Management of Agitation in Emergency Medical Services for Older Adults: A Qualitative Exploration.

Abstract

Emergency medical services (EMS) providers are often first responders to agitated older adults, providing critical clinical care and transport. However, significant knowledge gaps persist in our understanding of agitation management for older adults in the prehospital setting. To describe the barriers and facilitators to the management of agitation in older adults and the reduction of restraint use by EMS providers. In-depth semi-structured qualitative interviews (n = 30) took place with EMS providers employed in Alberta, Canada. The theoretical domains framework (TDF) served as a guiding structure for the development of the interview guide. Framework analysis was used to analyze the qualitative data: a line-by-line thematic analysis was used to identify codes/themes, which were then mapped onto the TDF, and behavior change wheel. Six major thematic categories were identified. EMS providers reported inadequate training and support, especially for managing agitation in older adult populations. Restraints are used as a safety measure for patient and provider safety, and as a last resort once other agitation management strategies have been exhausted. EMS providers report a complex decision-making matrix of balancing the risks, benefits, and ethical considerations of restraint use, which is often collaborative and integrates EMS protocols. Common barriers to effective agitation management in EMS, as well as non-restraint agitation management techniques are also discussed. The present study is the first in-depth exploration of EMS provider experiences regarding the management of agitation and chemical and physical restraints in older adults.