Reconsidering Rural Policy as Emergency Medical Service Workers Piloted New Screening and Referral Practices

In a state where all rural communities were served by emergency medical services (EMS), it made sense to make those services more responsive to community needs including the potential for risk-reducing services found in the lives of older adults. A rural EMS provider, an EMS education provider, and a university researcher partnered and sought funding for a pilot project where EMS workers adopted new practices to screen medically stable older adults (aged 60 years and up) for risks related to falls, medication errors, untreated depression and household hazards. After EMS continuing education and during a 13-month pilot project, 14 EMS workers incorporated new screening and referral practices into their regular response to 1,556 requests for help from older adults (or 63% of all medical calls to 911). EMS workers transported 1,378 older adults to a hospital and based on project-related screening, the EMS workers referred 369 persons to hospital social services for risk-reducing services. While both the hospital social service and EMS workers agreed that referrals benefitted patients, project partners reconsidered both policy barriers and policy solutions that would benefit persons who were not transported to hospitals, and policy alternatives that would allow easier access to risk-reducing services outside of the hospital.