This comprises a paper-based decision support

system in the form of a structured questionnaire at each site. Outcomes Primary • Interval to the first 999 call or ED attendance categorised as fall; or death Principal • Interval to the first subsequent 999 call, ED attendance or death (event free period) • Quality-adjusted event free period Secondary • Number per patient of further falls for which a 999 call is made • Number per patient of further 999 calls • Number per patient of self-reported further falls • Number per patient of ED attendances • Number per patient of emergency hospital admissions • Number per patient Inhibitors,research,lifescience,medical of GP (General Practitioner) contacts • Mortality rate • Health related quality of life • Patient satisfaction • Fall-related self-efficacy (fear of falling) • Change in place of residence • Length of hospital stay • NHS costs • Personal Inhibitors,research,lifescience,medical costs to patient and family • Pathways of care: proportions of index falls: conveyed to ED referred to falls service referred to GP left at scene without further care • Operational indicators: length Inhibitors,research,lifescience,medical of time: spent on scene in ambulance service job cycle in episode of care to respond to 999 call (effect of intervention on response time?) for falls service to respond • Quality of care: compliance by paramedics with: ambulance service treatment protocols decision support algorithms clinical documentation

protocol for referral to falls service These outcomes are consistent with those recommended in recent guidance from Inhibitors,research,lifescience,medical the PRevention Of FAlls Network Europe (PROFANE) [30]. Participants The trial will

be carried out in three ambulance services. In each service we shall recruit paramedics from ambulance stations that serve a General Hospital with a full ED and one or more community-based falls services. Paramedic find more recruitment and consent Paramedics are eligible for the trial if they are on active duty at ambulance stations within its catchment area. We shall write to eligible paramedics to invite them to participate. We shall select 24 volunteers from each service at random and allocate Inhibitors,research,lifescience,medical half to intervention group and half to controls, again at random. Of these 24 we expect 20 to complete patient recruitment and TCL four to withdraw. Patient recruitment and consent Patients are eligible for the trial if they are: • aged 65 or over • the subject of an emergency ambulance call categorised by the call-taker as a fall without priority symptoms • attended by a trial paramedic during the recruitment period • living in the catchment area of a falls service; and • not living in residential care To make findings apply to all such patients, we shall not exclude patients with other co-morbidities, including cognitive impairment. However we shall recruit them to the trial only once, namely the first time they meet the inclusion criteria within the study period.