Quality and Productivity case study

East Midlands Ambulance Service NHS Trust
Publication Date
09 Sep 2016
Publication Type


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.