Emergency Medical Service Responses for Older Adults: A Retrospective Observational Study Comparing Nursing Homes and the Community

<b>Background</b>: Older adults (≥65 years) account for a substantial share of Emergency Medical Service (EMS) activations, yet differences between nursing homes (NHs) and the community are insufficiently defined. This study aimed to compare EMS responses for older adults inside and outside NHs. <b>Methods</b>: We conducted a retrospective observational study of all EMS activations involving patients ≥65 years in a rural German region from July 2020 to March 2025, based on fully anonymized prehospital patient care reports electronically documented on tablets. Prehospital patient care was assessed using the ABCDE approach, with additional analysis of feedback codes transmitted to the control center (response and on-scene times, physician dispatch, lights and sirens use, feedback codes, hospital destination, and admission urgency). Continuous variables were summarized as mean (SD) or median [IQR], categorical variables as <i>n</i> (%), and group comparisons performed using the Chi-Square test or Fisher's exact test (categorical) and the t test or Mann-Whitney U test (continuous), as appropriate. <b>Results</b>: Among 46,598 EMS activations in adults aged ≥65 years, 28,749 EMS responses were included in the analysis after excluding non-emergency transports and duplicate physician records. Of these, 20% occurred in NHs (5707/28,749) and 80% in the community (23,042/28,749). Median age was 85 years (IQR 80-89) in NH patients and 80 years (IQR 73-86) in community patients (<i>p</i> < 0.001). Females accounted for 60% (3450/5705) of NH patients and 53% (12,223/23,036) of community patients (<i>p</i> < 0.001). Emergency physicians were dispatched in 7% of NH incidents (392/5707) and 10% of community incidents (2327/23,042; <i>p</i> < 0.001). In NHs, bronchitis/pneumonia was a leading feedback code (6%, 354/5707), whereas in community patients, acute coronary syndrome (ACS) was prominent (5%, 1249/23,042). Admission urgency categories also differed significantly, with NH residents classified as category 3 (outpatient evaluation) in 11% (621/5706) and category 0 (no admission) in 5% (280/5706), whereas community patients were more often classified as category 1 (immediate intervention) in 13% (2886/23,037) (all <i>p</i> < 0.001). <b>Conclusions</b>: NH residents were older, more often female, and presented with low-to-moderate acuity. Frequent diagnoses were closed extremity injuries and bronchitis/pneumonia. In contrast, ACS and other cardiovascular emergencies were more common in the community, particularly among men, consistent with international evidence on sex-specific incidence. NH residents were more often classified as non-urgent or outpatient and transported to nearby hospitals, whereas community patients more frequently required immediate intervention and referral to tertiary centers. In summary, EMS responses for older adults differed in clinical presentations, operational patterns, and hospital pathways.