Management of Agitation in Emergency Medical Services for Older Adults: A Multi Methods Exploration in Alberta, Canada

Abstract

Background: Agitation is a commonly encountered challenge with emergency medical services (EMS), which can be difficult to manage, especially in older adults (aged 65+ years). Objectives: The objectives of this thesis were to first understand EMS providers experiences when managing agitated older adults and using physical or chemical restraints. Second, to explore the barriers and facilitators to the management of agitation in older adults faced by EMS providers. Third, to explore the barriers and facilitators to the reduction of restraint use in older adults by EMS providers. Methods: An online survey link was emailed to EMS providers (~6000) in Alberta to explore experiences of agitation management and restraint use. Using semi-structured qualitative Zoom interviews, we explored the barriers and facilitators to agitation management in EMS. Results: A total of 162 survey responses and 30 interviews were collected. EMS providers reported a lack of adequate training and support to manage agitation, however, experienced providers reported comfort with using non-restraint agitation management strategies. Restraints were emphasized as a last resort, especially for older adults, due to the potential for harm. EMS provider burnout, physical, and moral injury were commonly reported. Conclusions: This is the first multi-methods comprehensive understanding of restraint use for the management of agitation in older adults within EMS from the EMS provider perspective