An evaluation of paramedics' ability to screen older adults during emergency responses.

OBJECTIVES: This study evaluated the feasibility of using the emergency medical services (EMS) system as a public health provider by having paramedics screen older adults (age >or= 65 years) for influenza immunization status during emergency responses. It also determined the proportion of older-adult EMS patients who lacked an influenza vaccination.
METHODS: A retrospective descriptive study was performed, with medical-record review for patients treated between January 2003 and April 2003. Patients were included if they were age 65 years and older, requested assistance via a 9-1-1 call, and were treated by one of 13 paramedics using a directed medical record. The authors calculated the proportion of patients successfully screened and the proportion who reported being nonimmunized. They also compared the patients screened and not screened by the EMS providers and patients who reported being immunized and reported being nonimmunized.
RESULTS: Two hundred eighty-eight patients were eligible; the median age was 80 years, 53% were women, 73% were white, and 59% required advanced life support care. Paramedics successfully screened 177 patients (61%; 95% CI, 56-67%). Sixty-five patients (37%; 95% CI, 30-44%) reported being nonimmunized. Failure to screen was associated with a Glasgow Coma Scale score of 13 or less. Lack of immunization was associated with younger age and female gender.
CONCLUSION: Paramedics can screen a majority of older adults for influenza immunization status during emergency responses. Older adult users of EMS reported lacking influenza vaccination at levels similar to national estimates. An EMS-based, paramedic-implemented screening program has the potential to identify older adults at risk for preventable illnesses and to augment traditional screening programs, but additional measures are needed to enhance screening rates.