Prior EMS Encounters Common Before Injurious Falls

One in 3 adults aged 60 years or older transported by emergency medical services (EMS) after an injurious ground-level fall had at least 1 EMS encounter in the preceding year, according to a retrospective cohort study published in JAMA Network Open.

Investigators used 2018-2024 ESO Data Collaborative deidentified data linked with emergency department (ED) outcomes. The study included index 911 EMS transports to an ED from January 1, 2019, through December 31, 2024, for patients aged 60 years or older with an ED discharge diagnosis of an injury limiting activities of daily living after a ground-level fall. The primary outcome was the number of EMS encounters during the preceding 365 days.

Among 267,972 patients, the median age was 80 years, and 66.0% were female. Overall, 87,985 patients (33%) had at least 1 prior EMS encounter, representing 240,057 encounters; 39,729 of those patients (45.2%) had exactly 1 prior encounter.

The median interval from the most recent EMS encounter to the index transport was 78 days. Among patients with prior EMS use, 9.5% had an encounter within 7 days of the injurious fall, 26.6% within 30 days, 41.5% within 60 days, and 52.2% within 90 days. Those with prior EMS encounters were more likely to reside in skilled nursing facilities (30.7% vs 15.7%) and have at least 1 Beers Criteria medication in their medical history (36.9% vs 22.6%).

The investigators interpreted the timing data as supporting fall-risk screening at the first EMS contact rather than waiting for recurrent use. Because the analysis was observational, it could not determine causality. The dataset did not include patients whose falls did not lead to EMS activation or who arrived at an ED another way. The authors said prospective studies are needed to determine which EMS contacts may be suitable for focused prevention.

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Source: Shaw MR, Godzdanker I, Crowe RP, Treichel A, Shah MN, Cash RE. Emergency medical services encounters preceding injurious falls in older adults. JAMA Netw Open. 2026;9(9):e2631260. doi:10.1001/jamanetworkopen.2026.31260