Northern Ireland Ambulance Service

Best Practice at Northern Ireland Ambulance Service

Dealing with Frailty in Northern Ireland

45% of calls to the Northern Ireland Ambulance Service (NIAS) are for patients over 65 years of age. That’s approximately 100,000 per year. 

Frailty has become a common pre-hospital presentation with falls being the most common reason people call 999. There are approximately 30,000 calls to NIAS per year for patients who have fallen.

In addition, nursing and residential homes make roughly 18,000 calls per year to NIAS.

How does NIAS manage these calls?

NIAS have employed a four pronged approach to managing frailty:

Appropriate Care Pathways (ACPs):

NIAS has access to a range of pathways which offer patients options as to the care they receive. On occasion, this may mean that patients are treated at home and referred to a specialist service or they may be transported to a facility more appropriate to meet their needs.

NIAS ACPs include:

  • Diabetes hypoglycaemia
  • Cardiac PPCI
  • Minor Injuries
  • Palliative Care
  • Frailty – including referral to frailty assessment units and acute / enhanced care at home teams
  • Respiratory
  • Epilepsy
  • Mental Health
  • Alcohol
  • Heart Failure
  • Safeguarding
  • District Nursing

Education opportunities have been offered to staff to enhance their underpinning knowledge of frailty and the challenges associated with frailty such as social isolation and polypharmacy. All NIAS staff received education on the topic of delirium during their annual post proficient training.

In addition, NIAS in partnership with the HSC Clinical Education Centre, offered a range of courses to NIAS clinicians across NI including falls preventions and palliative / end of life care.


NIAS engaged with colleagues across Health and Social Care to develop the appropriate care pathways. Following on from the ACPs, NIAS engaged with the local regulating body, RQIA, and presented at a range of forums which were attended by staff from nursing and residential homes.

This engagement highlighted the role that NIAS plays within the local health community but also led to the Nursing Home standards being revised to state that an ambulance should only be requested where a resident has a clinical need to attend hospital.


NIAS is keen to explore innovative ways of working which enhance patient care and safety. To date this has included a short pilot whereby a paramedic and occupational therapist co-responded to patients who have fallen.

In addition, a paramedic and consultant geriatrician jointly facilitated a training session for nursing / care home managers which was aimed at recognising the deteriorating patient.

The future

With an increasing demand on our Service due to an ageing population NIAS intends to;

  • Introduce the Rockwood Frailty Score. This frailty tool is being used by other healthcare professionals and will therefore ensure consistency in frailty assessment throughout the system.
  • In order to further manage the demand from nursing / residential homes, NIAS plans to Implement the Nursing/Residential Manchester Triage tool in 5 care homes.
  • Pilot a paramedic / geriatrician co response to patients who have called 999 and have frailty related problems.
  • Work with Community Navigators to help manage patients who are socially isolated.

Contact details:
Phone: 028 9040 0999
Twitter: @nias999

For further details contact

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