LAUSR

Patients living with frailty are at risk of worse outcomes. The Clinical Frailty Scale (CFS) is a tool that has been developed to assess a patient’s level of frailty. It is determined by a patient’s baseline health (status two weeks prior to hospital admission), with a score of 1 being very fit and 9 being terminally ill. Prior to the COVID19 pandemic, frailty screening was part of the National Health Service England commissioning tariff, although there is no current agreement on when this should be assessed in the patient’s journey, and this has ceased since the pandemic. Helicopter emergency medical services (HEMS) teams respond to critically unwell medical and trauma patients of all ages, making challenging decisions on scene. These decisions, which have longterm implications for the patients and their families, include whether or not to preform invasive procedures, such as prehospital anaesthesia, and triage destinations, including whether to transport patients to a specialist centre or to remain at the nearest hospital. Traditional triage tools are thought to underestimate the injury burden in the elderly population and encompassing frailty may help with such decisions. Currently, we are unaware of the use of the CFS in a HEMS service. The aim was to establish the feasibility of assessing a CFS in the HEMS environment, for both medical and trauma patients. The study was registered with the Lincs & Notts Air Ambulance (LNAA) Clinical Research & Audit Team (LNAA/A/003). The computerised record system (HEMSbase V.3.0; Medic One Systems, London, UK) was updated centrally by the developers on 1 January 2022 to incorporate a section for ‘Frailty’, in which a CFS score can be recorded. Eight months following its introduction, an anonymised retrospective review of the database was conducted for all attended patients ≥65 years to establish the percentage of frailty scores that had been documented. Analysis was performed in Microsoft Excel relating to outcomes of patients. Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed. Additionally, comparison was made between the patient’s initial Glasgow Coma Score (GCS) and the presence or absence of the CFS score to establish if this was associated with results. Out of 508 patients attended between 1 January 2022 and 31 July 2022, 103 patients were ≥65 years old and therefore potentially eligible for a CFS assessment. Of the 103 patients, 59 patients (57.3%) had the CFS measured, with a range of 1–8 and a median of 3. Table 1 summarises the demographics of the patients attended and shows the frequency of assessment of CFS according to GCS. GCS does not appear to explain the differential assessment; if all patients with a GCS of ≤8 were excluded, the overall assessment rate would only increase slightly from 57.3% to 61.0%. Although outcomes did not appear different depending on whether or not a CFS was assessed, no patient with a CFS score of ≥6 received a prehospital anaesthetic (figure 1). Similarly, only one patient (6.67%) was transported to a major trauma centre who had a CFS assessed at ≥6 (figure 1). In Research letter