The unseen cost of falls: the environmental impact of attending falls call out by the emergency ambulance services

Falls in older people are a major public health problem. This has major consequences to the individual, which can ultimately lead to injury, functional decline, psycho-social impairment and increased risk of mortality. It is also a major burden on healthcare resources. In the United Kingdom (UK), falls account for 3% (about £980 million) of the total National Health Service (NHS) expenditure [1] and the prevention of falls in older people has been highlighted as a priority area [2] and [3]. Older people commonly call out an emergency ambulance following a fall. This group account for 8% of emergency ambulance responses, which is similar to the proportion reported in Australia [4] and an urban Emergency Medical Service system in USA [5]. Transfer of these patients to the emergency department is also high, close to 60% and account for 60,000 of attendances in the UK [6], with similar proportions in the USA [7] and as high as 75% in Australia [4]. Previous studies examining healthcare cost of falls suggest costs of approximately £2000–£3000 per faller, with hospital costs accounting from 50% to 80% of these costs [8] and [9]. Global warming is becoming an increasing concern. In a natural carbon cycle, carbon dioxide is re-absorbed by plants and trees but this excess has now reached dangerous levels not seen in the last 3 million years and has led to an overall rise in atmospheric temperature-global warming. The transportation sector is the second largest source of anthropogenic carbon dioxide emissions. Transporting goods and people around the world produced 22% of fossil fuel related carbon dioxide emissions in 2010. Since the 1990s, transport related emissions have grown rapidly, increasing by 45% in less than 2 decades. Road traffic accounts for 74% of this sector's carbon dioxide emissions. Automobiles, freight and light-duty trucks are the main sources of emissions for the whole transport sector and emissions from these three have steadily grown since 1990 [10]. The NHS itself accounts for 3% of the UK's carbon footprint, which makes it a bigger polluter than some small countries [11]. The direct contribution related to the ambulance service and more specifically to falls is unknown. The aim of this study was to assess the environmental implication of falls in older people who call out an emergency ambulance