Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies

Quatman, Carmen E.; Mondor, Michael; Halweg, Jodi; Switzer, Julie A.

doi:10.1177/2151459318783453

Cited by 14 publications

(15 citation statements)

References 20 publications

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“…The RISING-DOM project has emerged from an insistent request of our EMS department that has warned about the growing number of calls from elderly people who have fallen with no intervention or specific follow-up. In addition, many of them have had multiple fall-related calls, sometimes within a short period of time, which is in accordance with previous studies [60,61] These calls may, however, be early indicators of problems requiring comprehensive medical evaluation and follow-up [62]. The main purpose of the RISING-DOM study is to assess the effectiveness of a PIP monitored by a close nurse home follow-up on time to institutionalisation or death.…”

Section: Discussionsupporting

confidence: 77%

Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol

et al. 2022

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Background A growing number of emergency calls are made each year for elderly people who fall. Many of them are not taken to hospital or are rapidly discharged from the Emergency Department (ED). Evidence shows that, with no further support, this vulnerable population is particularly at risk of injuries, dependency and death. This study aims to determine the effectiveness of a comprehensive geriatric assessment and a tailored intervention in the elderly calling on an Emergency Medical Service (EMS) for a fall at home, but not conveyed to the ED or rapidly discharged from it (less than 24 h from hospitalisation), to the time to institutionalisation or death. Methods Rising-Dom is a two-arm randomised (ratio 1:1), interventional, multi-centre and open study. Community-dwelling elderly people (≥ 70 years) who call an EMS for a fall at home are recruited. The intervention group receives home visits by a nurse with a comprehensive fall risk assessment and a personalised intervention care plan with a planned follow-up (six nurse home visits and five nurse phone calls). Subjects enrolled in the usual care-control group continue to receive their routine care for the prevention or treatment of diseases. Primary (time to institutionalisation or death) and secondary (unscheduled hospitalisations, additional EMS calls relating to falls, functional decline and quality of life) outcome data will be collected for both groups through five phone calls made by Clinical Research Associates (CRA) blind to the participants’ group during the follow-up period (24-months). Twelve hospital centres in the South-West of France are participating in the study as study sites. The inclusion period started in October 2019 and will end in March 2022. By the end of this period, 1,190 subjects are expected to be enrolled. Discussion Studies on elderly home falls have rarely concerned people who were not taken to hospital. The Rising-Dom intervention scheme should enhance understanding of features related to this vulnerable population and investigate the impact of a nurse care at home on delaying death and institutionalisation. Trial registration Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. Sponsor: University Hospital, Toulouse. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1

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Section: Discussionsupporting

confidence: 77%

Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol

et al. 2022

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“…During these calls, the responding team could quickly conduct an environmental assessment and offer real time referrals for community or home based injury prevention programs. They may also help those who live alone with medication compliance [ 27 ], especially in reference to cardiac and anti-cholinergic agents, since compliance or non-compliance with these medications may be associated with syncope or gait instability [ 28 ]. Moreover, in this sample, a majority of patients suffered from hypertension and cardiovascular problems and often the fall was a precursor of worsening health.…”

Section: Discussionmentioning

confidence: 99%

When falls become fatal—Clinical care sequence

et al. 2021

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Objectives This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall–related deaths. Understanding this pathway lays the groundwork for identification of gaps in healthcare needs. Design This is a retrospective study of 2014 fall-related deaths recorded by one medical examiner’s office (n = 511) within a larger dataset of all trauma related deaths (n = 1848). Decedent demographic characteristics and fall-related variables associated with the deaths were coded and described. Results Of those falling, 483 (94.5%) were from heights less than 10 feet and 394 (77.1%) were aged 65+. The largest proportion of deaths (n = 267, 52.3%) occurred post-discharge from an acute care setting. Of those who had a documented prior fall, 216 (42.3%) had a history of one fall while 31 (6.1%) had ≥2 falls prior to their fatal incident. For the 267 post-acute care deaths, 440 healthcare admissions were involved in their care. Of 267 deaths occurring post-acute care, 129 (48.3%) were readmitted within 30 days. Preventability, defined as opportunities for improvement in care that may have influenced the outcome, was assessed. Of the 1848 trauma deaths, 511 (27.7%) were due to falls of which 361 (70.6%) were determined to be preventable or potentially preventable. Conclusion Our data show that readmissions and repeated falls are frequent events in the clinical sequence of fall fatalities. Efforts to prevent fall-related readmissions should be a top priority for improving fall outcomes and increasing the quality of life among those at risk of falling.

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“…It can also result from preventable health issues: poorly managed medications, 24 for example, or unsafe living environments. 25,26 EMS providers also frequently respond to calls that do not result in ED transfers: the prime example is "lift assists," when EMS providers are called to help older adults get up after falling; calls of this type can indicate broader, intensifying health care needs [27][28][29][30] and represent a significant amount of EMS business; one study found that 21% of falls-related EMS trips for older adults did not result in an ED transfer; 28 one small study found the 5% of all EMS calls were lift-assists. 27 Because such calls are uncompensated by insurance, EMS providers are motivated to support efforts to reduce their frequency.…”

Section: Introductionmentioning

confidence: 99%

The impact of health‐related supports in senior housing on ambulance transfers and visits to emergency departments: The Right Care, Right Place, Right Time Project

Nadash

Cohen

Tavares

et al. 2021

Health Services Research

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Objective: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. Data sources/study setting: Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. Study design: We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. Data collection/extraction methods: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. Principal findings:The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings.Conclusions: Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.

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Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies

Cited by 14 publications

References 20 publications

Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol

Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol

When falls become fatal—Clinical care sequence

The impact of health‐related supports in senior housing on ambulance transfers and visits to emergency departments: The Right Care, Right Place, Right Time Project

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