Background <p>Residents of nursing homes often need emergency medical services or visits to the emergency department, due to deterioration of their general condition or to trauma. However, some of these situations could be treated in nursing homes. This study examined the reason for calling emergency medical services to nursing homes and the outcomes of these missions.</p> Methods <p>This was a descriptive retrospective register study of emergency medical service missions of 510 older adults in 106 nursing homes in Southwest Finland, from September 1, 2023 to January 31, 2024. Emergency medical service reports and related emergency department visits were analyzed descriptively.</p> Results <p>In total, 633 emergency medical service (EMS) missions were included in the study: 581 were on-scene missions and 52 missions were managed remotely. The most common cause reported for a mission was a fall (<i>n</i> = 169), followed by deterioration of the patient’s general condition (<i>n</i> = 89) and shortness of breath (<i>n</i> = 73). In 60.5% of EMS missions, some treatment procedures had been performed prior to the emergency call, 60.3% of patients visited the emergency department and 20.8% needed follow-up treatment.</p> Conclusions <p>The majority of nursing home missions are non-urgent, and only some patients require follow-up treatment after an emergency department visit. Prospective studies are needed to determine whether outreach acute care services and mandatory advance care planning (ACP) can reduce unnecessary missions and transfers.</p>