Pre-hospital management, injuries and disposition of ambulance attended adults who fall: A scoping review protocol


Emergency medical services
emergency medical technicians
Joanna Briggs Institute
Accidental falls

How to Cite

Watkins PM, Buzzacott P, Brink D, Masters S, Hill A-M. Pre-hospital management, injuries and disposition of ambulance attended adults who fall: A scoping review protocol. Australasian Journal of Paramedicine [Internet]. 2021Mar.30 [cited 2022Nov.26];18. Available from:



Falls are a globally prevalent health issue, with 37.3 million falls severe enough to require medical attention each year. Falls can result in major trauma and are the second leading cause of unintentional injury deaths worldwide. The role of emergency medical services (EMS) in the pre-hospital emergency treatment of falls is critical, however the sources describing this phase of care has not previously been synthesised. The aim of this scoping review is to identify and map the published literature on the characteristics and injuries of adults who fall, are attended by EMS, EMS interventions and patient disposition.


The methods for scoping reviews outlined by the JBI Manual for Evidence Synthesis will be used. Databases including Medline, Scopus, CINAHL Plus, Cochrane, EMBASE and ProQuest will be searched from inception. Reference lists of included sources will also be searched. Two reviewers will independently complete title, abstract and full text screening. Included sources will be summarised using narrative synthesis and conceptual categories including patient characteristics, injuries, EMS intervention and patient disposition will be mapped.


This protocol describes the framework to identify the scope, comprehensiveness and concepts surrounding pre-hospital falls to identify gaps in knowledge regarding the role of EMS in attending patients who sustain a fall.


World Health Organization. Falls 2018 [updated 16 January 2018]. Available at:

Government of Western Australia. Falls prevention and management in WA 2014: Perth: Department of Health WA; 2014. Available at:

Ballestas T, Xiao J, McEvoy S, Somerford P. The epidemiology of injury in Western Australia, 2000-2008. Perth: Department of Health WA; 2011.

Australian Institute of Health and Welfare: Pointer S. 2019. Trends in hospitalised injury due to falls in older people 2007-08 to 2016-17: injury research and statistics series no. 126. Cat. no. INJCAT 206. Canberra: AIHW. Available at:

Faul M, Stevens JA, Sasser SM, et al. Older adult falls seen by emergency medical service providers: a prevention opportunity. Am J Prev Med 2016;50:719-26.

Simpson PM, Bendall JC, Patterson J, et al. Epidemiology of ambulance responses to older people who have fallen in New South Wales, Australia: ambulance response to older fallers. Australas J Ageing 2013;32:171-6.

Cox S, Roggenkamp R, Bernard S, Smith K. The epidemiology of elderly falls attended by emergency medical services in Victoria, Australia. Injury 2018;49:1712-9.

Simpson PM, Bendall JC, Tiedemann A, Lord SR, Close JC. Epidemiology of emergency medical service responses to older people who have fallen: a prospective cohort study. Prehosp Emerg Care 2014;18:185-94.

Thomas SL, Muscatello DJ, Middleton PM, Zheng W. Characteristics of fall-related injuries attended by an ambulance in Sydney, Australia: a surveillance summary. New South Wales Public Health Bulletin 2011;22:49-54.

Tohira H, Williams TA, Jacobs I, Bremner A, Finn J. The impact of new prehospital practitioners on ambulance transportation to the emergency department: a systematic review and meta-analysis. Emerg Med J 2014;31.

Brown E, Tohira H, Bailey P, et al. Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth. Emerg Med Australas 2019;31:763-71.

Bedwell R, Tracey S. Falls response service: a joint initiative between OT and the North West Ambulance Service. College of Occupational Therapists Conference, June 28-30, 2016. Br J Occup Ther 2016;79:65-6.

Cone DC, Ahern J, Lee CH, et al. A descriptive study of the 'lift-assist' call. Prehosp Emerg Care 2013;17:51-6.

Snooks HA, Anthony R, Chatters R, et al. Paramedic assessment of older adults after falls, including community care referral pathway: cluster randomized trial. Ann Emerg Med 2017;70:495-505.e28.

Colbeck M, Maria S. A comparative taxonomy of Australasian paramedic clinical practice guidelines. Australasian Journal of Paramedicine 2018;15.

Ambulance Victoria. Clinical practice guidelines: ALS and MICA paramedics. 2018. AUTHOR: PLEASE PROVIDE LINK.

Mikolaizak AS, Simpson PM, Tiedemann A, Lord SR, Close JC. Systematic review of non-transportation rates and outcomes for older people who have fallen after ambulance service call-out. Australas J Ageing 2013;32:147-57.

Snooks HA, Halter M, Close JCT, et al. Emergency care of older people who fall: a missed opportunity. Qual Saf Health Care 2006;15:390-2.

Gray JT, Walker A. Avoiding admissions from the ambulance service: a review of elderly patients with falls and patients with breathing difficulties seen by emergency care practitioners in South Yorkshire. Emerg Med J 2008;25:168-71.

Mason S, Knowles E, Colwell B, et al. Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial. BMJ 2007;335:919.

Mason S, O’Keeffe C, Coleman P, Edlin R, Nicholl J. A national evaluation of the clinical and cost effectiveness of emergency care practitioners (phase two) final report. Medical Care Research Unit, School of Health and Related Research, University of Sheffield; 2005.

Tricco AC, Cogo E, Holroyd-Leduc J, et al. Efficacy of falls prevention interventions: protocol for a systematic review and network meta-analysis. Syst Rev 2013;2:38.

Gillespie L Handoll H. Prevention of falls and fall-related injuries in older people. Inj Prev 2009;15:354-5.

Halter M, Chatters R, Koniotou M, Evans B. A systematic review of literature on the care of older people who fall and use out-of-hospital emergency services. Emerg Med J 2015;32.

Institute of Medicine (US) Division of Health Promotion and Disease Prevention; Berg RL, Cassells JS, editors. The second fifty years: promoting health and preventing disability. Washington (DC): National Academies Press (US); 1992.

Peters MDJ, Godfrey C, McInerney P, et al. Chapter 11: scoping reviews (2020 version): Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis, 2020. Available at:

Peters MDJ, Godfrey CM, McInerney P, et al. The Joanna Briggs Institute Reviewers’ Manual 2015: methodology for JBI scoping reviews. Adelaide: Joanna Briggs Institute; 2015. Available at:

Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467-73.

Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 guideline statement. J Clin Epidemiol 2016;75:40-6.

Peters MDJ, Godfrey CM, Khalil H, et al. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015;13:141-6.