In a retrospective study of trauma patients over 65 years of age attended by KSS, it was found that, although a number of these patients had sustained a minor injury through seemingly innocuous mechanisms, a high proportion of this group required advanced clinical interventions and subsequent tertiary level care at a major trauma centre.
The study also identified that dispatch time to these patients was typically longer, in particular in instances when KSS’s critical care was requested by an ambulance crew already in attendance.
With response time often critical to patient outcomes, the findings suggest that dispatch accuracy to older trauma patients could be improved. Further evaluation is also warranted of how age-dependent triggers for mechanism and physiological parameters could optimise dispatch sensitivity and HEMS utilisation for this group, helping to overcome under-triage.
Older trauma patients increasingly more common
The research looked at KSS data over a six-year period. During this time:
- KSS attended 1,321 trauma patients aged over 65 years (median age 75 years)
- KSS’s dispatch was immediate in 32 per cent of cases, after interrogation by a dispatcher in the Emergency Operations Centre in 43 per cent of cases, and following a request from South East Coast Ambulance Service crew from the scene in 25 per cent of cases
- Older age was found to be associated with a longer dispatch interval and was significantly longer in the crew request category (median 37 minutes);
- Immediate dispatch to patients with isolated head injuries often resulted in the KSS HEMS team delivering pre-hospital emergency anaesthesia (PHEA, 39 per cent). However, over one third of head-injured patients attended by a crew request dispatch also received PHEA (36 per cent);
- Sixty-nine per cent of those head injured patients attended by a crew request were still triaged to a major trauma centre.
Professor Richard Lyon MBE, Associate Medical Director at KSS and Professor of Pre-Hospital Emergency Care at the University of Surrey, said: “We know that trauma in older people, particularly simple falls from standing height in patients on blood thinning medication, is becoming increasingly common. Older trauma represents 20 per cent of all major trauma in the UK and projections suggest that by 2040, one in four people will be aged 65 or over. Many of these patients would benefit from early pre-hospital critical care and rapid transfer to a major trauma centre, so it is imperative we optimise dispatch to this group of patients.”