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Systematic review
Community emergency medical services approaches to fall prevention: a systematic review
  1. Tynan H Friend1,2,
  2. Hannah M Thomas3,4,
  3. Alexander J Ordoobadi2,
  4. Paul A Bain5,
  5. Molly P Jarman2,6
  1. 1 Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2 Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3 Department of Orthopaedic Surgery, University of California Irvine, Irvine, California, USA
  4. 4 Harvard Medical School Orthopaedic Trauma Initiative, Boston, Massachusetts, USA
  5. 5 Harvard University Francis A Countway Library of Medicine, Boston, Massachusetts, USA
  6. 6 Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Tynan H Friend; tfriend{at}mgh.harvard.edu

Abstract

Background Falls are a leading cause of morbidity and mortality among older adults in the USA. Current approaches to fall prevention often rely on referral by primary care providers or enrolment during inpatient admissions. Community emergency medical services (CEMS) present a unique opportunity to rapidly identify older adults at risk for falls and provide fall prevention interventions in the home. In this systematic review, we seek to assess the efficacy and qualitative factors determining success of these programs.

Methods Studies reporting the outcomes of fall prevention interventions delivered by EMS were identified by searching the electronic databases PubMed, Embase, Web of Science Core Collection, CINAHL and the Cochrane Central Register of Controlled Trials through 11 July 2023.

Results 35 studies including randomised and non-randomised experimental trials, systematic reviews and qualitative research primarily from Western Europe, the USA, Australia and Canada were included in our analysis. Current fall prevention efforts focus heavily on postfall referral of at-risk community members. CEMS fall prevention interventions reduced all-cause and fall-related emergency department encounters, subsequent falls and EMS calls for lift assist. These interventions also improved patient health-related quality of life, independence with activities of daily living, and secondary health outcomes.

Conclusions CEMS programmes provide an opportunity for direct, proactive fall prevention on the individual level. Addressing barriers to implementation in the context of current emergency medical systems in the USA is the next step toward widespread implementation of these novel fall prevention interventions.

  • interventions
  • trauma systems
  • fall
  • older people
  • prehospital
  • systematic review

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

https://doi.org/10.1136/ip-2023-045110

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • X @MollyJarman

    • Contributors PAB constructed the study search database and described the methods used to do so. THF and HMT screened and extracted all studies for review. MPJ reviewed each screening decision and oversaw the planning, conduct and analysis of the study. THF completed the objective and subjective data analysis and drafted the manuscript and tables/figures. THF, HMT, AJO, PAB and MPJ edited the manuscript. THF submitted the manuscript. MPJ is the Guarantor of the study, had access to all data, controlled the decision to publish and accepts full responsibility for the finished work and the conduct of the study.

    • Funding Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number K01AG065414.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.