Falls Assistance

1. Falls Assistance Damon Wheddon – Area Clinical Lead Nick Williams – Specialist Paramedic Friday 13th July 2018 Twitter: @EastEnglandAmb Facebook: /EastEnglandAmb

2. The history Number of people aged over 60 will pass 20 million by 2031 1 in 3 over 65 yrs (and 1 in 2 over 85 yrs) will fall each year Costing the NHS £2.3 billion (North East Ambulance Service 2011) Mortality rate post fall for over 75 yrs in 1/5 falls is 3 months 4 million hospital bed days were attributed to falls in 2011 A falls prevention scheme could reduce the number of falls by 30% Not all falls are preventable Implementation of measures to reduce the risk of falls 95% of A&E admissions are by Ambulance

3. Background Increasing call volumes to Care Facilities (Nursing, Residential and Care homes) Increasing stays in hospital for patients that could have been managed at home Improvements in referral pathways for front line staff:- Wound Management, currently Paramedic only skill OOH (Out of Hours referrals via CARE UK) DIST (Dementia Intensive Support Team – only 9-5 Mon to Fri) CIS (Community Intervention Service – formerly APS) 111 referral and follow up with DIST teams

4. Raw Data 10,883 calls to top 30 care facilities in East and West Suffolk Date Period 01/01/2011 til 31/12/2015 7,871 unique calls – (4,168 paper PRF, 3,703 electronic PRF) 3,012 additional resources called to these 38% of all calls have secondary vehicle attendance 2,468 calls identified as falls (by primary call) 23% of total Of total 2,468 assigned vehicle unique calls – 1961 (26%) Non Conveyance rate 59% of all falls….!!!!

5. Falls by Facility Care Home AD = 196 falls (49% NC) Care Home B = 33 falls (35% NC) Care Home M = 3 falls (100% C) Care Home AE = 58 falls (72% NC) What is driving these figures :- Local policy Understanding of injury Lack of falls procedures Poor experience Poor staffing numbers

6. The COST of falls Revenue per call by CCG – estimated at £224.00 per call (999 or 111) 7,871 x £224.00 = £1.8 million Cost of sending resources to care homes – estimated at £56.00/hr for response car and £92.00/hr for ambulance Based upon 7,871 calls – of which 2,347 are falls (30%) = £96,484 non conveyed and £93,196 conveyed (1022) Time on scene for Falls – 2,347 118,123 minutes in total (1,968 hours – 82 days on scene) 81,106 minutes on scene and non conveyed (1,351 hours – 56 days on scene) Cost to the ambulance service - £123/hr – (£242,064 Con, £166,173 Non Con) 723 calls actual falls – coded incorrectly Stroke, Chest Pain, Shortness of Breath etc

7. What can we do to change history Ambulance services nationally have recognised that 33% of our business is Falls related Non injury Injury Stroke Collapse ? Cause Falls Cars Manned by paramedic and district nurse/occupational therapist etc Local policies within regional Clinical Commissioning Groups (Derbyshire county council, 2011) – “it is not the responsibility of EMAS to lift uninjured people from the floor”… ….”the responsibility for lifting residents will rest with the staff of the care home”.

8. Response Times

9. Response Times

10. Call type split

11. I-Stumble Project Pilot studies were initiated with local care home providers with the top 10 high volume callers for falls This initiative showed a positive decrease in calls to care homes in the trial areas of 30% (NEAS) NEAS introduced a Falls Prevention Strategy incorporating a multi disciplinary team who reduced 999 related falls by 75% between 2006 and 2011 Enabling more ambulances and more clinicians available for Life Threatening Emergencies

12. Clear of Dangers ? • Any Response ? • Airway Open ? • Breathing Adequate ? • Pulse Present ? CALL 999  K Keep resident CALMSTILLCOMFORTABLE Answer all questions and follow instructions from 999 call taker Wait with resident until ambulance arrives  Prepare medications:- MAR sheets Relevant documentation Inform Next of Kin • Step by step algorithm to identify injury, illness post fall • If no injuries are found and all checks are satisfactory, assist patient from floor using lifting aids. • REASSESS • Document, record fall details and any injuries found • If required call 111 or 999 for assistance No Yes INTENSE PAIN SUSPECTED COLLAPSE TRAUMA TO NECK/BACK/HEAD UNUSUAL BEHAVIOUR MARKED DIFFICULTY IN BREATHING/CHEST PAIN BLEEDING FREELY LOSS OF CONSCIOUSNESS/KNOCKED OUT EVIDENCE OF FRACTURE Yes to 1 or more e No FAST Test normal Face – equal on both sides Arms – able to hold both arms up without assistance Speech – no slurring, able to speak as normal Time – Get an accurate time of onset No Yes Use correct lifting aids and manual handling to lift resident from the floor REASSESS Treat minor injuries within scope of practice Consider GP/Nurse for minor injury treatment Observe regularly for changes in condition For further advice call NHS 111 Document Falls record and any injuries on body map Commence Falls investigation Complete a Falls Referral

13. I STUmble Intense Pain New Pain since Fall Includes Headache, Chest Pain and Abdominal Pain Consider both pain from injury caused by fall or medical causes Suspected Collapse Ask resident if this was a trip or collapse (do they remember falling) Any dizziness, sudden nausea or pain before the fall Includes “near fainting” episodes Trauma – to Head/Neck/Back New pain in Head/Neck or Back following the fall New visible or physical injury, lump or dents to head – with or without bleeding Any new numbness or paralysis in any limbs or face

15. i stUMBle continued… Unusual Behaviour New Confusion Acting Different to Normal Self e.g. agitated, combative, aggressive, sleepy, quiet Difficulty Speaking e.g. Slurred Speech, words mixed up, unable to verbalise objects, stuttering Marked Difficulty in Breathing/Chest Pain Severe shortness of breath, not improved when any anxiety is reduced Unable to complete full sentences Blue/Pale lips or fingers, becoming lethargic or confused New Onset of inability to mobilise/lay still without difficulty in breathing Bleeding Freely Free flowing, pumping or squirting blood from a wound Widespread swelling and bruising to face/head or injured limb Apply constant direct pressure to injury with clean dressing, elevate if possible Try to “estimate” blood loss, in mugful’s (often difficult)

17. i stumbLE continued… Loss of Consciousness Knocked Out Drifting in and out of consciousness Limited memory of events leading up to, during or after fall. (unusual for resident) Unable to retain or recall information, repetitive speaking (unusual for resident) Evidence of Fracture Obvious Deformity – e.g. shortened and rotated limb, bone visible, severe swelling Reduced range of movement in affected area Unusual movement in affected area In all 999 cases remember to keep resident: CALM, STILL & COMFORTABLE If any bleeding is present, apply constant pressure with a clean dressing

18. Moving Forward Greater education of Care Facilities Building better relationships Reduction in time on scene Reduction in cost of Response Greater funds to be made available for Clinical Commissioning Groups to reinvest Increase in Health and Welfare of Residents

19. Data Collection Every time a resident falls, please fill in the ISTUMBLE AUDIT This supports and guides your decision making Recorded at time of fall and within 10-20 mins post fall If initial “primary survey” raises concerns default to 999 Allows staff empowerment over patient care

20. I Stumble Audit At Time of Fall When Reassessed

21. Tools in our Arsenal Raizer Lifting Chairs £2,995 each Single person operated Perfect for upper limb injuries Safe and effective Base unit can be bulky Manger Elk £1,571.60 (Amazon) Single person operated Needs stabilisation Biggest ASSET – our STAFF

22. Thank youAny questions please contact as below Damon.wheddon@eastamb.nhs.uk Nicholas.williams@eastamb.nhs.uk