“Call Before Conveyance”: A Frailty-Supported Paramedic Model for Older Adults with Head Injury

Introduction
Falls with head injury in older adults frequently prompt ambulance conveyance to the Emergency Department (ED), despite many patients being clinically stable. 

Unnecessary conveyance contributes to ED crowding and may expose older patients living with frailty to avoidable risks. 

This abstract evaluates a collaborative “call before conveyance” model between South East Coast Ambulance Service (SECAmb) paramedics and a specialist frailty team, assessing whether selective non-conveyance is safe and effective.

Method
Between June and November 2025, paramedics attending patients aged ≥65 years with head injury contacted the frailty team at St Peter’s Hospital (SPH) for real-time advice and guidance. 

Calls were made during in-hours service provision (08:00–16:00). 

The frailty team provided remote clinical review, supported decision-making on conveyance, and facilitated direct pathways where required. 

Outcomes included rates and destination of conveyance, and re-admission to ED within seven days.

Results
A total of 128 head injury patients were referred to the frailty service during the study period. 

Of these, 116 referrals occurred between 08:00 and 16:00, with 47 patients directly referred by SECAmb for remote frailty review. 

Among these 47 patients, 22 (46.8%) were safely managed without conveyance to ED.

25 patients were conveyed to hospital, with only one requiring ED attendance and the remaining 24 conveyed directly to an Older Persons Assessment Unit (OPAU). Of these, only 2 were admitted.

Importantly, only 2 patients re-attended ED within 7 days, indicating a low short-term adverse outcome rate.

Conclusion
This service evaluation demonstrates that not all falls with head injury in older adults require ED conveyance. 

High non-conveyance rates combined with negligible ED attendance for those conveyed and low re-attendance rates support the safety of paramedic-led, frailty-supported decision-making. 

The findings highlight the value of a “call before conveyance” approach, empowering paramedics to access specialist advice and deliver patient-centred, system-efficient care.