10th May 2021
Research published from us and the University of Surrey reveals that minor accidents can lead to serious consequences for older people.
The retrospective study of patients we attended over a six-year period showed that this is particularly notable in falls, where a fall from standing height (less than two metres) resulted in serious head injury for 4% of patients under 65 and for 30% of patients over 65 years of age.
Previous research has identified that these older patients are consequently ten times more likely to die.
The findings show that, as these incidents often present as minor, there can be a delay in older patients receiving the emergency care they need; in the majority of these cases, we were dispatched once a ground ambulance crew had assessed the patient.
With the speed at which we are able to start treating patients at the scene often critical to outcomes, the study highlights the need for age to be taken into consideration when a 999 call is received, to decide whether we should be dispatched at once.
The research also points to a need for wider community education to make people aware that minor incidents can be life-threatening for older people.
Professor Richard Lyon MBE, our Associate Medical Director 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% of all major trauma in the UK and projections suggest that by 2040 one in four people will be aged 65 or over.”
“This study has demonstrated that many of these patients do not fulfil the initial criteria for immediate dispatch of KSS, but that they need advanced interventions and subsequent specialist care at major trauma centres.”
“It is imperative we optimise the dispatch of KSS to this group of patients.”
Advances in healthcare have enabled greater independence and activity in older people. This has led to a greater prevalence of older trauma, with 50% of severely injured patients over the age of 65 years recorded on the Trauma Audit and Research Network (TARN).
Helicopter Emergency Medical Services (HEMS), like us, provide enhanced pre-hospital medical care to major trauma patients, such as Pre-Hospital Emergency Anaesthesia. Accurate dispatch of HEMS to those patients who may benefit most from their advanced critical care interventions is important as this is a highly valuable resource.
Emergency medical dispatchers track an established pathway during a 999 call to identify traumatic injuries. This pathway has been developed based on the adult trauma population and not specifically adapted to older trauma patients.
This research has shown that the existing pathway can lead to injury severity in older patients being overlooked, and that consequently HEMS dispatch to traumatically injured older patients can be delayed.
Previous research has shown that HEMS can contribute to a survival benefit in older trauma patients, and now this study identifies the need to improve the efficiency of HEMS dispatch to this group.
Professor Richard Lyon continued: “Advanced interventions provided by HEMS are an unparalleled but scarce resource and it is crucial that dispatch triggers are effective. Improving triage is key, so that those patients who need immediate critical care receive it as quickly as possible.”
“It is also vital that the wider community is aware that, whilst an older person might appear to be fine after a fall or minor accident, they are at significantly greater risk of experiencing potentially life-threatening trauma and it is crucial that medical advice is sought.”
The research has been published by Scandinavian Journal of Trauma Resuscitation and Emergency Medicine.
 Hawley C, Sakr M, Scapinello S, Salvo J, Wrenn P. Traumatic brain injuries in older adults—6 years of data for one UK trauma centre: retrospective analysis of prospectively collected data. Emerg Med J. 2017; Aug 1;34(8):509–16.
 Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015 Dec 1;32(12):911–5.
 Voskens FJ, van Rein EA, van der Sluijs R, Houwert RM, Lichtveld RA, Verleisdonk EJ, Segers M, van Olden G, Dijkgraaf M, Leenen LP and van Heijl M. Accuracy of prehospital triage in selecting severely injured trauma patients. JAMA Surg. 2018; 153(4), pp.322-327.