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Challenges of prehospital silver trauma patients

02 December 2022
Volume 14 · Issue 12


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.

Silver trauma is a relatively new phrase describing major trauma in patients aged >65 years (Chowdhury, 2020). Previously, major trauma was thought to occur mainly in working-age patients with high mechanism of injury. However, a report by the Trauma Audit and Research Network (2017) revealed most major trauma patients were aged >60 years with low mechanism of injury, although people aged >65 make up only 18% of the UK population (Atinga et al, 2018).

Older people have an altered physiology which increases their chance of major risk despite low mechanism of injury so they may require different treatments. Such changes also make prehospital assessment and identifying injuries challenging.

However, unlike paediatric patients, who have their own guidelines because of their specific physiology, older people receive the same treatment as younger adults. This article discusses neurological, haemorrhage and osteological pathophysiology, prehospital assessment and the effectiveness of two prehospital guidelines, those of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) (Brown et al, 2019) and National Institute of Health and Care Excellence (NICE) (2016; 2019), when applied to geriatric patients. These guidelines were chosen because they are frequently used in prehospital care.

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