Advertisement

Prehospital Care

  • Juan Duchesne
  • Connie DeLa’O
Chapter

Abstract

The geriatric trauma patient presents unique challenges to prehospital personnel and hospital providers. There are many ways to classify older adults, but for the purpose of this chapter, the term geriatric is defined as individuals who are ≥65 years old. Our general population of baby boomers is living longer and are relatively healthier than their counterparts a generation ago, resulting in a rapid increase in both the number and percentage of people 65 years old and over. Estimates predict that by year 2030, one in five people in the United States will have reached age 65. Because of this, it is important to make a distinction between management strategies for geriatric trauma patients when compared to younger patients. Geriatric populations are associated with physiological changes that occur with normal aging, multiple co-morbidities, and prescription drug regimens that are present prior to their injuries. Because of these age-related differences, the geriatric trauma patient involved in relatively minor accidents can have devastating consequences—their response to bleeding, injury, and shock differs greatly from their 18-year-old counterparts. The objective of this book chapter is to better understand the physiology difference in the elderly and their response to injury in the prehospital setting in order to maximize outcomes.

References

  1. 1.
    Strange GR, Chen EH. Use of emergency departments by elder patients: five-year follow up study. Acad Emerg Med. 1998;5(12):1157–62.CrossRefPubMedGoogle Scholar
  2. 2.
    Evans R. Physiology of aging. In: Sanders AB, editor. Emergency care of the elder patient. St. Louis: Beverly Cracom; 1996. p. 11–27.Google Scholar
  3. 3.
    Ferrera PC, Bartfield JM, D’Andrea CC. Outcomes of admitted geriatric trauma victims. Am J Emerg Med. 2000;18(5):575–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Phillips S, Rond PC 3rd, Kelly SM, et al. The failure of triage criteria to identify geriatric patients with trauma: results from the Florida trauma triage study. J Trauma. 1996;40(2):278–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma. 2001;50(1):116–9.CrossRefPubMedGoogle Scholar
  6. 6.
    State of Ohio State Board of Emergency Medical Services Trauma Committee: Geriatric trauma task force report and recommendations. www.ems.ohio.gov/datacenter/Geriatric%20Trauma%20Triage%20Study.pdf.
  7. 7.
    Hoffman JR, Mower WR, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343:94–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Evans D. Alzheimer’s disease in a community population of older persons. Higher than previously reported. JAMA. 1989;262(18):2551–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Kiel DP, Eichorn A, et al. The outcomes of patients newly admitted to nursing homes after hip fractures. Am J Public Health. 1994;84(8):1281–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Scalea TM, Kohl L. Geriatric trauma. In: Feliciano DV, Moore EE, Mattox KL, editors. Trauma. Norwalk, CT: Appleton-Lange; 1996. p. 899–915.Google Scholar
  11. 11.
    Gleason PP, Meehan TP, et al. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med. 1999;159:2562–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Telfer S, Fenyo G, et al. Acute abdominal pain in patients over 50 years of age. Scand J Gastroenterol. 1988;23(Suppl 144):47–50.Google Scholar
  13. 13.
    Deehan DJ, Heys SD, et al. Mesenteric ischemia: prognostic factors and influence of delay on outcome. J R Coif Surg Edinb. 1995;40:112–5.Google Scholar
  14. 14.
    Wenzel V, Idris AH, et al. Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure. Resuscitation. 1998;38:113–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Thiemann DR, Coresh J, et al. Lack of benefit for intravenous thrombolysis in patients with MI who are older than 75 years. Circulation. 2000;101:2239–46.CrossRefPubMedGoogle Scholar
  16. 16.
    Kennedy RD, Caird FI. Physiology of the aging heart. Cardiovasc Clin. 1981;12:1–8.PubMedGoogle Scholar
  17. 17.
    Fallon WF Jr, Rader E, Zyzanski S, et al. Geriatric outcomes are improved by a geriatric trauma consultation service. J Trauma. 2006;61(5):1040–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Kothari R, Pancioli A, et al. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999;33:373–8.CrossRefPubMedGoogle Scholar
  19. 19.
    The National Institute of Neurological Disorders and Stroke RT-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.CrossRefGoogle Scholar
  20. 20.
    Vickery D. The use of the spinal board after the prehospital phase of trauma management. Emerg Med J. 2001;18(1):51–4.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Pudelek B. Geriatric trauma: special needs for a special population. AACN Clin Issues. 2002;13(1):61–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Brown BA. The history of advance directives: a literature review. J Gerontol Nurs. 2003;29:4–14.CrossRefPubMedGoogle Scholar
  23. 23.
    Omnibus Budget Reconciliation Act of 1990, Pub Law No. 101-508. 1990.Google Scholar
  24. 24.
    Council of the European Union. Council conclusions on common values and principles in European Union Health Systems. Official Journal of the European Union, June 22, 2006. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2006:146:0001:0003:EN:PDF. Accessed 28 Mar 2016.
  25. 25.
    French Parliament. Law No. 2002-303 of 4 March 2002 on patients’ rights and the quality of the health system. http://www.legifrance.gouv.fr/affichCodeArticle.do;jsessionid=AB85CDED5DA6C2F01D482487F7BC0C7E.tpdjo07v_2?cidTexte=LEGITEXT000006072665&idArticle=LEGIARTI000006685759&dateTexte=20100225&categorieLien=id. Accessed 28 Mar 2017.
  26. 26.
    Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362(13):1211–8.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Schmidt TA, Zive D, Frommes EK, Cook J, et al. Physician orders for life-sustaining treatment (POLST): lessons learned from analysis of the Oregon POLST Registry. Resuscitation. 2014;85(4):480–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Bomba PA, Kemp M, Black JS. Polst: an improvement over traditional advance directives. Cleve Clin J Med. 2012;79:457–64.CrossRefPubMedGoogle Scholar
  29. 29.
    Lahn B, Friedman P, Bijur M, et al. Advanced directed in skilled nursing facility residents transferred to emergency departments. Acad Emerg Med. 2001;8:1158–62.CrossRefPubMedGoogle Scholar
  30. 30.
    Sehgal A, Galbraith A, Chesney M, Schoenfeld P, Charles G, Lo B. How strictly do dialysis patients want their advance directives followed? JAMA. 1992;267:59–63.CrossRefPubMedGoogle Scholar
  31. 31.
    Weinick RM, Wilcox ER, Park RT, et al. Use of advanced directives for nursing home residents in the emergency department. Am J Hosp Palliat Care. 2008;25:179–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Trauma and Critical CareTulane UniversityNew OrleansUSA
  2. 2.Division of Trauma, Acute Care Surgery and Surgical Critical CareWest Virginia UniversityMorgantownUSA

Personalised recommendations