Falls in the Elderly: Conveyance vs Stay Decision Aid

A practical prehospital support tool for older adults after a fall. Designed to help assess red flags, head injury risk, hidden medical cause, frailty, cognition, home safety, follow-up needs, and the wording you may need for a safer PCR entry.

Red flags
0

Medical cause concerns
0

Head injury concerns
0

Home safety concerns
0

Patient Details

Patient name or identifier

Age

Location

Date and time

Step 1: Immediate Conveyance Triggers

Reduced GCS, new confusion, or significant altered mental status
Head injury with concerning features or clinician concern
Anticoagulant or antiplatelet use with head strike or possible head injury concern
Suspected hip fracture, major injury, or unable to weight bear safely
New focal neurology, stroke or TIA concern
Chest pain, syncope, SOB, sepsis concern, or persistently abnormal observations
Uncontrolled pain or pain out of keeping with minor injury
Unable to mobilise or transfer safely after assessment

A single significant red flag should usually push the outcome away from routine stay at home.

Step 2: Was This a Mechanical Fall or a Medical Fall?

Overall impression of cause

Symptoms before the fall

Dizziness, postural symptoms, or weakness before the fall
Collapse, blackout, or possible syncope
Palpitations or possible cardiac cause
Seizure features, post-ictal period, or abnormal movements
Infection symptoms, delirium concern, or reduced oral intake
Stroke or TIA features
Hypoglycaemia risk or diabetes-related cause
Medication change, alcohol, or intoxication may have contributed

Step 3: Head Injury Mini-Branch

Use this even when the patient appears well

Head strike

Anticoagulant / antiplatelet use

Loss of consciousness

Vomiting after fall

Worsening headache or concerning headache
Amnesia, uncertainty around events, or poor recall
Drowsiness, reduced alertness, or not at usual baseline
Visible head or facial trauma adds concern

This branch is not a replacement for guideline-based head injury assessment. It is here to stop crews downplaying head injury risk in older adults.

Step 4: Frailty, Cognition, Function, and Injury Screen

Baseline mobility

Current mobility after assessment

Baseline cognition

Acute change from baseline cognition or new confusion
Delirium concern
Neck, back, or spinal pain concern
Hip, pelvis, or limb injury concern
Minor soft tissue or skin injury only
Recurrent falls history
Prolonged lie or unable to get up for a long period
Frailty level or deconditioning increases concern

Step 5: Observations, Capacity, and Home Safety

Observations

Capacity for conveyance decision

Support at home

Follow-up / onward pathway

Able to access food, fluids, medication, toilet, and phone or alarm
Home environment safe and adequately heated
Can seek further help if worse
Safeguarding concern present
Carer or family significantly concerned despite patient minimising situation
Patient refuses conveyance despite meaningful ongoing risk

What risks were explained to the patient?

How did the patient show understanding?

Additional Notes

Clinical summary, scene factors, or important context

Key Decision Points

Recommended Actions

Follow-Up and Escalation

Safety Netting

Suggested PCR Wording

This tool is decision support only. It does not replace local policy, senior advice, guideline-based head injury assessment, or clinical judgement.

YOUR LEARNING

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Self-reported reading. This does not complete a CPD reflection.

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