Can Fire and Rescue Services and the National Health Service work together to improve the safety and wellbeing of vulnerable older people? Design of a proof of concept study

Abstract

BackgroundOlder adults are at increased risk both of falling and of experiencing accidental domestic fire. In addition to advanced age, these adverse events share the risk factors of balance or mobility problems, cognitive impairment and socioeconomic deprivation. For both events, the consequences include significant injury and death, and considerable socioeconomic costs for the individual and informal carers, as well as for emergency services, health and social care agencies.Secondary prevention services for older people who have fallen or who are identifiable as being at high risk of falling include NHS Falls clinics, where a multidisciplinary team offers an individualised multifactorial targeted intervention including strength and balance exercise programmes, medication changes and home hazard modification. A similar preventative approach is employed by most Fire and Rescue Services who conduct Home Fire Safety Visits to assess and, if necessary, remedy domestic fire risk, fit free smoke alarms with instruction for use and maintenance, and plan an escape route. We propose that the similarity of population at risk, location, specific risk factors and the commonality of preventative approaches employed could offer net gains in terms of feasibility, effectiveness and acceptability if activities within these two preventative approaches were to be combined.Methods/DesignThis prospective proof of concept study, currently being conducted in two London boroughs, (Southwark and Lambeth) aims to reduce the incidence of both fires and falls in community-dwelling older adults. It comprises two concurrent 12-month interventions: the integration of 1) fall risk assessments into the Brigade's Home Fire Safety Visit and 2) fire risk assessments into Falls services by inviting older clinic attendees to book a Visit. Our primary objective is to examine the feasibility and effectiveness of these interventions. Furthermore, we are evaluating their acceptability and value to key stakeholders and services users.DiscussionIf our approach proves feasible and the risk assessment is both effective and acceptable, we envisage advocating a partnership model of working more broadly to fire and rescue services and health services in Britain, such that effective integration of preventative services for older people becomes routine for an ageing population.

Burn related mortality in Greater Manchester: 11-year review of Regional Coronial Department Data

“…Unlike some other reports we did not find a significant correlation between living in a residential/nursing care facility and relative risk of death due to sustained burn injury as only 9 deaths (2.8%) occurred in these facilities [52]. Also in contrast to previous studies that have reported increasing mortality with increasing socioeconomic deprivation our study showed that within the GM region in the >75 years age group reducing deprivation increased the relative risk of death [54]. This regional variation has also been observed by the ONS in correlating accidental mortality with deprivation and can partly be explained by the relatively small number of deaths involved in comparison to chronic diseases such as ischemic heart disease.…”

Older Adult Falls Seen by Emergency Medical Service Providers

“…22 This program includes a fall prevention educational program provided by trained EMS providers but does not include a fall risk assessment. Also in the United Kingdom, a pilot study showed that linking older adults who had fallen and been seen by EMS but not transported to a hospital to a community-based fall prevention program reduced fall rates by 55%.…”

Coordinating Care for Falls via Emergency Responders: A Feasibility Study of a Brief At-Scene Intervention

“…Evidence suggests that emergency medical service (EMS) providers can engage and educate lay persons and affect practice for a number of important health conditions (7), and firefighters and emergency medical technicians (EMTs) are a well-trusted information source. However to-date, few studies have assessed the potential for an EMS role in fall prevention (8, 9), and data on the feasibility and effectiveness of proactive outreach by EMS providers in the context of a 9-1-1 call for a fall are lacking. Because of the widespread availability of EMS services throughout the United States, examination of an active EMS role in the prevention of falls is warranted.…”