Silver trauma patients, defined as those aged >65 years who have traumatic injuries, are a complex group because physiology alters with age leading to difficulties with assessment. This is exacerbated within the prehospital setting as environmental factors and ambulance delays increase the risk of complications. This article focuses on the pathophysiology and application of clinical guidelines on three aspects of prehospital silver trauma: neurology, osteology and haemorrhage. Neurologically, silver trauma patients have a higher risk of traumatic brain injury and are harder to assess because of age-related cognitive decline. Regarding osteology, older people, particularly postmenopausal women, are at a higher risk of vertebral fracture, with many going undiagnosed. Haemorrhage is also influenced, as geriatric patients typically experience occult bleeding or rebleeding several days after an event when crews have left. Despite these risks, prehospital guidelines often offer little support for clinicians in making holistic, clinically sound decisions for their patients.
Emerging evidence indicates that some healthcare students are developing stress disorders, due to factors relating to their chosen field of study. If accurate, this could have a major impact not only on those students, but also on the professions into which they are entering. To understand the extent of the problem, a literature review was conducted to identify the overall prevalence of stress disorders in healthcare students who are exposed to occupational stress/trauma, and/or course-related stress. Two databases were searched to include studies reporting on the presence of primary or secondary stress disorders in healthcare students. Six studies were reviewed, which included primary outcomes of depression, anxiety and stress. The pooled prevalence of primary outcomes was 41.4%. Pooled prevalence of depression was 49.58%, anxiety 54.55% and stress 20.2%. High prevalence figures suggest the need for adequate provision of mental health resources.
Elderly people who have fallen make up a large proportion of the ambulance workload: falls and fall-related injuries are prevalent within the older population, with half of those aged >80 years falling annually. Rhabdomyolysis is a common and potentially life-threatening condition, which has many causes. It occurs when the contents of skeletal muscle are released into the bloodstream and cause an obstructive cast in the glomerulus, leading to acute tubular necrosis and acute kidney injury. Of the multiple causes of rhabdomyolysis, significant ones are statin use and falls where elderly people are immobile for prolonged periods of time. However, a large number of patients are discharged by ambulance crews following long-lie falls, and they are more likely to request ambulance reattendance in the following month and have increased mortality rates following discharge from ambulance crews. Rhabdomyolysis often occurs after the initial fall, so emphasis should be placed on recognising not only the condition but also those at increased risk of developing it.