Prehospital emergency care for patients with suspected hip fractures after falling - older patients' experiences.

AIMS AND OBJECTIVES: To describe and explain older patients' lived experiences of prehospital emergency care in cases of suspected hip fractures after falling.

BACKGROUND: Falls among the elderly is an issue internationally and a public health problem that seems to be on the increase. In the emergency medical services, older people are frequent patients after having suffered a fall, but there is little information on how older patients experience prehospital emergency care in cases of suspected hip fractures after falling.

DESIGN: Qualitative interview study.

METHODS: Ten older patients were interviewed. These depth interviews were tape-recorded, transcribed verbatim and analysed for meanings.

RESULTS: The comprehensive understanding of the phenomenon is: 'Glad to have been rescued, despite bad experiences as well as good'. The older patient is offered care in an open and friendly atmosphere concurrently with feeling anxiety about the treatment. Intervention with streamlined care and treatment can thus simultaneously be beneficial as well as doing harm. Patients experience confusion and the need to ask questions about what really happened in the ambulance. Bad experiences remain unexplained. These findings are based on three themes with relevant subthemes: efficiency, concerned encounters and suffering from care.

CONCLUSIONS: Our study shows that prehospital emergency care when hip fracture is suspected - from patients' point of view - is insufficient and unsatisfying. Prehospital emergency care for these vulnerable patients could be improved through more compassion being shown towards older patients' existential needs and their increased participation. Furthermore, alternative methods of prehospital pain relief need to be developed.

RELEVANCE TO CLINICAL PRACTICE: Responsibility for patients' safety regarding pain relief is emphasised. Pain relief in the emergency medical services should be individualised. This development should focus on care that is already good and gradually eradicate compassionless care.