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  • Rates of EMS Transports for Falls Can Be Related to Factors Beyond Injury Severity

    Falls among people 65 and older make up a significant portion of the 911 calls to emergency medical services (EMS) providers—but the likelihood of the event resulting in transport to a trauma facility can depend on the location of the fall, sex of the injured individual, and even geographic setting, according to an analysis of events recorded in 2012.

    In an article published in the American Journal of Preventive Medicine (pdf), researchers looked at data from 903,588 calls made to EMS providers related to falls by individuals 65 and older, including age and location of the victim, as well as the initial clinical impressions of the EMS provider and final dispensation of the call.

    Here's a sampling of what they found:

    1 in 5 calls did not result in transport.
    Overall, 20.7% of patients 65 and older who fell were not transported to an emergency department, trauma center, or other facility. That's a higher percentage than among patients in the same age group who are seen by EMS personnel for no-fall events (10.9% not transported). Most of those who were not transported after a fall—57%—were not transported because they refused care.

    Sex and age seem to be related to transport rates.
    Women were 30% more like to be transported than men overall, and among both sexes, individuals 85 and older were 14% more likely to be transported than patients 65-84.

    Falls in facilities are more likely to result in transport.
    Researchers found that people who fell in institutional settings such as nursing homes were 3.5 times more likely to be transported. "Nursing home residents are older and frailer than community-dwelling older adults," authors write. "As such, they are at much greater risk of falling and more likely to suffer a serious injury, such as a fracture or head injury." Falls in "business locations" such as stores or restaurants were the settings least likely to result in a transport.

    Geography seems to matter—a bit.
    Beyond the home vs facility vs business setting, transport rates also varied according to what researchers describe as the "scene location"—that is, the geographic location of the call. Falls in rural areas were 1.15 times more likely to result in a transport, followed by falls in "wilderness environments." Falls in suburban areas resulted in slightly below-average transport rates, and urban areas fell in line with the average rate.

    Training of the emergency medical technician (EMT) comes into play, too.
    Researchers found that compared with EMT-Basic providers, EMT-Intermediates were less likely to transport patients. Nurse providers were most likely—about 1.47 times the average.

    Authors of the study write that the patients who are not transported—20% of all calls—represent a significant opportunity for education on falls prevention.

    "Many older adults do not want to be identified as a person who is likely to fall, because they fear losing their ability to live independently and remain in their own home," authors write. "When an EMS call for a fall does not require transport, the older adult may be more receptive to information about steps they can take to reduce their chances of falling again by eliminating home hazards or undertaking a strengthening and balance training program."

    APTA offers multiple falls prevention-related resources, such as how to develop consumer events on balance, falls, and exercise, and information on evidence-based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf) and a clinical summary on falls available through PTNow.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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