Lift Assists and Their Connection to Mortality
We all know the call type well: the lift assist. You arrive on scene for an older adult who has fallen, help them up, check their vital signs, and often leave without a transport. On paper, it may feel like a routine, even minor, encounter. Yet, research is increasingly showing that these calls may be anything but benign and, in fact, dangerous for the patient. The need for a lift assist can serve as a sentinel event, an early warning sign that something more serious is occurring.
Previous studies have linked lift assists with later hospital visits, admissions, and even mortality. However, what has been less clear is the timeline: How soon after an initial lift assist are patients falling again or calling 9-1-1? Understanding this helps EMS clinicians recognize the potential diagnostic significance of these encounters and consider whether more comprehensive assessments are warranted.
That’s where the authors of this new study come in.
Study Parameters
This retrospective analysis was conducted across a suburban EMS system in upstate New York with a combined annual call volume of over 120,000. The study included 12 ALS transport, 5 BLS transport, and 12 first response agencies, all using common protocols, medical direction, and electronic documentation. The agencies serve a suburban population and transport to six different hospitals.
Researchers examined all patients aged 60 and older who had an initial EMS encounter coded as “lift assist only” in 2022, followed by a repeat EMS encounter within seven days. The authors chose this age cutoff as it captured 90% of patients in this category while focusing on the older adult population most at risk. In total lift assists accounted for 3% of the call volume in the study area in 2022.
Key variables the authors reviewed included vital signs, ambulation assessment, subsequent transport decisions, and the primary impression of repeat encounters. Researchers also reviewed narratives to better understand why vital signs were sometimes missing or why transport was declined.
Results
A total of 1,054 encounters involving 428 unique patients were analyzed. The average age of the patients was 81 years. On the initial “lift assist” encounter, 85% of patients had a full set of vital signs documented, while fewer than half had their ability to ambulate formally assessed. Specifically, only 42% of those who were able to ambulate had this documented, leaving a significant gap in the evaluation of mobility following a fall. Abnormal vital signs were present in a subset of patients, most commonly tachycardia, which occurred in 10% of documented cases.
The timeline for repeat visits was short, with the median time to a repeat EMS encounter being just over one day (1.13 days), and the majority occurring within three days of the initial call. On the first repeat encounter, nearly four out of five patients (78%) were transported to the hospital. Overall, 76% of all repeat encounters resulted in transport, most often for a presumed medical complaint rather than trauma. In fact, 61% of transports were attributed to an underlying medical etiology, 29% were related to trauma, 9% were again categorized as lift assist only, and 1% involved cardiac arrest.
In several cases, patients had documented abnormal vital signs or limited assessments during the initial encounter but either refused care or requested only assistance to get up. Narrative review of these encounters showed that refusals were common even in the presence of concerning findings, such as hypoxia
or hypotension.
Discussion
This study reinforces a critical point for EMS providers: A lift assist is not always a simple assist. Rather, it may represent the first visible sign of a serious underlying medical condition. The fact that most repeat encounters happened within 72 hours suggests that the initial EMS
contact may be a missed opportunity for early diagnosis.
Interestingly, abnormal vital signs at the initial visit did not predict transport on repeat encounters. This finding does not mean assessments are unimportant or can be rushed when caring for a lift assist patient. Instead, it highlights the complexity of clinical decision-making for geriatric patients. Falls may be caused by a wide range of conditions: infections, cardiac events, neurological changes, or medication side effects. No single abnormality tells the whole story.
The study also points to the challenges of refusal encounters. Even when clinicians document abnormal findings, patients often decline care and transport. The authors note, this raises questions about how EMS can better communicate risks, engage caregivers, and use shared decision-making strategies to ensure patients understand potential consequences. Additionally, the authors advocate for an evidenced based tool that can help predict those at higher risk for repeated encounters, including having the patient ambulate on scene.
Conclusion
Lift assists may feel routine, but this study underscores that they are anything but trivial. For many patients, the first fall is the harbinger of a serious medical problem that will bring EMS back within days, often for transport to the hospital.
As providers, this is a reminder that we are in a unique position to recognize these early warning signs, document them carefully, and consider whether a transport is in the patient’s best interest. For EMS leaders and educators, the study provides a roadmap toward developing evidence-based quality measures for this vulnerable population.
We thank the authors for shining a light on an often-overlooked call type. Their work challenges us to view every lift assist as an opportunity to prevent delayed diagnosis and improve patient outcomes.
About the Author
Michael Kaduce, MPS, NRP, is director of the Falck Health Institute, West Coast Board Director for the National Association of EMTs, and a research associate for the UCLA Prehospital Care Research Forum.
