A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review
OBJECTIVES To describe the characteristics of older people who fall and call an emergency ambulance, and the operational and clinical impact of the ambulance responses they receive. METHODS A prospective cohort study of people aged ≥65 who had fallen and called for an ambulance was conducted between October 1, 2010 and June 30, 2011. Fall-related data were collected using a project-specific data collection tool. These data were then linked to routinely collected ambulance service clinical records and dispatch data, providing a sequential description of fall-related cases from time of ambulance dispatch through to the end of the prehospital episode of care. RESULTS There were 1,610 cases eligible for analysis. The median response time was 15 minutes (IQR 10-24) and "long-lies" (>60 minutes on the ground) occurred in 13% of cases. Patients were predominantly female (61%) and community dwelling (82%). Forty-four percent had never previously called an ambulance for a fall, whereas 248 (15%) had called within the past month. The most common patient-reported reasons for falling were loss of balance (30%) and "simple trips" (25%). New injury and/or pain was documented for 1,172 (73%) of patients, and 656 (41%) presented with "abnormal" physiology; only 238 (15%) presented with no new injury/pain and normal physiology. The nontransport rate was 28%. CONCLUSION In this population, ambulance services appear to provide timely responses to older people who have fallen, and "long-lies" are relatively uncommon. More than one-quarter of patients were not transported to an emergency department, and repeat use of ambulance resources appears to be common. Opportunities exist to explore alternate pathways and models of care that maximize outcomes for nontransport patients as well as improving operational efficiency of the ambulance service.