Falls: a better way?

Joanne Crosby is involved in a radical scheme to treat people after a fall without recourse to the ambulance service and hospital treatment.

A scheme aimed at people who have fallen has been launched in Great Yarmouth and Waveney, Norfolk.
The primary aims are to reduce A&E attendance, alleviate pressure on the ambulance service and improve patient experience. 
The pilot started on 17 November and is a collaboration between East of England Ambulance Service, James Paget University NHS Trust and East Coast Community Healthcare.
If a fall is reported via a 999 call, where the patient is uninjured, they will be attended by an early intervention vehicle instead of an ambulance. The vehicle is crewed by an emergency medical technician and a physiotherapist or occupational therapist. This is the first scheme in the region to have physiotherapists on board.
We work alongside the emergency medical technician to ensure the patient is medically well and safe to remain at home. The patient receives a multifactorial full assessment at home and a joint decision is made with the patient/family about any interventions we put in place. 
The early intervention vehicle  is full of equipment if it’s needed, but we are also able to;
  • dress superficial wounds that would previously have required an A&E visit;
  • make environmental changes at home to reduce risk of further falls; 
  • arrange carer input; 
  • provide temporary pendant alarm systems; 
  • signpost to other support agencies; 
  • liaise with the GP if we feel a patient has non-urgent health needs; 
Everything is completed before we leave the patient’s home. 
If the patient can’t safely remain at home, another ambulance crew conveys them to hospital or an intermediate care bed.
Patient feedback has been very encouraging. Our older patients rarely want to attend hospital but this often used to be their only option. Now they receive all the input they need from one call. 
Falls are traumatic for the patient, but I feel we provide them with the best experience possible in the circumstances. Uninjured fallers can also expect a faster response as there is now a designated team waiting for their call. 
As the only two physiotherapists involved, Charlotte Tracy and I (both senior physios at James Paget University Hospital) find the role challenging but really rewarding.
Both of us normally work in inpatient settings and are having to change our thinking from discharge planning to admission prevention. 
The scheme has so far been very successful in reducing unnecessary A&E admissions, with 77 per cent of our patients remaining at home one month into the pilot. 
We have received excellent training alongside our emergency medical technician colleagues and have great trust in each other’s skills.
The pilot is initially restricted to a Friday to Monday service and will run until the end of March. We hope the service will be extended, long term, to seven days a week.
  • Joanne Crosby is a senior physiotherapist at John Paget University Hospital Trust 
Joanne Crosby is a senior physiotherapist at John Paget University Hospital Trust

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