The Victorian State Trauma System provides support and retrieval services for critically injured patients requiring definitive care, transfer and management. This older person trauma guideline provides advice on the initial management and transfer of major trauma patients who present to Victorian health services with severe injuries.
This guideline is developed for all clinical staff involved in the care of trauma patients in Victoria. It is intended for use by frontline clinical staff that provides early care for major trauma patients; those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS.
These guidelines provide the user with accessible resources to effectively and confidently provide early care for critically injured patients. They provide up-to-date information for front-line healthcare clinicians. The guideline is evidence based, has followed the AGREEII methodology for guideline development and is under the auspice of the Victorian State Trauma Committee (VSTC).1
Clinical Emphasis Points
Older person trauma patients are a specialised patient population that requires consideration of the effect that increased age has on physiological functions.
The older patient may be more vulnerable and less adaptable to changes due to pre-existing injuries / illness and co-morbidities.
They may be on multiple medications that mask signs of shock and may make assessment and management more challenging. 2
Diminished senses such as vision and hearing combined with slower reaction times are associated with an increased risk of trauma in the older population.
Trauma may have been precipitated by a medical condition. It is important to consider potential precipitants during patient workup.
Older patients are often under-triaged. A higher index of suspicion of injury should be maintained even with a seemingly innocuous mechanism of injury.
The principles of emergency assessment and management are the same for the older person population.
As in all clinical scenarios, the patient should be viewed in the context of the person as a whole, not just as an injury or illness.This should include their medical history, their functional capacity (including their ability to participate in therapies including transportation) and their personal values.
Established Advance Care Plans and Goals of Care should be integrated into management strategies.Patient Centred Care should aim to preserve or improve Quality of Life, not simply extend Quantity of Life.