If there is one call that EMS providers dislike responding to it is the so called “Lift Assist.” I’ll be a bit more specific about this. In most states and EMS systems, there is no such thing as a “Lift Assist.” At least not legally even though factually that may be what happens.

What is a “Lift Assist” you say. A “Lift Assist” is a type of EMS call that most often is a response to an elderly person who fell. For dispatch purposes the height of the call rarely matters. What matters is that the person can’t get up on their own.

I know that everyone has seen those “I’ve fallen and I can’t get up” commercials. Some falls result in no injury and the person just needs assistance getting up off the floor. In fact, in some systems that’s about half of the calls. The other half are the trickier part. They might have an injury and they need to be assessed, if injured they also need to be treated and transported to a hospital.

One problem though. Elderly people are often stubborn and will refused to “Go back to the damned hospital again.” Elderly will often minimize their injury and will also, well I can only put this one way, lie about what happened.

While it’s not uncommon for elderly people to trip, or catch their foot on a rug, or even just slide off of a bed or chair, it’s also not uncommon for them to pass out and have an unprotected fall to the ground. Even a fall from standing height can cause serious injury. Denial of injury or illness is common.

I won’t go into detail on patient refusals as the subject is rather complicated and varies a bit from state to state and even agency to agency. What I will say is that smart EMS managers discourage crews from taking the easy way out by accepting a refusal from someone that the crew is not completely confident can make an informed decision.

One other thing. Among my company’s client agencies “Falls” are the most common call type. Depending on the agency and population demographics that can be between 17 and 24 percent of all EMS calls. That’s a lot of calls.

A lot of these calls originate because some facilities require staff to call 9-1-1 whenever a resident or patient falls for any reason. Even if it’s a slip out of chair or bed with a “soft” landing. Assisted Living Facilities almost always call for an ambulance (or someone) when a resident falls. Nursing Homes sometimes do, but sometimes don’t. Falls in Nursing Homes may trigger state reporting requirements, so sometimes they may not call even though they should.

Which brings me to this article at EMS1. Geriatric slips, trips, and falls. There are some good points in the article, but there are some things that based on my field career and post retirement Continuous Quality Improvement career are not entirely correct. I do recommend that you read the article.

Obtaining your party’s blood pressure – and I say “party” because they may not be a patient quite yet – may be a courtesy measure that you offer to any individual that you interact with.

This may be true in some areas, but if so I haven’t run into it. Exactly when a person becomes a patient is not completely clear, however as soon as you make contact it is appropriate to work on the basis that the person in front of you is a patient. They are called “Patient Refusals” for a reason. The patient doesn’t have to be the person that called, doesn’t have to say “Take me to the hospital.” In the state where I spent my active career the state EMS agency regulations stated that it was the expectation that when an ambulance was called, someone would be going to the hospital. Other states don’t go quite that far, but there is always some level of expectation that someone thought that the patient needed to be assessed, treated, and transported.

Here are some considerations that may sway your decision toward patient transport of an elderly fall victim:

• • Are there any injuries noted or observed (old; indicating a pattern of multiple falls, or new; indicating recent trauma)?
  • Are there any complicating factors that might have led to the fall (i.e., medications, additional symptoms, etc.)?
  • Is the patient prescribed any blood thinners (anticoagulants or antiplatelets)? Do you have an available list to reference these medications?

• Is there something more to this fall? Could the patient be suffering from a stroke or TIA, or could this have been the result of a syncopal episode?

I mostly agree with this. I advise all of my client agency medics to do a thorough examination of fall patients to the extent that the patient will allow them to do so.

The bolded part is where I think that there is a problem. It is never in the patient or for that matter the providers best interests to suggest anything other than transport. Provider initiated refusals run a high risk of a career ending mistake.

If the patient had Loss of Consciousness then an ALS assessment including Stroke Exam and 12 lead EKG is indicated. Vital signs should be assessed before the patient is moved. Never allow or “assist” a patient to stand without taking vital signs including a Blood Pressure. If they passed out because of a loss of blood pressure, that is very, very likely to happen if you stand them up.

Don’t be a dumbass.

Most patients with Atrial Fibrillation are on blood thinners these days. Eliquis is the most common, then Xarelto. There are still a few on Coumadin (Warfarin). A stronger dose of Warfarin is used as rat poison because it causes internal bleeding at high doses.

That that means is that any of those three drugs can cause cerebral hemorrhage, especially if the patient strikes his or her head when they fall. Even without loss of consciousness that is a risk.

Some of these calls are classified as “High Risk” refusals. That risk is primarily to the patient, but mishandling a patient refusal call is also high risk to the providers.

As far as “trip” risks, those little area rugs that elderly people seem to have an affinity for are very dangerous, especially on hardwood or other polished floors. I refer to them as “landmines for the elderly” and can result in serious or even devastating injuries.

Lift assists aren’t as simple as they may seem on the surface, especially among elderly populations.