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Embargoed until 2017-02-28
Copyright: Simpson, Paul
Embargoed until 2017-02-28
Copyright: Simpson, Paul
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Abstract
‘Falls’ is the most common incident category to which an emergency ambulance is dispatched in New South Wales (NSW), with approximately 60% of these involving patients aged 65 years or more. This thesis explores the epidemiology of older fallers attended by paramedics, employing a mix of quantitative and qualitative research methods with the aim of providing new information in an area of paramedic practice about which little is known. A retrospective, population-level study (n=42,331), prospective cohort study (n=1,610), and retrospective linked data analysis (n=34,313) form the basis of the epidemiological analyses, reporting operational and clinical outcomes arising from an ambulance response and paramedic intervention. A qualitative investigation, using grounded theory methodology, presents a theoretical model exploring paramedic decision making when providing care to older people who have fallen.
Significant findings include:
1. Older fallers constitute 5.1% of the annual emergency ambulance workload in NSW; 28% are not transported to hospital.
2. 1 in 10 older fallers who receive an ambulance response experience a ‘long lie’ (>1 hour on the ground).
3. Prediction of non-transport at time of dispatch is not feasible for cases involving older fallers, making risk management through dispatch of specialised resources unfeasible.
4. Rates of analgesia administration among fallers with suspected hip fracture (67%) has increased compared to earlier research, but almost one third still receive no prehospital pain relief.
5. Non-transported older fallers are at twice the risk of death at 28 days compared to those transported to ED and discharged without admission. Ambulance re-attendance within one month is common.
6. Paramedics do not perceive cases involving older fallers to be ‘real paramedic work’. This arises from confusion around role perception, and impacts negatively on the clinical decision making relating to the treatment of older fallers.
The findings of this thesis constitute a comprehensive analysis of an area of paramedicine about which little was previously known in an Australasian context. The results will inform clinical and operational strategy being developed by ambulance services and will make a meaningful contribution to optimising prehospital service delivery to, and improving outcomes of, older people who have fallen.