Abstract

Background
The Falls Response Partnership (FRP) is an innovative approach to ensuring a safe health and social care response to people who fall in Lincolnshire. It involves LIVES Lincolnshire First Responders being trained and supported to attend adults who fall and then either call for an ambulance or an ambulance is called on their behalf. This scheme was implemented from December 2018 and this report describes the interim evaluation of the service. We aimed to investigate the effect of LIVES responders allocated to and attending people who fell and the overall effect of the FRP.
Method
We accessed data from East Midlands Ambulance Service NHS Trust (EMAS) and LIVES to conduct the evaluation, comparing outcomes for adults who fell and called the ambulance, and who then received an ambulance response or a LIVES response. We have provided descriptive analyses based on these data and more detailed economic models and analyses comparing LIVES with ambulance responses in terms of outcomes and costs while adjusting for other factors likely to be associated with these.
Results
Between December 2018 and the end of June 2019 we ascertained that 445 patients were attended by LIVES through the FRP. Patients were seen on average in under 30 minutes and around 30 minutes was spent on average assessing and managing each patient. In just over half the cases (53%) ambulance backup was called. 62% of FRP patients were conveyed to hospital. Additional data on severity category, location and adjustment for inclusion and exclusion criteria were available for 183 unique cases of falls attended by CFRs of which 153 remained that were actually attended by the Bariatric Support Vehicles (BSVs) allocated to the FRP. Of the 153 cases FRP attended the scene, 95 (63%) eventually went to hospital. More severe cases increased the likelihood of an ambulance being called to attend. Costs of standard care and the LIVES responders attending have been estimated and are presented based on an economic model formed as a decision tree. The model suggests that the effectiveness and costeffectiveness of the FRP increases as transportation to hospital following FRP attendance decreases, as referral to the community falls service increases and with the duration of the intervention because of a reduction in recurrent falls. Cost effectiveness estimates are presented as incremental cost effectiveness ratios (ICERs).
Conclusion
Our preliminary results suggest that the FRP has the potential to be effective and cost-effective, for management of adult fallers who call the ambulance service and are attended by LIVES CFRs, as additional ambulance attendance and transportation decreases, referrals to community falls services increase and as the intervention continues over time, due to reduction in recurrent falls.