UK-wide survey of emergency ambulance staff confidence in decision-making when attending older adults who have fallen: AMBOFALL

Introduction

One in three people aged 65 and over, and half of those aged 80 and over, fall each year. Previous interview studies found confidence affected ambulance staff decision-making, without exploring what impacts this confidence.

This eSurvey aimed to describe the confidence in decision-making of patient facing emergency ambulance staff when attending older adults who have fallen, and the factors which impact this confidence.

Methods

Ambulance staff were eligible to participate in a national eSurvey, shared by all UK NHS/HSC ambulance services and on social media. Participants were asked about their confidence using Likert scales (1-No confidence to 5-High confidence), and multi-choice questions. Results were analysed descriptively using medians and IQR, and inferentially using logistic regression and chi-squared for relationships to participant demographics.

Results

1632 participants completed the survey, representing 13 UK ambulance services. One-third were aged 25-34 (31%, n=502), over two-thirds (70%, n=1153) were paramedics. Half (52%, n=841) had 2-10 years frontline emergency ambulance experience.

88% of participants reported confidence in assessment (Median 4, IQR 2-5), and when assessing confidence between older adult age groups, only ambulance staff age (χ²(8)=31.27, p<0.001) and total experience providing healthcare (χ²(12)=35.90, p<0.001) were significant.

Notably, there appears more variability around non-conveyance or referral decisions especially when outside of normal area (Median 3, IQR 1-5). Conveyance decisions between youngest-old and oldest-old have significant relationship to staff age again (χ²(8)=25.71, p=0.001) and emergency experience replaces total healthcare provision experience (χ²(12)=22.16, p=0.036) 

92% of participants selected patient wishes, whilst 69% considered communication with pathway colleagues important to conveyance decisions.

Conclusions

Emergency ambulance staff are more confident in assessing and deciding to convey older adults, than non-conveyance or alternative pathway referral decisions. Highlighting guidance with access to hospital avoidance pathways need more development to improve confidence and care provision. Future work should correlate confidence with appropriateness of the decision.