Crisis response falls team: reducing admissions and repeat falls

NICE Quality and Productivity Case Studies
East Midlands Ambulance Service NHS Trust
Publication date:
09 September 2016


Falls-related calls make up about 20% of all calls received by the
East Midlands Ambulance Service (EMAS); approximately 90,000
calls per year. Reducing demand on hospitals and the potential
negative outcomes associated with hospital admission for
patients and psychological impacts are important priorities.
EMAS covers several counties with a combined population of 4.8
million. The solution developed in the Northamptonshire area
(population 700,000) is the Crisis Response Falls Team (CRFT).
The CRFT comprises specialist ambulance crews and a social
care support team.

The ambulance crews include 7 staff made up of paramedics and
emergency care assistants who are trained in enhanced
diagnosis and lifting techniques related to falls. The ambulance
control’s computer system uses an algorithm to dispatch a CRFT
ambulance to people who have fallen. The crews use 2 bariatric
ambulances and specialist lifting equipment to ensure people of
any size who fall can be helped.

Enhanced diagnosis and faster access to lifting equipment helps
to reduce conveyance to hospital and subsequent admissions.
The service prior to the inception of the CRFT was a standard
ambulance response, often requiring either a manual lift of a
person who has fallen, or a further response with appropriate
equipment. In both cases, a person who had fallen may have
been left in situ for a significant period of time, causing secondary
injuries, exacerbating primary injuries and potentially reducing
quality of life or life expectancy.

The CRFT social care support team is provided by
Northamptonshire County Council, under a contract with a social
care provider. The social care team works with people who have
fallen, who are referred by the CRFT ambulance crews, other
clinicians or the local authority. The social care team is able to
assess people in their own home and identify risk factors for
repeat falls, remove trip hazards and install aids to help reduce
the risk of repeat falls. They also attend A&E to assess patients
and facilitate discharge, undertaking a home visit and supporting
patients afterwards, thereby avoiding unnecessary admissions.
Patients may be referred to consultant geriatricians for further
assessment and support if required.