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

Abstract

Falls account for a substantial portion of 9-1-1 calls, but few studies have examined the potential for an emergency medical system role in fall prevention. We tested the feasibility and effectiveness of an emergency medical technician (EMT)-delivered, at-scene intervention to link elders calling 9-1-1 for a fall with a multifactorial fall prevention program in their community. The intervention was conducted in a single fire department in King County, Washington and consisted of a brief public health message about the preventability of falls and written fall prevention program information left at scene. Data sources included 9-1-1 reports, telephone interviews with intervention department fallers and sociodemographically comparable fallers from three other fire departments in the same county, and in-person discussions with intervention department EMTs. Interviews elicited faller recall and perceptions of the intervention, EMT perceptions of intervention feasibility, and resultant referrals. Sixteen percent of all 9-1-1 calls during the intervention period were for falls. The intervention was delivered to 49% of fallers, the majority of whom (75%) were left at scene. Their mean age (N = 92) was 80 ± 8 years; 78% were women, 39% had annual incomes under $20K, and 34% lived alone. Thirty-five percent reported that an EMT had discussed falls and fall prevention (vs. 8% of comparison group, P < 0.01); 84% reported that the information was useful. Six percent reported having made an appointment with a fall prevention program (vs. 3% of comparison group). EMTs reported that the intervention was worthwhile and did not add substantially to their workload. A brief, at-scene intervention is feasible and acceptable to fallers and EMTs. Although it activates only a small percent to seek out fall prevention programs, the public health impact of this low-cost strategy may be substantial.

Frequent 911 Fall Calls in Older Adults: Opportunity for Injury Prevention Strategies

“…In a recent intervention study leveraging an EMS‐delivered on‐scene intervention for individuals who called 911 for a fall, the perception of the EMS providers was that the intervention was feasible and led to resultant referrals to a multifactorial fall prevention program . The strategy for linking people with fall prevention opportunities included a brief public health message about preventability of falls and a fall prevention program pamphlet given to individuals at the scene.…”

“…Although the information left at the scene statistically increased enrollment of people in a fall prevention program, fewer than 35% of individuals given the information reported that they had EMS discuss falls with them at the time of 911 call, and only 3% more individuals given the information than in the control group enrolled in fall‐prevention programs. Although only a few individuals enrolled in a fall‐prevention program after EMS education after a fall, this strategy was cost effective, was supported by EMS providers, and has the potential to create a new pathway for activating fall prevention strategies and education . These concepts build on the SAFER trials performed in the United Kingdom that concluded that involving EMS in fall reduction strategies is feasible and effective, but further work on timing of the intervention, whether to activate fall prevention strategies and education at the scene or at a later date, may prove to be more effective.…”

“…In a recent intervention study leveraging an EMSdelivered on-scene intervention for individuals who called 911 for a fall, the perception of the EMS providers was that the intervention was feasible and led to resultant referrals to a multifactorial fall prevention program. 35 The strategy for linking people with fall prevention opportunities included a brief public health message about preventability of falls and a fall prevention program pamphlet given to individuals at the scene. Although the information left at the scene statistically increased enrollment of people in a fall prevention program, fewer than 35% of individuals given the information reported that they had EMS discuss falls with them at the time of 911 call, and only 3% more individuals given the information than in the control group enrolled in fall-prevention programs.…”

“…Although only a few individuals enrolled in a fall-prevention program after EMS education after a fall, this strategy was cost effective, was supported by EMS providers, and has the potential to create a new pathway for activating fall prevention strategies and education. 35,36 These concepts build on the SAFER trials performed in the United Kingdom that concluded that involving EMS in fall reduction strategies is feasible and effective, but further work on timing of the intervention, whether to activate fall prevention strategies and education at the scene or at a later date, may prove to be more effective. Comprehensive systemlevel strategies that help coordinate care among care providers, individuals, and community programs may help change the paradigm of care for older adults and bridge some of the gaps in fall prevention strategies for older adults.…”

Programs and Place: Risk and Asset Mapping for Fall Prevention

“…This intervention strategy holds great potential because EMS first responders are trusted members of the community with the ability to educate and influence health behavior ( 30 ). While some evidence-based fall prevention interventions delivered by emergency personnel exist (e.g., Remembering When) ( 31 ), other opportunities exist for EMS to adopt fall prevention efforts in their routine practice ( 32 ). Such interventions hold great potential to prevent falls because EMS first responders can educate older adults about fall-related risk, perform environmental scans to correct modifiable home safety issues, and make referrals to other fall prevention resources in the community.…”