Fire departments and ambulance services are responding to a surge of “lift-assist” calls. A detailed look at these calls shows the impact of an aging community, troubling health trends, social isolation, and healthcare cost-shifting.
Lift-Assist At a Home
Our assumption is that the patient has fallen and needs help from local EMS or fire. Research on patient outcomes shows that responding to home-based lift-assist calls may be an indication of a developing medical condition that needs attention.
Leggatt, Aasen, et. al (2017) looked at a Canadian county that handles approximately 40,000 EMS calls a year. For their study, lift-assist meant “When an individual is assisted up to a more mobile position from the ground by paramedics, but not treated or brought to hospital for further medical attention.”
These 804 patients were crossed referenced to see if they made an emergency department visit, were admitted to a hospital or died within 14 days.
Most of the 93 that were admitted to a hospital later required attention to a medical condition. The age of the patient seemed to be the biggest driver of those who ended up in the hospital.
Cone, Ahern, et. al (2013) looked at the lift assist experience in a shoreline town in Connecticut, where 5% of their responses were for lift-assists. Their results matched the findings of earlier London Ambulance Service research ” … which found that 47% of elderly (age ≥65 years) fall, patients, not transported to the hospital summoned EMS again within two weeks, with about half of those second call patients calling three times or more.”
In the Connecticut study, they found EMS caregivers returning to the home of repeated fall patients within 30 days. Half of those patients assessed a second time were transported to a hospital.
The aging baby boomers are contributing to this workload, as 25% of those 65 and older have a fall event every year. Many are widows, with 50.1% of them living alone.
HoverJack Air Patient Lift
Bariatric Patients
The entire adult population is generating more lift-assist calls, as 7.7% of the population is extremely obese. These patients have a Body Mass Index of over 40. We are routinely moving patients in the 400-600+ pound range.
Staffing for these lift-assists may require the services of two fire companies along with a bariatric equipped ambulance.
There are scant guidelines provided for the effective moving of obese patients. A rule-of-thumb is that a minimum of 4 people is needed to move a patient who weighs 250 pounds.
Every additional 100 pounds requires an additional person. In the reality show “My 600-lb Life” it took seven firefighters to move the patient.
Healthcare Cost Shifting
In 2018 the Omaha, Nebraska, Fire Department noticed that it was responding to a lift-assist response almost every day to an assisted living or nursing facility. On arrival, they find no medical emergency or injury. The resident cannot get off the floor without help and the healthcare staff called 9-1-1.
These calls increased as these facilities reduced staffing, especially in the evenings, overnights and weekends. The instructions were to “… call the Fire Department if they needed help moving a patient.” Omaha instituted a $400 fee.
In a recent discussion with other fire-based ems caregivers, they shared that their departments also implemented a lift-assist fee. The result was a significant reduction in the 9-1-1 lift-assist calls from health care facilities.
A deeper dive revealed that in some healthcare facilities, the labor organizations representing security and maintenance workers removed patient handling as one of their job-related responsibilities. This was due to worker compensation claim denials and liability concerns.
Lift-Assist Take-Aways
Consider the reason why a person fell while in their home. Is it due to the built environment, such as a throw rug; or due to a medical condition that made the patient dizzy or disoriented? Every person receiving a lift-assist should have vital signs recorded and the encounter documented in a patient care report.
A community risk reduction activity would be to check up on the home-based lift-assist calls that did not result in medical care or transportation. The follow-up is to see how the person is doing a week later. Elderly folks can quickly move from self-sufficient to frail due to underlying medical conditions.
Assure that enough help is available to move overweight and obese patients. This could be a component of a community risk reduction plan for “persons of size” living in the community.
Meet with your nursing homes and assisted living facilities to review the jurisdiction’s lift-assist protocol. While at the facility, see if they have appropriate lifting devices and staffing.
+++++++++++++++++++
Adult Body Mass Indicator (click here)
Golden, Dan (2018 September 10) Omaha’s fire department wants $400 fee for calls solely to lift people off the floor. Omaha World-Herald
Fite, Elizabeth (2019 May 27) Wrong number? Increasing number of fire departments’ calls involve medical, non-emergency help. Chattanooga Times Free Press
Neale, April (15 February 2017) “Food addict Diana needs seven firefighters to move her on ‘My 600-lb Life’.”
Featured image: An elderly man trying to get up after falling down the stairs. File photo courtesy of ©Can Stock Photo / Babar760.
In the lift assist article, under the heading of Bariatric Patients, what is a “40% BMI” (“Body Mass Index of over 40%”)? Did a writer perhaps confuse or conflate a BMI of 40 with a mistaken notion of 40% body fat?
Thanks Pat, corrected