• Beatrice Martínez, María P Aranda, Stephen Sanko, Iris Aguilar, and William A Vega.
• USC Edward R. Roybal Institute on Aging, Los Angeles, California; USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California; University of Southern California, Los Angeles, California.
• J Emerg Med. 2023 Dec 1; 65 (6): e522e530e522-e530.

BackgroundHigh utilizers of 9-1-1 place a substantial burden on emergency medical services (EMS). Results of a retrospective review of records data of the City of Los Angeles Fire Department (LAFD) showed a significant increase in older adult high utilizers of 9-1-1.ObjectiveThe objective of this study was to explore individual- and system-level factors implicated in EMS use among older adults, and to provide system recommendations to mitigate overuse.MethodsA phenomenological study was conducted, drawing from LAFD EMS records between 2012 and 2016 to identify and contact high-utilizing patients older than 50 years, their family, agency representatives, and LAFD personnel. Interviews were recorded, transcribed, and coded and a thematic analysis was completed.ResultsWe conducted in-depth interviews with 27 participants, including patients (n = 8), their families (n = 6), social service agency representatives (n = 3), and LAFD personnel (n = 10). The following cross-cutting themes emerged: nature of 9-1-1 calls, barriers to access, and changing the system. In addition, LAFD and social service agency representatives identified the role of EMS responders and social agency representatives. Patients and their families agreed that previous encounters and interactions with emergency care responders were relevant factors.ConclusionsThis study described reasons for 9-1-1 calls related to medical and social service needs, including mental health care. Our analysis offers insight from different stakeholders' perspectives on access to medical care and types of barriers that interfere with medical care. All groups shared recommendations to advance access to medical and mental health care.Copyright © 2023 Elsevier Inc. All rights reserved.

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