. 2005;14:1141–50.
  18. Mason S, Knowles E, Colwell B, Dixon S, Wardrope J, Gorringe R, et al. Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomized controlled trial. BMJ. 2007;335:919.
  19. Vicente V, Sjöstrand F, Sundström BW, Svensson L, Castren M. Developing a decision support system for geriatric patients in prehospital care. Eur J Emerg Med. 2013;20:240–7.
  20. Leroy C, Ricard-Hibon A, Chollet C, Marty J. Out-of-hospital management of elderly patients. Ann Fr Anesth Reanim. 2003;22:183–8. French.
  21. Simpson PM, Bendall JC, Patterson J, Tiedemann, Middleton PM, Close J. Epidemiology of ambulance responses to older people who have fallen in New South Wales, Australia. Austral J Ageing. 2013;32:171–6.

Most read articles by the same author(s)

1 2 > >>