One in 7 falls in older adults result in fracture and despite improvements in surgical and medical management techniques, up to 50% of patients that fracture after a fall show substantial decline in daily function and have up to a 30% risk for mortality within 1 year. Mortality rates after hip fracture have remained unchanged for over 40 years. Over the past decade, there has been a marked increase in fall calls to emergency medical services (EMS) for patients 60 years of age or older. However, transport rates to hospitals for care after fall calls have significantly decreased. Instead, EMS is increasingly being used to provide lift assists (calls for transfer needs or falls that do not result in transport). Utilization of EMS for lift assists has substantial financial consequences and diverts care from higher acuity related calls that need immediate triage and transport to care. Currently, no triage or clinical protocol exists in the United States to facilitate decision making about triage and referral after a fall related EMS call in older adults. This study aims to identify modifiable biological, psychological and social variables that predict high utilization of EMS for fall calls that may be targeted for intervention strategies in a patient's home environment. Identifying patients at highest risk for higher level care needs and social support is critical to providing high impact, cost efficient care strategies in patients at high risk for falls within their own home environment. In addition, this study will help optimize identification techniques of patients living within communities who may benefit from community paramedic support. When the goals of this study are met, an EMS triage protocol will be established to reduce unnecessary resource utilization for the first responder community and re-direct those resources to implement nationwide fall prevention strategies to decrease fall related deaths and disability.
Falls are the leading cause of injury and result in 40% of hospitalizations in older adults in the United States with costs related to falls expected to reach 54.9 billion dollars by 2020. Currently, no triage or clinical protocol exists in the United States to facilitate decision making about triage and referral after a fall related emergency medical service (EMS) call in older adults. At the completion of this study an EMS triage protocol will be established to reduce unnecessary resource utilization for the first responder community and re-direct those resources to implement nationwide fall prevention strategies to decrease fall related deaths and disability.
