American College of Emergency Physicians
Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial
Snooks, H.A., et al, Ann Emerg Med Epub ahead of print, March 13, 2017
METHODS: In the British Support and Assessment for Fall Emergency Referrals (SAFER-2) trial, EMS units in three ambulance services were randomized to an intervention in which paramedics were trained in assessment of older patients experiencing a fall and protocolized referral when appropriate to a community-based fall service without transport to the ED or to provision of usual care. Referred patients managed by intervention units were contacted by the fall service during the following week to arrange additional care. The mean patient age was 82; 2,391 patients were managed by intervention units and 2,264 by control units. The primary outcome was subsequent emergency event within 1 to 6 months.
RESULTS: Just under two-thirds of the patients in both groups were transported to the ED at the time of the index fall. Intervention patients were referred to the community fall service in 8% of EMS evaluations compared with 1% of the control group. There were no significant differences between patients in the two groups in the duration of the index episode of paramedic care, or in the percentage of patients reporting additional falls or fractures during the month after the index fall (about two-thirds and 4% respectively), or at six-month follow-up. There were no significant intergroup differences in rates of serious adverse events, ED visits or emergency hospitalizations during the two days after the index event. Although there were no statistically significant differences between the groups in overall healthcare costs at one and six months, the intervention group had statistically lower mean costs for 911 calls at one month ($77 vs. $85) and for ED attendance at six months ($130 vs. $140).
CONCLUSIONS: These findings suggest that paramedic referral of elderly fall patients to a community-based fall service, without transport to the ED, appears to be a safe strategy. 30 references (h.a.snooks@swansea.ac.uk – no reprints)
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