• Ambulance response times and mortality in elderly fallers

      Cannon, Emily; Shaw, Joanna; Fothergill, Rachael; Lindridge, Jaqualine (2016-09)
      Background Worldwide, the number of people aged over 60 is growing faster than any other age group. Increased age is associated with a higher risk of falling and roughly a third of individuals aged 65 and over experience a fall each year. One way in which ambulance services may impact the outcome of patients is the time taken for a response to arrive on scene. Lying on the floor for a long time has been found to be strongly associated with serious injuries, admission to hospital, and mortality. However, previous research has not assessed the impact of ambulance response times on mortality. Methods To determine whether there is a relationship between the time elderly fallers (aged 65 and over) spend on the floor and mortality, an observational study was undertaken. A convenience sample of 503 ambulance response times, patient records detailing the amount of time spent on the floor, and patient outcomes at 90 days were analysed using logistic regression. Results Eight percent of patients in the sample died within 90 days of their fall (n=38). Patients who were deceased at 90-day follow-up (n=38) did not wait significantly longer for an ambulance than patients who were still alive (n=464) (means= 34 min vs 37 min, p=.678). Of the patients who were still on the floor upon LAS arrival (n=178), those who had died within 90 days following their fall (n=14) spent less time in total on the floor than patients who were still alive at 90-day follow-up (n=164) (means= 59 min vs 98 min, p=.296). Conclusions Increased ambulance response time or prolonged time spent on the floor was not associated with 90-day mortality in elderly fallers who presented to the ambulance service. Whilst any delays in attending elderly fallers require monitoring, we can be reassured that long waits are not leading to mortality in this patient group. https://emj.bmj.com/content/emermed/33/9/e9.1.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2016-206139.29
    • Genuine illness and injury during Europe’s largest emergency service major incident exercise

      Cannon, Emily; Edwards, Timothy; Fothergill, Rachael (2017-05)
      Aim Previous studies of patient presentation rates at mass gatherings have been limited to social events. None have assessed presentation rates in the context of a large-scale emergency service exercise where individuals (actors playing hypothetical casualties) are exposed to an environment containing many potential hazards. Methods Exercise Unified Response was the largest multi-agency exercise ever held in Europe. It was a four-day major incident exercise in the UK, in which 2700 individuals acted as casualties. Clinical records completed by healthcare professionals providing on-site medical cover for the duration of the event were reviewed. Clinical records were included where the individual’s role in the exercise was listed as ‘actor’. Results Thirty actors required medical attention, giving a patient presentation rate (PPR) of 11.1 per one thousand actors. Of these, 10% were conveyed to hospital with musculoskeletal (n=2) or head injuries (n=1); an ambulance transfer rate (ATR) of 1.11 per 1000. Just under half of all patients (40%, n=12) had a contributory factor to seeking medical help, where they had: not eaten on the day (n=4); a pre-existing condition exacerbated by the exercise, such asthma (n=3); pre-existing symptoms of acute illness (n=3), or a pre-existing injury (n=2). Conclusion Patient presentation rate was in line with previous research1. However, we believe this is the first study to report similar data for a mass emergency service exercise. Our findings regarding the factors and pre-existing illnesses/conditions that contributed to individuals seeking medical help will be valuable in planning future large-scale exercises. https://bmjopen.bmj.com/content/7/Suppl_3/A3.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.8