title: Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial.
abstract: OBJECTIVE
  We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall.
  
  
  METHODS
  We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer the patient to a community-based falls service instead of transporting the patient to the emergency department. Control paramedics provided care as usual. The primary outcome was subsequent emergency contacts or death.
  
  
  RESULTS
  One hundred five paramedics based at 14 intervention stations attended 3,073 eligible patients; 110 paramedics based at 11 control stations attended 2,841 eligible patients. We analyzed primary outcomes for 2,391 intervention and 2,264 control patients. One third of patients made further emergency contacts or died within 1 month, and two thirds within 6 months, with no difference between groups. Subsequent 999 call rates within 6 months were lower in the intervention arm (0.0125 versus 0.0172; adjusted difference -0.0045; 95% confidence interval -0.0073 to -0.0017). Intervention paramedics referred 8% of patients (204/2,420) to falls services and left fewer patients at the scene without any ongoing care. Intervention patients reported higher satisfaction with interpersonal aspects of care. There were no other differences between groups. Mean intervention cost was $23 per patient, with no difference in overall resource use between groups at 1 or 6 months.
  
  
  CONCLUSIONS
  A clinical protocol for paramedics reduced emergency ambulance calls for patients attended for a fall safely and at modest cost.
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom. Electronic address: h.a.snooks@swansea.ac.uk.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Snooks
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anthony
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, England.
authors.forename: Robin
authors.initials: R
authors.lastname: Chatters
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, England.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Dale
authors.affiliation: Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, England.
authors.forename: Rachael T
authors.initials: RT
authors.lastname: Fothergill
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gaze
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, England.
authors.forename: Mary
authors.initials: M
authors.lastname: Halter
authors.affiliation: Swansea University, Swansea Centre for Health Economics, Swansea, Wales.
authors.forename: Ioan
authors.initials: I
authors.lastname: Humphreys
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Marina
authors.initials: M
authors.lastname: Koniotou
authors.affiliation: Community Health Sciences, University of Nottingham, Nottingham, England.
authors.forename: Phillipa
authors.initials: P
authors.lastname: Logan
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom; Farr Institute, Swansea University, Swansea, Wales.
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Lyons
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, England.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mason
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, England.
authors.forename: Jon
authors.initials: J
authors.lastname: Nicholl
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Peconi
authors.affiliation: Swansea University, Swansea Centre for Health Economics, Swansea, Wales.
authors.forename: Ceri
authors.initials: C
authors.lastname: Phillips
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Porter
authors.affiliation: School of Health and Social Care, University of Lincoln, Lincoln, England.
authors.forename: Aloysius Niroshan
authors.initials: AN
authors.lastname: Siriwardena
authors.affiliation: Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, Wales.
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Wani
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Watkins
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Lynsey
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Russell
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D002985:Clinical Protocols; D016000:Cluster Analysis; D019058:Community Networks; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006113:United Kingdom