School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia.
Centre for Remote Health, Alice Springs, Northern Territory, Australia.
Aust J Rural Health. 2023 Aug;31(4):605-616. doi: 10.1111/ajr.12994. Epub 2023 May 18.
Australian rural and remote areas are faced with the double burden of an ageing population paired with inequitable access to health resources due to the paradigm of major city centred health care. This complicates fall management within this space. Paramedics are a registered health profession, which provides mobile, equitable health care. However, this resource is not being effectively utilised in rural and remote areas where primary care access barriers may cause patient needs to go unmet.
To describe the existing literature and describe the international scope of current paramedicine practice in the out-of-hospital management of falls amongst older adults in rural and remote settings.
Joanna Briggs Institute scoping review methodology was employed. CINAHL (EBSCO), MEDLINE (Ovid), EMBASE (Ovid), SCOPUS (Elsevier), Google Scholar and These Global were searched and Australian, New Zealand and the UK ambulance service guidelines were sought.
Two records met inclusion criteria. Currently, rural and remote paramedic fall management involves preventative health promotion through patient education, population-based screening and referrals.
The use of paramedics to screen at-risk populations and refer is vital, as many rural adults had screened positive to fall risks and other unmet needs. There is poor recollection of physically printed education material and low acceptance of further in-home assessments following paramedic departure.
This scoping review has highlighted a significant knowledge gap on this topic. Further research is needed to effectively utilise paramedicine within areas where access to primary care is not possible to achieve downstream, risk reducing care in the home.
澳大利亚农村和偏远地区面临着人口老龄化的双重负担，由于以大城市为中心的医疗保健模式，医疗资源的获取也存在不平等。这使得该地区的跌倒管理变得复杂。护理人员是一个注册的医疗专业，提供移动的、公平的医疗服务。然而，在农村和偏远地区，由于初级保健的获取障碍可能导致患者的需求得不到满足，这种资源并没有得到有效利用。
描述现有的文献，并描述国际范围内农村和偏远地区老年患者院外跌倒管理中护理人员的现状。
采用 Joanna Briggs 研究所的范围综述方法。在 CINAHL（EBSCO）、MEDLINE（Ovid）、EMBASE（Ovid）、SCOPUS（Elsevier）、Google Scholar 和 These Global 进行了检索，并寻找澳大利亚、新西兰和英国的救护服务指南。
有两条记录符合纳入标准。目前，农村和偏远地区的护理人员跌倒管理包括通过患者教育、人群筛查和转介进行预防保健。
通过护理人员对高危人群进行筛查并转介至关重要，因为许多农村成年人的跌倒风险和其他未满足的需求都呈阳性。对纸质教育材料的记忆较差，而且护理人员离开后，对进一步的家庭评估的接受度较低。
这项范围综述突出了该主题的一个重大知识差距。需要进一步的研究，以在无法获得初级保健的地区有效地利用护理人员，在家庭中提供下游的、降低风险的护理。
