From data from participating ambulance services, we expect 250 older people to fall in each site each month. However it will not be possible to identify all who have fallen as eligible for the trial from information given during the emergency call. Furthermore some patients will opt out. Estimating conservatively that we can recruit 133 older people per site per month, a recruitment period of four months will enable us to recruit 500 patients per site, that is 25 per cluster and 1500 in all. This sample size will yield 80% power when using a 5% significance level to detect a fall in the proportion of participants who make Inhibitors,research,lifescience,medical another emergency call for a fall (or death) within six months from

50%, as found in London recently [41], to 40% if, as we expect, the intra-cluster correlation coefficient is less than 0.035. Since this proportion is a binary variable, the time to first reported fall (or death), which is an interval variable, will yield greater Inhibitors,research,lifescience,medical power. We shall also have power to detect an effect size of 0.20 (i.e. one fifth Inhibitors,research,lifescience,medical of the population standard deviation) in SF12 scores. Randomisation and blinding The ‘West Wales Organisation for Randomised Trials in health and social care’ (WWORTH) is randomising paramedics between intervention and control. We shall

conceal the resulting allocation until we reveal it by inviting individual paramedics to training days. Blinding participants to trial group allocation is neither feasible nor appropriate in a pragmatic trial like this. Older people who fall and are attended by a click here control paramedic will receive the participating ambulance service’s standard care. As Inhibitors,research,lifescience,medical it may not be feasible to blind the dispatchers in ambulance control to the trial group of their paramedics, we shall monitor and, if necessary, manage Inhibitors,research,lifescience,medical ambulance dispatch to avoid selection bias, which might manifest itself in a higher transfer or recruitment rate in the intervention group. Statistical

methods We shall comply with all standards defined in the CONSORT guidelines [43]. We shall compare measures of process, outcome and cost between intervention and control patients by ‘intention to treat’. As we expect many subsequent emergency calls for falls, many participants Etomidate will call more than once during the trial period. If the intervention is effective, therefore, later attendances by paramedics with the CCDS could dilute the true effect on outcomes. For primary analysis, nevertheless, participants will remain in the group to which they are allocated. We shall compare our primary and principal outcomes between groups by multi-level survival analysis. This will include separate analyses for later falls (including deaths) and for deaths alone. We shall review all deaths within 72 hours, the typical interval between index fall and referral to falls service.