Beyond 911: Paramedics - Essential Care Responders for Older Adults and Long-Term Care Residents

While the image of paramedics rushing to emergencies with flashing lights and sirens is firmly ingrained in popular culture, their role extends far beyond responding to life-threatening situations. For older adults and those residing in long-term care facilities (LTCFs), paramedics often serve as crucial first responders, providing vital medical care and ensuring timely access to the health system.

The Growing Need

The aging population in the United States presents a unique challenge for the health care system. As more individuals live longer lives, the demand for medical care, including emergency services, for older adults is expected to rise significantly. 

Additionally, LTCFs, which house a large population of individuals with complex aging and medical needs, often lack the on-site resources to manage all medical emergencies. This is where paramedics step in, bridging the gap between immediate care and definitive medical treatment within hospitals.

From Squad 51 to Real Life: The Rise of Paramedics and "Emergency!"

Before the iconic red jackets and the pulsating sirens became synonymous with emergency medical care, the concept of paramedics was a revolutionary idea. In the early 1970s, the United States health care system lacked a formalized system for pre-hospital care beyond basic first aid. It was during this period that the television show "Emergency!" emerged, offering a glimpse into the groundbreaking world of some of the first fire department paramedics in the country.

"Emergency!" followed the lives and work of the crew of Los Angeles County Fire Department Station 51, specifically focusing on their paramedic unit, Squad 51. The show, created by Jack Webb and starring Randolph Mantooth and Kevin Tighe, depicted these pioneering paramedics' dedication, skill, and compassion as they responded to various medical emergencies. While the show took some artistic liberties for dramatic effect, it undeniably played a crucial role in raising public awareness about the concept of paramedics and the critical role they could play in saving lives.

Before "Emergency!" the standard response to medical emergencies often involved transporting patients directly to hospitals, even for situations requiring immediate medical intervention. The show's portrayal of paramedics equipped with advanced life support skills, including administering medications and utilizing specialized equipment, sparked public interest and ignited discussions about the potential benefits of a more robust pre-hospital care system.

The success of "Emergency!" coincided with a growing movement advocating for establishing paramedic programs nationwide. The show's positive portrayal of paramedics and real-world advancements in medical technology and training contributed significantly to the rapid expansion of paramedic services throughout the United States. 

Today, paramedics are an integral part of the health system, providing essential medical care to individuals in need, and "Emergency!" remains a cultural touchstone, serving as a reminder of the show's lasting impact on shaping public perception and paving the way for a more comprehensive approach to emergency medical care.

According to the National Fire Protection Association, as of 2023, approximately 77% of fire departments in the United States have at least one paramedic on duty. This signifies a significant portion of fire departments offering widespread access to advanced life support services across diverse communities.

It's safe to say that most private ambulance services also employ certified paramedics.

Assessment and Intervention

It is hard not to notice the fire department's responses to area assisted living facilities and nursing homes. When there is a medical emergency, or someone falls or suddenly shows confusion, 911 is called. This is where paramedics, often referred to as Emergency Medical Technicians (EMTs) in some areas, play a critical role.

When responding to a call at a Long-Term Care Facility, paramedics utilize a comprehensive assessment approach:

• Medical History Review: They collaborate with facility staff to gather information about the resident's medical history, medications, and any pre-existing conditions.
• Physical Examination: This includes vital sign assessment, checking for signs of pain, injury, or illness, and performing age-specific evaluations like mental status assessments.
• Communication and Collaboration: Effective communication with residents, their families, and LTCF staff ensures accurate information gathering and facilitates informed decision-making about the course of care.

Paramedics: A Lifeline for Aging at Home

For older adults choosing to age in place, either independently or with the support of caregivers, maintaining safety and independence is paramount. While this desire for autonomy is commendable, it also necessitates a robust emergency response system equipped to address the unique needs of this population. 

Responding to Emergencies in the Home Setting

Paramedics are trained to respond to a wide range of medical emergencies, and calls from older adults living at home are a frequent occurrence. These emergencies can encompass a diverse spectrum, including:

• Falls: A leading cause of injury and hospitalization among older adults, falls often necessitate immediate medical attention, and paramedics can provide on-site assessment, stabilization, and transport to appropriate medical facilities.
• Chronic health conditions: Individuals managing chronic health conditions like diabetes, heart disease, or respiratory illnesses may experience sudden complications requiring immediate intervention. Paramedics can administer medications, initiate life support measures, and ensure swift transport to hospitals for further treatment.
• Sudden illness: Unexpected illnesses like stroke, seizures, or severe allergic reactions can strike unexpectedly. Paramedics are equipped to assess the situation, provide initial treatment, and facilitate timely transport to emergency departments.

Training for Specialized Care

Paramedics undergo extensive training to provide emergency medical care in diverse settings. This includes:

• Emergency Medical Technician (EMT) Certification: This basic level of training equips them with skills in CPR, first aid, and basic life support.
• Paramedic Certification: This advanced training builds upon EMT certification, enabling paramedics to provide advanced life support, administer medications, and utilize specialized medical equipment like defibrillators and intravenous fluids.
• Geriatric Emergency Medical Services (GEMS) Certification: This additional training equips paramedics with specialized knowledge and skills for assessing and caring for older adults, including understanding age-related physiological changes and recognizing specific geriatric emergencies.

Some people will choose an accelerated paramedic program to get the training they need to help those in the field. 

Collaboration and Future Directions

Effective communication and collaboration between paramedics, LTCF staff, and other health providers are crucial to ensure continuity of care for older adults. Additionally, initiatives like expanding GEMS training and developing specialized protocols for caring for LTCF residents are evolving to address the unique needs of this growing population.

Paramedics play a vital role in the health system, particularly for older adults and LTCF residents. They provide timely medical care, offer preventive and chronic disease management support, and collaborate with other medical professionals to ensure optimal care for this vulnerable population. 

As the aging population grows, the need for long-term care, either in the home or a facility, will increase. With that, paramedics' role in supporting older adults' well-being is expected to become even more crucial in the years to come.

Additional Resources:

• American College of Emergency Physicians (ACEP)
• The Gerontological Society of America (GSA)
• National Highway Traffic Safety Administration (NHTSA): Provides information on emergency medical services (EMS) topics, including standards and training.
• Centers for Disease Control and Prevention (CDC): Offers resources on topics related to EMS, including infection control, preparedness, and response.
• National Registry of Emergency Medical Technicians (NREMT): The official registry for EMTs and paramedics in the United States.
• International Association of EMS Chiefs and Medical Directors (IAEMSCMD): A global organization representing EMS leadership professionals.
• National Association of EMS Educators (NAEMSE): A professional organization for EMS educators and trainers.