Background Falls involve around 13% of 999 Emergency Medical Service (EMS) attendances in the East Midlands, UK. The Falls Response Partnership (FRP) between LIVES, Lincolnshire and East Midlands Ambulance Service (EMAS) was commissioned to provide a safe response using vehicles fitted with mobile lifting equipment to adult patients who fall and staffed by two Community First Responders (CFRs) from LIVES. A model-based economic evaluation of the FRP over the pilot period of December 2018-June 2019 reported improvements in effectiveness and cost-effectiveness of FRP versus standard care linked inversely to the ambulance back up rate following FRP attendance.

The FRP was recommissioned in February 2020, where 3 vehicles operated 8 am-8 pm daily throughout areas of Lincolnshire, urban and rural.

We aimed to examine the operation of the recommissioned FRP against the benchmarks established in the pilot.

Methods Descriptive statistics were applied to routine data collected, and linked, from EMAS and LIVES over the period April 2020-December 2021. Information included incident location, timing of response and treatment, ambulance backup, and conveyance.

Results Overall, the recommissioned FRP service attended 2090 incidents. Most (1,793, 85.8%) were falls in urban (57.2%) and rural (42.8%) areas, the remainder were non-protocol attendances at non-fall emergencies and life-threatening episode falls.

1,517 falls patients were treated per FRP protocol, an average work rate of 24.1 patients per month per CFR team. Of these, the ambulance backup rate was 51.9% (split 60.2% urban, 39.8% rural). Where backup was sent, 75.4% of patients were conveyed to hospital.

Model projections set to 51.9% backup rate suggest that the recommissioned FRP has become cost saving to the National Health Services (NHS). Including benefit arising from auxiliary use only serves to add further value to the NHS.

Conclusion The recommissioned CFR falls response service was potentially cost saving to the NHS. A CFR falls scheme responding to people who had fallen at home, led to fewer ambulances attending and likely financial savings. They were distributed in both rural and urban areas to different extents across different service regions. Costs of providing CFR schemes were incompletely recorded and reported by ambulance services but reported figures varied considerably, around 20-fold from £40,000 to over £800,000 per year, between ambulance services so true costs, may have been even higher. Costs reported were attributed to staff providing management and training, together with reimbursement of out-of-pocket costs of volunteering including fuel and vehicle use. Smith et al (2020) report on a model-based economic evaluation in which when patient circumstances dictate that ambulance backup is required, in particular, estimates of the average intervention cost are £195 without backup, but £440 when backup is required.

The recommissioned CFR falls response service had the potential to save costs for the NHS. The implementation of a CFR falls scheme, resulted in a decrease in ambulance usage and likely led to financial savings. These schemes were implemented to varying extents in both rural and urban areas across different service regions. However, the costs associated with providing CFR schemes were not consistently recorded or reported by ambulance services. The reported figures varied significantly, ranging from £40,000 to over £800,000 per year, among different ambulance services. Therefore, the true costs may have been even higher. The reported costs included expenses related to staff management and training, as well as reimbursement for out-of-pocket costs incurred by volunteers, such as fuel and vehicle use.

According to a study by Smith et al. (2020), a model-based economic evaluation indicated that when patient circumstances necessitate ambulance backup, the estimated average intervention cost is £195 without backup, but increases to £440 when backup is required.