Findings of interviews exploring ambulance staff decision-making when attending older adults who have fallen - AMBOFALL

Introduction

Around 10% of UK emergency ambulance calls (approximately 700,000) are to older adults who have fallen. Previous studies have explored the complex decision-making of ambulance staff, finding confidence to be a theme. This interview study aimed to explore understand the factors and experiences that impact the decision-making, confidence and actions of patient facing emergency ambulance staff when attending older adults who have fallen.

Methods

Semi-structured interviews with frontline emergency ambulance staff, purposively sampled from the recent UK-wide AMBOFALL eSurvey. Interviews were held on MS Teams, audio-recorded and transcribed. Data were analysed using reflexive thematic analysis.

Findings

N=18 interviews completed from N=53 invited. Most participants were male (66%,n=12), with 56%(n=10) aged 25-44. Four themes were identified:

Ambulance staff perceptions: Variation in whether participants thought it was their job to attend uninjured falls.

Sharing decision-making: Involving patients, family and multidisciplinary colleagues are important for clinical and holistic patient needs.

Doing the ‘right’ thing: Participants desire to provide good care to their patients, but lack of feedback on previous cases inhibits progress. Staff and institutional culture introduces tension between what people think they should do and what they’re expected to do.

Response Delays: Decisions are increasingly impacted directly and indirectly by delays arriving on scene, and then at hospital. Often through demand and service pressures, rather than rurality and location of the call.

Conclusions

Ambulance staff value opportunities to share decision-making (with patients and others) and a desire to do the right thing are important in decision-making. Delays further impact decisions both for patients waiting for the ambulance arrival, and the likelihood of queuing at hospital, highlighting factors influencing decisions are systematic as well as individual.