First Responders: An Innovative Approach to Better Predict and Prevent Falls in Older Adults in the Community

项目摘要 老年人中有七分之一的福尔斯跌倒导致骨折，尽管手术和医疗管理有所改善， 技术，高达50%的患者，骨折后跌倒表现出日常功能大幅下降， 一年内死亡风险高达30%。髋部骨折后的死亡率保持不变， 40年在过去的十年里，秋季紧急医疗服务的需求明显增加 (EMS)对于60岁或以上的患者。然而，秋季电话后前往医院接受护理的交通费 显著下降。相反，EMS越来越多地用于提供电梯辅助（呼叫转移需求 或不导致运输的福尔斯）。使用环境管理系统进行电梯辅助具有重大的财务后果 并且将护理从需要立即分类和运送到护理的更高敏锐度相关呼叫转移。当前没有任何 在美国，存在分类或临床协议，以便于在以下情况下做出关于分类和转诊的决策： 老年人中与跌倒相关的EMS呼叫。 本研究旨在确定预测高利用率的可修改的生物，心理和社会变量 EMS的秋季电话，可能有针对性的干预策略，在病人的家庭环境。识别 高风险患者需要更高水平的护理，社会支持对于提供高影响、高成本 有效的护理策略，在高风险的病人福尔斯在自己的家庭环境。另外这款 这项研究将有助于优化居住在社区内的患者的识别技术， 社区护理支持。当达到本研究的目标时，将制定EMS分诊方案， 建立以减少第一响应者社区的不必要的资源利用，并重新引导那些 资源，以执行全国预防跌倒战略，减少与跌倒有关的死亡和残疾。

Project Summary One in 7 falls in older adults result in fracture and despite improvements in surgical and medical management techniques, up to 50% of patients that fracture after a fall show substantial decline in daily function and have up to a 30% risk for mortality within 1 year. Mortality rates after hip fracture have remained unchanged for over 40 years. Over the past decade, there has been a marked increase in fall calls to emergency medical services (EMS) for patients 60 years of age or older. However, transport rates to hospitals for care after fall calls have significantly decreased. Instead, EMS is increasingly being used to provide lift assists (calls for transfer needs or falls that do not result in transport). Utilization of EMS for lift assists has substantial financial consequences and diverts care from higher acuity related calls that need immediate triage and transport to care. Currently, no triage or clinical protocol exists in the United States to facilitate decision making about triage and referral after a fall related EMS call in older adults. This study aims to identify modifiable biological, psychological and social variables that predict high utilization of EMS for fall calls that may be targeted for intervention strategies in a patient's home environment. Identifying patients at highest risk for higher level care needs and social support is critical to providing high impact, cost efficient care strategies in patients at high risk for falls within their own home environment. In addition, this study will help optimize identification techniques of patients living within communities who may benefit from community paramedic support. When the goals of this study are met, an EMS triage protocol will be established to reduce unnecessary resource utilization for the first responder community and re-direct those resources to implement nationwide fall prevention strategies to decrease fall related deaths and disability.