In the UK, falls are the leading cause of injury among people over 65 years of age, with approximately 1 in 3 sustaining a fall each year. However, according to a study published online in Emergency Medicine Journal, the ambulance service response to these 999 calls varies considerably. (The emergency services number in the UK is 999, in the USA it is 911)
1 in 12 emergency calls for ambulance services in London alone are made for elderly individuals who have fallen.
The researchers conducted a survey of all 13 ambulance trusts in the UK regarding their response to all categories of 999 calls received for individuals suspected of having had a fall.
Of the 13 services, 11 (85%) responded. The researchers found that the trusts have dedicated substantial resource to handling these 999 calls. In addition, they also found that the provision of care differs considerably across the services, and that it is not clear what works most effectively and cost-effectively.
All 11 services had systems in place to transfer 999 calls about elderly falls to phone based clinical advisors. One service had a further system where calls categorized as less urgent were referred to a dedicated falls team. Two other trusts reported plans for similar schemes.
In addition, 7 services had local response mechanisms in place for emergency calls from personal alarm services, while 1 service reported plans for a similar scheme.
The researchers found that specially trained healthcare workers, such as emergency care practitioners, were deployed from all 11 services to respond to calls. However, survey results showed that 7 trusts sent vehicles that were not crewed by emergency technicians or paramedics to elderly patients who had fallen, and that 11 reported sending vehicles crewed by only 1 member of staff.
Furthermore, 1 service had a specialist falls response ambulance, crewed by a paramedic and a social worker, while another service was testing out deployment of non-clinical staff.
Results also indicated that 9 services left 7% to 65% of patients at home, while 2 left below 42%.
Referrals to other services were made by various different categories of staff. Some made referrals at the scene, some from the communication rooms, and others from base stations.
The researchers also found that many services were restricted on the type of referral they could make and to whom/where. In addition, not all staff received further training in this area.
Results from the survey indicate that ambulance services in the UK have made considerable efforts in order to ensure that elderly individuals who fall do not have to endure delays in response, which are an unavoidable consequence of increasing demand on these services.
The researchers explained:
“However, although service innovation for falls is widespread, clinically effective and cost effective service models are yet to be developed.”
They conclude:
“These findings highlight the urgent need for research to inform policy, service and practice development for the large and frail population of older people who have fallen and for whom a 999 call has been made.”
Written by Grace Rattue