Factors infuencing conveyance of older adults with minor head injury by paramedics to the emergency department: a multiple methods study

Factors infuencing conveyance of older adults with minor head injury by paramedics to the emergency department: a multiple methods study

Head Injury, Minor, Injuries, Head, Aged 65+, Paramedic, Emergency Medical Services, Interview, Decision
Making

Background: Head injury (HI) in older adults due to low-energy falls result in a substantial number of emergency
department (ED) attendances. However, mortality associated with minor HI is very low. Reducing conveyance to
hospital is important for older adults and is a priority for the National Health Service (NHS). Therefore, paramedics
are required to make accurate decisions regarding conveyance to the ED. This study used routine data and semistructured interviews to explore the factors that infuence paramedic decision-making when considering whether to
convey an adult aged 65 years and over with a minor HI to the ED.
Methods: Semi-structured telephone interviews were completed with ten UK paramedics from a single EMS (ambulance) provider organisation. Interviews explored the factors infuencing the paramedics’ conveyance decision-making in adults aged 65 years and over with a minor HI. Data were initially analysed inductively to develop a thematic
framework. A retrospective analysis of ambulance service data was also completed to determine the scope and scale
of the issue in Southwest England. An in-depth audit of 100 conveyed patient records was used to determine the
proportion of patients conveyed to the ED who met National Institute for Health and Care Excellence (NICE) and Joint
Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.
Results: In 2019 South Western Ambulance Service NHS Foundation Trust (SWASFT) attended 15,650 emergency
calls to patients aged 65 and over with minor HI, with 70.5% conveyed to ED. 81% of conveyed patients met NICE
and JRCALC guideline criteria for conveyance, with the remainder conveyed due to wound care or other medical
concerns. The framework developed from the interviews comprised four themes: resources; patient factors; consequences; paramedic factors. Important factors included: the patient’s social situation; guidelines; clinical support availability; the history and presentation of the patient; risk.
Conclusion: This study examined paramedic conveyance decisions for older people with minor HI. It identifed multiple infuencing factors, highlighting the complex nature of these decisions, and may serve as a basis for developing
an intervention to safely decrease ED conveyance in this patient group

Helen Nicholson, Sarah Voss, Sarah Black, Hazel Taylor, David Williams and Jonathan Benger

BMC Emergency Medicine

(2022) 22:184

Fajar Bagus W

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