Gravity always wins!

It’s no secret and no big surprise but all aspects of the NHS in the UK are overstretched now.  The pressure is felt as much in the Ambulance service as anywhere.  The impression given by the media is that drunk and drug related incidents are the main cause.  We do get these jobs, of course, but in my experience these are not the most time consuming of our jobs.

My experience is that most of our jobs are elderly people unwell or falling.  NHS (in the UK) stats tell us that 1 in 3 people over the age of 65 will have at least 1 fall per year, about half of these fallers will have more than 1 fall.  At the end of the 20th century and start of the 21st we are living longer than our ancestors.  This means that the age range of the population is increasing and the proportion of elderly in the population is increasing.

With age can come weakness, balance problems and reduced co-ordination – these all contribute to the increased risk of falling.  The highest risk times for falling seem to be late at night and early morning.  Many of our elderly population seem to be prescribed medication to help them sleep at night this obviously leads to drowsiness and increased risk of falling when getting out of bed to visit the bathroom.

The consequences of falls in the elderly can be severe.  A common injury is a fractured ‘neck of femur’ (#nof (the hash symbol in this case is not a hashtag, it’s medical shorthand for fracture)).  The femur is the thighbone, the longest bone in the body.  At the top of the femur there is a ball shape which projects at an angle and fits in a socket in the pelvis forming the hip joint.  The portion of bone between the main shaft of the femur and the ball joint is called the ‘neck of the femur’ and is the weakest part of the whole bone.  With increasing age the bones can become less dense and more brittle.  If a person then falls and lands on his or her hip then this easily causes a #nof.  This requires surgery to repair with all the associated risks of surgery in the elderly and then a period of immobilisation in hospital (typically 6 weeks) followed by a period of physiotherapy.  Another common problem is a head injury – many elderly people are on ‘blood thinning’ medication (anticoagulotherapy).  In this case a trip to the Emergency Department is needed for a CT scan to rule out a bleed on the brain.

What do we do when we get to a fall?

First thing, as always, is to quickly assess airway, breathing, circulation and responsiveness.  Once we’re happy that the patient is alive and breathing we make them as comfortable and warm as possible on the floor while we assess their baseline observations and examine for injuries.  If there are no injuries and the patient is medically stable the next step is to get up from the floor.  If the patient is unable to get up themselves with instruction and assistance from us we use an inflatable cushion to lift.  When deflated, the cushion is flat and can be slid under the patient’s bottom (with some shuffling, leaning, sliding and under-the breath-swearing!).  Once in position we connect a series of pipes to a compressor and inflate the cushion.  The patient can then simply stand from sitting and we can assess his/her mobility.  If all is well, we can safely leave the patient at home (after we have completed the mountain of associated paperwork).  One further service we perform is to refer the patient on to a falls prevention team.  This is a multi-disciplinary team of people who visit the patient and get involved to try and prevent further falls.  This may involve physiotherapy to improve strength and balance, it may involve a review of possible walking aids with training in how to use them and it usually involves advice on lifestyle and adapting the home to remove or minimise trip hazards.

I’m not for one second suggesting that falls are not a genuine part of our job but falls do take up a lot of ambulance time.  What’s the answer?  I don’t know if there is an answer.  We are always going to be needed when elderly and vulnerable people fall.  I believe falls prevention plays a huge part in preventing repeated falling.  It’s a pity that you have to have a fall before the falls prevention team get involved; it would be good to see the falls prevention team’s roles increased so they could get involved with everyone as a certain age is reached to prevent even the first fall.

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