Improving Falls Response: Equipment, tools & training | James Gough Webinar
In his Felgains Friday Webinar, James discussed how WAST deals with the incredible demand that falls create for the service, including some of the exciting initiatives he has worked on to improve outcomes for patients. James Gough is a registered paramedic with the Welsh Ambulance Service Trust (WAST). Over his decade-long career, he has formed a strong background in quality improvement and is currently Project Lead for Falls Response
The challenges and demand that WAST face are comparable to those of ambulance trusts across the UK, and so we thank James for his invaluable insight into falls response. In particular, James raised one central idea which will certainly stay with us here at Felgains:
“Whether you work for a voluntary organisation, care home, or domiciliary care agency, improving outcomes for fallen people is everyone’s responsibility.”
Let’s dig in to some of the key themes James explored during his session.
Falls: the demand on the ambulance service
Requesting help for a fallen person is one of the most prevalent reasons that people call an ambulance in Wales – second only to shortness of breath. In fact, there were 60,000 falls-related incidents reported to the service via 999 in 2019. And the demand is only increasing, with around a 2% uplift year-on-year. Figures which James has “no doubt” are “exactly the same across the UK”.
Of those 60,000 calls relating to falls, 2,500 were on behalf on people who had fallen but were uninjured.
And prior to some of the more recent falls response initiatives, people who rang the ambulance service but were not hurt ‘had to wait’. This was to allow the service to attend patients who were clinically prioritised.
However, although 2,500 of the 60,000 people who reported a fall in 2019 were initially uninjured, this doesn’t mean that they didn’t eventually come to harm. As James discussed, many of the ambulance service’s patients who were recorded as suffering serious adverse incidents had initially requested help for a non-injurious fall. However, “patients had come to harm because they’d been waiting so long for an ambulance”.
Risks associated with long lies
James explained that a wait of any more than an hour on the floor is classified as a “long lie” and that patients who suffer long lies “will start to come to harm”. The associated consequences of a long lie are wide-reaching – ranging from pressure sores to psychological trauma. And as James discussed, there is “massive amounts of research that show the longer someone stays on the floor, the worse their outcomes are going to be.”
Working with partners to improve patient outcomes
In 2016, WAST realised that their limited resources meant they would never be able to respond to every fallen person within an acceptable timeframe. And so, they would need to work with other partners in the health and care sector in order to improve outcomes.
This included working with organisations on both falls prevention (such as providing training for non-emergency patient transport colleagues) and falls response.
One of the most critical groups of partners was care homes. And in 2019 the Welsh Government provided funding to equip all care homes in Wales with emergency lifting devices. WAST supported this activity by providing a simple falls assessment tool, known as ISTUMBLE, as well as training to all participating care homes. They also provided support to rewrite in-house policies on lifting and falls.
The benefits of empowering care homes to lift uninjured fallen residents were twofold:
1. Non-injured fallen residents could be lifted quickly, which avoided them coming to the harm associated with long lies.
2. The ambulance service were free to focus their specialist skills and resource on helping higher acuity patients.
These benefits were clearly demonstrated via one sample group of care homes which WAST tracked. During a small study, WAST followed ten care homes in one area of Wales.
Before WAST’s intervention, the care homes racked up a total of 1,000 calls to the ambulance for falls-related incidents in one year. After the same group of care homes had been equipped with emergency lifting devices, falls assessment tools, and training, their collective 999 calls reduced by 42% during the next 12-month period.
At the time of the webinar, James and his team were also working to empower domiciliary care providers to lift patients living in the community.
WAST have also equipped and trained Community First Responders across Wales to attend, assess and lift fallen patients.
Assessment (hear and treat) and Response (see and treat)
As well as empowering partner organisations to assess and lift fallen patients, WAST introduced a brand-new Falls Framework, which changed the way the service responded to fallen patients.
The Framework is based on three levels of response:
1. Non-injury Fall
For patients who have fallen and not sustained an injury, the priority is to get them off the floor as quickly as possible to prevent them coming to harm. To achieve this, WAST worked with St John’s Ambulance to introduce a new professional role to the service: Falls Assistants.
Falls Assistants are not registered clinicians, but are trained to assess and lift patients using the same emergency lifting devices and assessment tools as care home and domiciliary care staff.
They also take basic observations such as blood pressure, blood sugar, temperature and pulse. This information helps the centrally-based WAST team to make decisions about what further support the patients may require, and make onward referrals to community-based services if needed.
2. Possible Injury Fall/Complexity
A Level 2 response is required either where it is unclear if there is an injury or not or where the person has co-morbidities or complex needs. A level 2 response is where a multi-disciplinary team, such as a paramedic and a physiotherapist, can undertake a comprehensive assessment of the person in their own home and implement an appropriate care plan according to their individual need.
During the trial period that James discussed, over 80% of patients who received a level 2 response were able to remain in their own homes with a referral to community-based services. Whereas previously, around 50-60% of patients had been conveyed to hospital.
3. Injury Fall
When the control centre has ascertained that the patient is injured and is likely to need hospital treatment, an ambulance is dispatched.
Avoiding further harm
WAST have also reviewed the clinical advice that control centre colleagues give to patients who are waiting to be lifted from the floor. Patients are now advised to eat, drink and move as much as possible while waiting for an ambulance to avoid further harm.
Falls: what health and care partners can do to help
From the insight that James shared with us, it’s clear that when helping the thousands of people who experience a non-injury fall every year, the key to keeping them safe is lifting them from the floor as quickly as possible. And to do this, we need to work together and share responsibility.
Emergency lifting devices such as the Raizer Emergency Lifting Chair, along with falls assessment tools such as ISTUMBLE, can empower care givers to safeguard fallen people from avoidable harm.
The Raizer Emergency Lifting Chair enables just one caregiver to quickly and safely lift a fallen person. Assembly and operation can be completed in under ten minutes, and requires little to no physical effort.
Watch the video to find out more about the Raizer II and how to use it:
Talk to us about improving falls response in your organisation
Here at Felgains we help ambulance trusts, care homes, domiciliary care agencies and private individuals to quickly and safely lift fallen people.
Get in touch to discuss how our range of equipment solutions, including the Raizer Emergency Lifting Chairs, could help improve the outcomes of your residents, clients or loved-ones.