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NB: The information displayed below does not replace the protocol. The latest protocol version should always be consulted before making clinical decisions.
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SAFER 2
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SAFER 2: Support and Assessment for Fall Emergency Referrals.
Care of older people who fall: evaluation of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community based care
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Topic
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Injuries & Emergencies
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Portfolio Eligibility
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Automatically eligible
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ISRCTN
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60481756
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EudraCT
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MREC N°
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09/MRE09/61
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UKCRN ID
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6801
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WHO ID
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Research Summary
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The consequences of falls in the over 65s are well known and include reduction in quality of life and physical activity leading to social isolation and loss of independence as well as burden and cost for the NHS. Older people commonly present to the emergency ambulance service (999) following a fall, however, the majority of the falls they attend that do not progress to the Emergency Department (ED) occur in the home which is regarded as a safety risk. In most UK ambulance services, treatment guidelines indicate that all patients should be taken to the ED unless the patient refuses to travel to hospital, although in practice, informal triage by ambulance staff to decide who can safely be left at home has been accepted. Little is known, in the absence of specific protocols how this decision is made. With the National Service framework recommending referral to a falls service and recommendations for emergency care practitioners to play a role in providing care at the scene, a randomised controlled trial is required to assess the cost and benefit of introducing protocols to assess and refer older people who have fallen to community based care.
Ambulance stations in three participating services (London, Wales, East Midlands) have been randomly allocated to
1) implement the new protocols (intervention group) or
2) to continue to provide care according to their standard practice (control group).
Paramedics based at the stations selected for the intervention group will receive additional training, protocols and clinical support to enable them to assess older people and decide whether they need to be taken to the ED immediately, or whether they could benefit from being left at home, with a referral to a falls service. Further emergency healthcare contacts or deaths, costs, processes and outcomes will be compared between the intervention and control groups at 1 and 6 months.
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Study Type
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Interventional
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Design Type
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Treatment
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Disease(s)
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Injuries and Emergencies
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Phase
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III
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Current Status
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Closed - in follow-up
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Closure Date
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6/30/2012
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Global Sample Size
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6336
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Global Recruitment to Date
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 | 90% |
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Geographical Scope
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UK Multi-Centre
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Lead Country
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Wales (also active in England)
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Main Inclusion Criteria
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Consecutive patients who meet the following inclusion criteria will be recruited to the study during the trial period:
• Attended by an ambulance crew that includes a paramedic usually based at an intervention station, who has volunteered to participate in the study and is trained in use of the new protocol and issued with the protocol prior to the study period (intervention group patient)
OR
• Attended by an ambulance crew that includes a paramedic who is usually based at a control station and has volunteered to take part in the study (control group patient)
AND
• Resident within the falls service catchment area
• Aged 65 or above
• Categorised as fall in ambulance dispatch centre
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Main Exclusion Criteria
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Patients will only be recruited once to the study – subsequent falls attended by 999 crews will be included as patient outcomes only.
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Chief Investigator(s)
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| Prof Helen Snooks |
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Further details, please contact
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Ms Sarah Gaze
University of Swansea
School of Medicine
Singleton Park
Swansea
West Glamorgan
SA2 8PP
UNITED KINGDOM
Tel: 01792 513414
s.a.gaze@swansea.ac.uk
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| Funder(s) |
NIHR Health Technology Assessment
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| Sponsor(s) |
Swansea University
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