Collaboration between EMS and primary care physicians could reduce unnecessary emergency transport for fallen seniors
Researchers from the Wake County Emergency Medical Services have found that utilizing a protocol that unites paramedic assessments of patients with primary care physician consultations significantly lowered the need for unnecessary ambulance transport for senior patients in assisted living facilities who had fallen from ground level. The top cause of nonfatal injures for those aged 65 and over admitted to emergency departments are unintentional falls. Those who live in assisted living facilities are usually transported to emergency departments as a matter of policy, even if the falls are not serious, putting unnecessary strain on health services and increasing the exposure of patients to risks such as unnecessary tests or infections. The Wake County Emergency Medical Services worked alongside the Doctors Making Housecalls service to create a protocol for specifically-trained paramedics to identify which patients required emergency transport and which could be provided with primary care provider assessment within 18 hours of the call to the emergency medical services. The study took into account 953 residents, with the group having 359 residents that suffered 840 ground-level falls over a 43-month period. The protocol found that transport was unnecessary after 553 falls, a 62.9 percent decrease in the usual level of transports. The report found that 98-99 percent of those treated by a primary care physician instead of being transported were given safe and appropriate care. The findings could lead to more effective resolution of the high numbers of unnecessary ambulance transports to an emergency department for this common issue.

A protocol that couples paramedic assessment with primary care physician consultation and timely follow up significantly reduced unnecessary ambulance transport for fallen elderly residents of assisted living facilities. The findings of a prospective cohort study are published in Annals of Internal Medicine.

Unintentional falls are the leading cause of nonfatal injury for adults aged 65 years or older who are treated in emergency departments in the United States. Residents of assisted living facilities who fall may not be seriously hurt, but policy still dictates that they be transported to the emergency department. These policies burden the health care system and place patients at risk for harms, such as unnecessary tests or exposure to infection. Therefore, limiting unnecessary transport is desirable.

Researchers from Wake County Emergency Medical Services sought to determine whether unnecessary transport to the emergency department could safely be avoided for patients who experienced a ground-level fall in an assisted living facility. Wake County Emergency Medical Services collaborated with Doctors Making Housecalls, a group of primary care physicians specializing in home care for older adults, to develop a protocol for specially trained paramedics to identify a subset of patients who would not be transported to the emergency department but instead would be scheduled for a visit with a primary care provider within 18 hours of the call for emergency medical services.

The study involved a convenience sample of 953 residents, 359 of whom had 840 ground-level falls over 43 months. The protocol recommended nontransport after 553 falls, which marked a substantial decrease (62.9 percent) in transports. The researchers concluded that 98 to 99 percent of nontransported patients received safe, appropriate care. If implemented on a widespread basis, this approach could potentially avoid large numbers of unnecessary ambulance transports to the emergency department for simple falls.