scholarly journals Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Michael Eichinger ◽  
Henry Douglas Pow Robb ◽  
Cosmo Scurr ◽  
Harriet Tucker ◽  
Stefan Heschl ◽  
...  
Keyword(s):  
Older People ◽  
Scoping Review ◽  
Prehospital Care ◽  
Descriptive Analysis ◽  
Traumatic Injury ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Care Providers ◽  
Age Bias ◽  
Prehospital Management

Abstract Background Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. Methods and findings A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. Conclusions Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.

Functional Status after Injury: A Longitudinal Study of Geriatric Trauma

2010 ◽  
Vol 76 (10) ◽  
pp. 1055-1058 ◽  
Author(s):  
Lorraine Kelley-Quon ◽  
Lillian Min ◽  
Eric Morley ◽  
Jonathan R. Hiatt ◽  
Henry Cryer ◽  
...  
Keyword(s):  
Functional Status ◽  
Injury Severity ◽  
Living Arrangement ◽  
Statistical Significance ◽  
Functional Decline ◽  
Traumatic Injury ◽  
Community Dwelling ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Trauma Population

We evaluated self-rated functional status measured longitudinally in the year after injury in a geriatric trauma population. The longitudinal (L) group included 37 of 60 eligible trauma patients aged 65 years or older admitted December 2006 to November 2007 for greater than 24 hours who completed a Short Functional Status questionnaire (SFS) at 3, 6, and 12 months after injury. The SFS yields scores of 0 to 5 (5 = independent in all five activities of daily living [ADLs]) and has been validated among community-dwelling elders. The control (C) group included 63 trauma patients aged 65 years or older admitted December 2007 to July 2009 for greater than 24 hours who reported their preinjury functional status using the SFS at hospital admission. We used characteristics and scores of the C group to impute preinjury ADL scores for the L group. The groups were similar in baseline characteristics (age, ethnicity, Injury Severity Score, Charlson Comorbidity Index, and living arrangement; P > 0.05). For the C group, the preinjury ADL score was 4.6 (SD = 0.9). For the L group, ADL scores declined at all intervals reaching statistical significance at 12 months. We conclude that in the year after traumatic injury, geriatric patients lost the equivalent of approximately one ADL, increasing their risk of further functional decline, loss of independence, and death.

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

2020 ◽  
Vol 35 (5) ◽  
pp. 533-537
Author(s):  
Ashley Rosenberg ◽  
Leoncie Mukeshimana ◽  
Alphosine Uwamahoro ◽  
Myles Dworkin ◽  
Vizir Nsengimana ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Road Traffic ◽  
Prehospital Care ◽  
Descriptive Analysis ◽  
Traumatic Brain Injuries ◽  
Traffic Incidents ◽  
Middle Income ◽  
Pain Medications ◽  
Prehospital Management ◽  
Care Capacity

AbstractIntroduction:Traumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d’Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda.Hypothesis/Problem:What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda?Methods:A retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data.Results:Patients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU.Conclusion:Currently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.

scholarly journals Silent Myocardial Ischaemia: A Review of the Literature for Prehospital Care Providers

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Ziad Nehme ◽  
Malcolm Boyle
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Prehospital Care ◽  
Care Providers ◽  
Inclusion Criteria ◽  
Silent Myocardial Ischaemia ◽  
Prehospital Management ◽  
Artery Disease ◽  
Asymptomatic Coronary Artery Disease

Introduction There has been little emphasis in paramedic education about silent myocardial ischaemia, its implications, and management in the prehospital environment. There is also inadequate information about the aetiology and prehospital management of silent myocardial infarction. The objective of this study was to review the literature on silent myocardial ischaemia and determine appropriate prehospital management. Methods A review of the Medline database was conducted from 1950 to the beginning of March 2007. Inclusion criteria were, any study type reporting the epidemiology, pathophysiology, clinical concepts, and management of silent myocardial ischaemia. References of relevant articles were also reviewed. A review of prehospital clinical implications and management was also undertaken. Results The search yielded 1,332 articles; 110 articles met the inclusion criteria with another 32 articles located from review of relevant articles reference list. Silent myocardial ischaemia is not limited to patients with significant coronary artery disease or cardiovascular risk profiles, it may affect up to 10% of patients with asymptomatic coronary artery disease. Silent myocardial ischaemia is also associated with greater adverse outcomes, and has been defined as the single strongest factor attributing to cardiac death in patients with concurrent angina pectoris. All patients with coronary artery disease presenting with and without pain can be managed with GTN and aspirin, in the absence of contra-indications. Conclusion This study demonstrates that silent myocardial ischaemia is not limited to patients with significant cardiovascular risk profiles and may affect up to 10% of patients with asymptomatic coronary artery disease. There is little prehospital care providers can achieve with current clinical practice guidelines and management regimes.

scholarly journals Use of simulators in teaching and learning: Paramedics’ evaluation of a Patient Simulator?

2015 ◽  
Vol 5 (2) ◽  
Author(s):  
Andrea Wyatt ◽  
Frank Archer ◽  
Brian Fallows
Keyword(s):  
Teaching And Learning ◽  
Descriptive Analysis ◽  
General Concept ◽  
Trauma Patients ◽  
Learning Tool ◽  
Patient Simulator ◽  
Evaluation Form ◽  
Prehospital Management ◽  
High Regard ◽  
Preliminary Study

Introduction This study was undertaken as a precursor to a larger study investigating the benefits of simulation in reducing management and technique errors in the prehospital management of trauma patients. However, prior to this it was considered necessary to conduct a preliminary study to address the following: Undertake a structured evaluation of the Laerdal™ SimMan™ Patient Simulator. Determine the “functional fidelity” of the Laerdal™ SimMan™ Patient Simulator that was used in this project from the Paramedic perspective. Methods Participants taking part in the study were invited to complete an evaluation form that examined the various components of the simulator. A second evaluation form examined both the features of the simulator and their applicability to Paramedic practice. The simulator capabilities were assessed through an evaluation of the simulator features, and, with a qualitative element included, provided a descriptive analysis of simulator functional fidelity. Results Analysis identified 36 of 54 features (66%) of the simulator were rated by the respondents as at least ‘average physiological accuracy’. An analysis of applicability to practice identified 41 of 54 features (75%) were rated at least beneficial to practice by greater than 80% of respondents. In combining these results, only 5 features considered applicable to Paramedic practice demonstrated a below average level of physiological accuracy. These findings indicate that, as a general concept, the use of this particular simulator as an educational experience was held in high regard within this cohort of participants. Conclusion Previous studies in related health disciplines have identified an acceptance of a patient simulator as a learning tool by students. This study supports these findings, with Paramedic students evaluating the Laerdal™ SimMan™ Patient Simulator as having high functional fidelity, using the criteria outlined for this study. The findings from this study afford the opportunity for ongoing educational initiatives and research in the training of Paramedics utilising the Patient Simulator.

Opportunity for Seatbelt Usage by ALS Providers

1991 ◽  
Vol 6 (4) ◽  
pp. 469-471 ◽  
Author(s):  
Richard T. Cook ◽  
Steven A. Meador ◽  
Barry D. Buckingham ◽  
Lee V. Groff
Keyword(s):  
Cardiac Arrest ◽  
Time Management ◽  
Prehospital Care ◽  
Seat Belt ◽  
Cardiac Arrest Patient ◽  
Trauma Patients ◽  
Care Providers ◽  
Seat Belts ◽  
Additional Information ◽  
The Mean

AbstractPurpose:Prehospital care providers commonly indicate that they cannot wear seat belts owing to their need to be unrestrained while delivering care to the patient in the back of the ambulance. Each year, providers are injured in situations in which seat belts have been shown to be protective. Are ALS providers able to wear a seat belt and provide care in an ambulance?Methods:The ALS providers were asked to complete a form following calls during which they rode with a patient in the back of an ambulance. They indicated the amount of time which they felt they would have needed to have been unrestrained by seat belts and the reasons. There were no attempts to regulate or quantify seat belt usage. Additional information was gathered from the trip report.Results:The percentage of the time of each trip during which they felt they needed to be unrestrained was calculated for each trip. The mean was 41%. The mean transport time was 14.7 minutes. Sub-groupings by protocol type, showed that for cardiac arrest patients, providers felt they needed to be unrestrained for 82% of the duration of transport, for patients with “chest pain or cardiac dysrhythmia” 63%, for “shortness of breath” 38%, and for trauma patients 41%. Excluding cardiac arrest patients, the nine patients were assigned by the providers to have the most critical level of case severity required unrestrained time of 72%. Those nine patients with the lowest severity level requires that the provider by unrestrained only 18% of the time. Management of intravenous line and patient assessments most frequently were cited as reasons for needing to be unrestrained.Conclusion:Perceived need of ALS providers to be unrestrained varied with respect to the type of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of calls. The ALS providers should be able to wear seat belts for at least part of the time, on most ALS calls.

Clinical suspicion regarding needle decompression for patients with chest trauma

2019 ◽  
Vol 11 (8) ◽  
pp. 330-334
Author(s):  
Alastair Beaven ◽  
James Harrison ◽  
Keith Porter ◽  
Richard Steyn
Keyword(s):  
Chest Trauma ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Team ◽  
Trauma Network ◽  
Trauma Patients ◽  
Care Providers ◽  
Trauma Population ◽  
The Uk ◽  
Needle Decompression

Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.

scholarly journals Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Christine M. Van Dillen ◽  
Matthew R. Tice ◽  
Archita D. Patel ◽  
David A. Meurer ◽  
Joseph A. Tyndall ◽  
...  
Keyword(s):  
Confidence Level ◽  
Simulation Training ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Patients ◽  
Care Providers ◽  
Confidence Levels ◽  
Life Saving ◽  
Before And After ◽  
Needle Decompression

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training.Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel.Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42;P<0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77).Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

Older people and major trauma

2009 ◽  
Vol 19 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Elaine Cole ◽  
Antonia Lynch ◽  
Jackie Bridges ◽  
Anita West
Keyword(s):  
Older People ◽  
Major Trauma ◽  
Traumatic Injury ◽  
Psychological Impact ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Practice Research ◽  
Trauma Patients ◽  
Policy Practice ◽  
Research And Education

SummaryMajor traumatic injury is a leading cause of death in younger age groups, but increasingly older people are affected also. Adverse outcomes, both physical and psychological, are associated with injury in the older population. This review aims to locate and describe the evidence relating to older people and major trauma in order to inform policy, practice, research and education. The published research and systematic reviews fall into three main topics: mechanism of traumatic injury in older people, the effects of co-morbidities on older trauma patients and outcomes following serious traumatic injury in older people. The psychological impact of traumatic injury and the resulting functional alteration cannot be underestimated in this group of patients.

scholarly journals (A17) Epidemiology of Non-Vehicular Trauma Patients in the Prehospital Setting in India

2011 ◽  
Vol 26 (S1) ◽  
pp. s5-s5
Author(s):  
N.A. Lodhia ◽  
M. Strehlow ◽  
E. Pirrotta ◽  
B.N.V. Swathi ◽  
A. Gimkala ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Initial Study ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Care Providers ◽  
Elderly Age ◽  
Post Injury ◽  
Lower Socioeconomic ◽  
Prehospital Emergency

BackgroundNon-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.MethodsAll patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.ResultsA total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.ConclusionThis initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.

scholarly journals Telehealth Use in Geriatrics Care during the COVID-19 Pandemic—A Scoping Review and Evidence Synthesis

2021 ◽  
Vol 18 (4) ◽  
pp. 1755
Author(s):  
Sathyanarayanan Doraiswamy ◽  
Anupama Jithesh ◽  
Ravinder Mamtani ◽  
Amit Abraham ◽  
Sohaila Cheema
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Scoping Review ◽  
Evidence Synthesis ◽  
Geriatric Care ◽  
World Health ◽  
Research Database ◽  
Care Providers ◽  
Low Middle Income Countries

Introduction: Globally, the COVID-19 pandemic has affected older people disproportionately. Prior to the pandemic, some studies reported that telehealth was an efficient and effective form of health care delivery, particularly for older people. There has been increased use of telehealth and publication of new literature on this topic during the pandemic, so we conducted a scoping review and evidence synthesis for telehealth use in geriatric care to summarize learning from these new data. Methods: We searched PubMed, Embase, and the World Health Organization’s COVID-19 global research database for articles published between 1 January and 20 August 2020. We included 79 articles that met our inclusion criteria. The information collected has been synthesized and presented as descriptive statistics. Strengths, weaknesses, opportunities, and threats (SWOT) have also been discussed. Results: The articles included in our review provide some evidence of effective provision of preventive, curative, and rehabilitative telehealth services for older people, but they highlight a greater focus on curative services and are mostly concentrated in high-income countries. We identified convenience and affordability as the strengths of telehealth use in geriatric care. Weaknesses identified include the inability of telehealth to cater to the needs of older people with specific physical and cognitive limitations. While the threats of increasing inequity and the lack of standardization in the provision of age-friendly telehealth services remain, we identified opportunities for technologic advancements driven by simplicity and user-friendliness for older people. Conclusion: Telehealth offers futuristic promise for the provision of essential health care services for older people worldwide. However, the extent of these services via telehealth appears to be currently limited in low and low-middle income countries. Optimizing telehealth services that can be accessed by older people requires greater government investments and active engagement by broader participation of older people, their caregivers, physicians and other health care providers, technology experts, and health managers.

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