Assessing Paramedics’ Perspectives on an Emergency Department Virtual Observation Unit Fall Prevention Program
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Abstract
Introduction: Falls are the leading cause of fatal and nonfatal injury for older adults. We created the Emergency Department Virtual Observation Unit (EDVOU) to provide observation level care for older ED patients in their homes and better assess their fall risks. Mobile integrated health (MIH) paramedics visited patients’ homes where they conducted a multicomponent fall evaluation and facilitated an emergency medicine telemedicine consult. We aimed to understand paramedics’ experiences in our EDVOU Fall Program.
Methods: We conducted a qualitative study through semi-structured interviews of EDVOU Fall prevention paramedics to determine how comfortable they were with implementing the EDVOU fall program. Interviews were transcribed, independently reviewed by multiple team members, and subsequently coded into themes.
Results: Fifteen of thirty-six (42%) paramedics were interviewed. Three main themes emerged: 1) learning new skills otherwise not included in paramedic training, 2) having unique perspectives and interactions with patients in the home environment where most other clinicians do not have insight, and 3) being more integrated in a team to play a bigger role in patient care.
Discussion: MIH paramedics had an overwhelmingly positive experience with the program. Paramedics felt they played a pivotal role in fall prevention, as the program allowed them to learn more skills, form and share unique relationships and clinical perspectives given their role, and feel more valued as part of a patient team/care continuum. Paramedics’ unique role of entering the home to provide medical care are an untapped resource in preventative care, particularly as part of a virtual fall program.
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References
Agarwal, G., Angeles, R., Pirrie, M., Marzanek, F., McLeod, B., Parascandalo, J., & Dolovich, L. (2016). Effectiveness of a community paramedic-led health assessment and education initiative in a seniors’ residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). BMC Emergency Medicine, 17(1). https://doi.org/10.1186/s12873-017-0119-4
Akyol, A. D. (2007). Falls in the elderly: what can be done? International Nursing Review, 54(2), 191–196. https://doi.org/10.1111/j.1466-7657.2007.00505.x
Bonner, M., Capsey, M., & Batey, J. (2021). A paramedic’s role in reducing number of falls and fall-related emergency service use by over 65s: a systematic review. British Paramedic Journal, 6(1), 46–52. https://doi.org/10.29045/14784726.2021.6.6.1.46
Camp, K., Murphy, S., & Pate, B. (2024). Integrating fall prevention strategies into EMS services to reduce falls and associated healthcare costs for older adults. Clinical Interventions in Aging, 19, 561–569. https://doi.org/10.2147/cia.s453961
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (n.d.). Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-Based Injury Statistics Query and Reporting System. Retrieved from https://wisqars.cdc.gov/
Choo, E. K., Garro, A. C., Ranney, M. L., Meisel, Z. F., & Morrow Guthrie, K. (2015). Qualitative research in emergency care Part I: Research principles and common applications. Academic Emergency Medicine, 22(9), 1096–1102. https://doi.org/10.1111/acem.12736
Creating New EMS Education Standards. (n.d.). EMS.gov. Retrieved March 20, 2025, from https://www.ems.gov/resources/newsletters/may-2019/creating-a-people-centered-ems/
Davenport, K., Alazemi, M., Sri-On, J., & Liu, S. (2020). Missed opportunities to diagnose and intervene in modifiable risk factors for older emergency department patients presenting after a fall. Annals of Emergency Medicine, 76(6), 730–738. https://doi.org/10.1016/j.annemergmed.2020.06.020
Davenport, K., Cameron, A., Samson, M., Sri-On, J., & Liu, S. W. (2020). Fall prevention knowledge, attitudes, and behaviors: A survey of emergency providers. The Western Journal of Emergency Medicine, 21(4), 826–830. https://doi.org/10.5811/westjem.2020.4.43387
Dossett, L. A., Kaji, A. H., & Cochran, A. (2021). SRQR and COREQ reporting guidelines for qualitative studies. JAMA Surgery, 156(9), 875. https://doi.org/10.1001/jamasurg.2021.0525
Falls. (n.d.). Retrieved March 20, 2025, from https://www.who.int/news-room/fact-sheets/detail/falls
Harper, K. J., Arendts, G., Barton, A. D., & Celenza, A. (2021). Providing fall prevention services in the emergency department: Is it effective? A systematic review and meta-analysis. Australasian Journal on Ageing, 40(2), 116–128. Portico. https://doi.org/10.1111/ajag.12914
Hayden, E. M., Grabowski, B. G., Kishen, E. B., Zachrison, K. S., & White, B. A. (2024). The value of an emergency medicine virtual observation unit. Annals of Emergency Medicine, 84(3), 261–269. https://doi.org/10.1016/j.annemergmed.2024.02.001
How to better value EMS clinicians as key care team members. (2022). AMA Journal of Ethics, 24(9), E898–E905. https://doi.org/10.1001/amajethics.2022.898
Jiang, L. G., McGinnis, C., Benton, E., Nawa, E., Stern, M., Xi, W., Sharma, R., & Daniels, B. (2025). Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data. Journal of the American Geriatrics Society, 73(1), 232–242. https://doi.org/10.1111/jgs.19080
Joiner, A., Fernandez, A. R., Van Vleet, L., Cabañas, J. G., Grover, J., Godfrey, A., Crowe, R., Staton, C., & Pavon, J. (2023). Predictors of non-transport for older adult EMS patients encountered for falls. Prehospital Emergency Care, 27(7), 859–865. https://doi.org/10.1080/10903127.2022.2137744
Jones, A. E., Kennedy, M., Hayden, E. M., Ouchi, K., N. Shankar, K., Chary, A., Li, A., Loughlin, K. M., White, B., Franco-Garcia, E., Dellheim, V., & Liu, S. W. (2024). A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program. Pilot and Feasibility Studies, 10(1). https://doi.org/10.1186/s40814-024-01502-7
Jung, O. S., Graetz, I., Dorner, S. C., & Hayden, E. M. (2023). Implementing a COVID-19 Virtual Observation Unit in emergency medicine: Frontline clinician and staff experiences. Medical Care Research and Review: MCRR, 80(1), 79–91. https://doi.org/10.1177/10775587221108750
Kakara, R., Bergen, G., Burns, E., & Stevens, M. (2023). Nonfatal and fatal falls among adults aged ≥65 years — United States, 2020–2021. MMWR. Morbidity and Mortality Weekly Report, 72(35), 938–943. https://doi.org/10.15585/mmwr.mm7235a1
Kakara, R. S., Lee, R., & Eckstrom, E. N. (2024). Cause-specific mortality among adults aged ≥65 years in the United States, 1999 through 2020. Public Health Reports (Washington, D.C.: 1974), 139(1), 54–58. https://doi.org/10.1177/00333549231155869
Moreland, B., & Lee, R. (2021). Emergency department visits and hospitalizations for selected nonfatal injuries among adults aged ≥65 years - United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 70(18), 661–666. https://doi.org/10.15585/mmwr.mm7018a1
Paramalingam, A., Ziesmann, A., Pirrie, M., Marzanek, F., Angeles, R., & Agarwal, G. (2024). Paramedic attitudes and experiences working as a community paramedic: a qualitative survey. BMC Emergency Medicine, 24(1). https://doi.org/10.1186/s12873-024-00972-5
Quatman-Yates, C. C., Wisner, D., Weade, M., Gabriel, M., Wiseman, J. M., Sheridan, E., Garvin, J. H., Bridges, J. F. P., Santry, H. P., Panchal, A. R., Fernandez, S., & Quatman, C. E. (2022). Assessment of fall-related emergency medical service calls and transports after a community-level fall-prevention initiative. Prehospital Emergency Care, 26(3), 410–421. https://doi.org/10.1080/10903127.2021.1922556
Ranney, M. L., Meisel, Z. F., Choo, E. K., Garro, A. C., Sasson, C., & Morrow Guthrie, K. (2015). Interview-based qualitative research in emergency care Part II: Data collection, analysis and results reporting. Academic Emergency Medicine, 22(9), 1103–1112. https://doi.org/10.1111/acem.12735
Schofield, B., & McClean, S. (2022). Paramedics and health promotion. Perspectives in Public Health, 142(3), 135–136. https://doi.org/10.1177/17579139211053363
Shah, M. N., Caprio, T. V., Swanson, P., Rajasekaran, K., Ellison, J. H., Smith, K., Frame, P., Cypher, P., Karuza, J., & Katz, P. (2010). A novel emergency medical services–based program to identify and assist older adults in a rural community. Journal of the American Geriatrics Society, 58(11), 2205–2211. https://doi.org/10.1111/j.1532-5415.2010.03137.x
Snooks, H. A., Anthony, R., Chatters, R., Dale, J., Fothergill, R. T., Gaze, S., Halter, M., Humphreys, I., Koniotou, M., Logan, P., Lyons, R. A., Mason, S., Nicholl, J., Peconi, J., Phillips, C., Porter, A., Siriwardena, A. N., Wani, M., Watkins, A., … Russell, I. T. (2017). Paramedic assessment of older adults after falls, including community care referral pathway: Cluster randomized trial. Annals of Emergency Medicine, 70(4), 495–505.e28. https://doi.org/10.1016/j.annemergmed.2017.01.006
Speier, L., Kramer, N., Jammula, V., Kramer, S., & Diaz, G. (2024). Exploring the effectiveness of emergency medical services becoming active in fall prevention: A literature review. Cureus. https://doi.org/10.7759/cureus.61541
Tirrell, G., Sri-on, J., Lipsitz, L. A., Camargo, C. A., Jr, Kabrhel, C., & Liu, S. W. (2015). Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines. Academic Emergency Medicine, 22(4), 461–467. https://doi.org/10.1111/acem.12634
van Vuuren, J., Thomas, B., Agarwal, G., MacDermott, S., Kinsman, L., O’Meara, P., & Spelten, E. (2021). Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-020-06037-0
Watkins, P., Buzzacott, P., Tohira, H., Finn, J., Brink, D., Brits, R., & Hill, A.-M. (2024). “Mind the gap”: An exploratory qualitative study of paramedics’ experiences attending older adults who fall in Western Australia. Australasian Emergency Care, 27(3), 177–184. https://doi.org/10.1016/j.auec.2024.01.004