Aim To quantify the size and scope of the operational burden arising from older people who have fallen for a large ambulance service and to describe this population. Methods Retrospective analysis of ambulance records from New South Wales, Australia for emergency calls classified as ‘falls’ in the period 1 July 2008 to 30 June 2009. Results There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload. The median age of patients was 83 (interquartile range 76–87) and 62% were women. The transport rate was 76%. Transport to hospital was more likely during the day (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7–1.9) and on weekends (OR 1.06, 95%CI 1.0–1.1). Conclusion Falls by older people constitute approximately 5% of all emergency responses, of which one quarter are not transported to emergency department (ED) after paramedic assessment. Increasing the sophistication of ambulance dispatch processes to older people who have fallen, and continuing with the development of new models of care aimed at decreasing unnecessary transports to the EDs, should be a priority when planning ambulance service delivery for older people who have fallen.