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Geriatric MVC Victims
Geriatric MVC Victims: I'm looking for some opinions and possible a web link with some clear protocols on treatment and transport of our older generation who are involved in motor vehicle crashes. This is stemming from an incident today in which we had two 80 year old male patients who were involved in a lateral crash. They were hit by a full size Dodge pick-up truck just behind the drivers door and were pushed off the road into a wooded area. Impact was guestamaded at 40 mph. Not much intrusion in their mini van but all the side windows shattered and the vehicle was considered totaled. Neither had any complaints, but they did have extensive past medical histories, cardiac included. Our day staff BLS crew and neighboring ALS crew felt they did not need transport to the hospital and were going to sign them off (no vitals taken btw). However, as 1st Lt on our squad, I intervened and requested they go get checked out at the ER to be on the safe side. My decision rather pissed off both crews. That does not bother me, since as an officer, your decisions are not always popular. My thoughts on this is that this was a side impact hit, the patients were in their 80's, the were seatbelted, but my training tells me they should go. I would like to find something however to show these four EMS providers, in writing, why I stepped in and had them transport. Unfortunately, our younger generation EMS providers don't always get it when us older generation EMS providers, who have been doing this since before they were born, have something they do not have: years of experience out on the road that actually counts for something lol..... Well if anyone can help me out, I'd appreciate it. Got to teach these kids something :)
Replies to This Discussion
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Permalink Reply by Kimberly A Bownas on
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Ok, first of all here in my vollie squad if we are getting a sign off, we have to get a set of vitals. The patient can't just sign off on the pcr and that is that. We always recommend getting checked out and then if they still refuse then we go through our preceedures for getting an RMA. As I see it you were did the right thing. Even if the patient has no complaint and you feel due to age and past medical history they should go get checked out then by all means do it and see, most patients you will find will go and get checked out. This typically what happens after an extensive explanation of what could happen later on. Not getting a set of vitals is insane and just irresponsible on on the BLS and ALS crews part. Like I said before good call on your part and good job as an officer.... TCSS
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Permalink Reply by Brian Dumser on
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In order to obtain a signefd release, you mUST take a set of vitals. For God's sake these men were in their 80's! I've omly been at this for 14 years, but in my opinion, they should have been transported unless they refused AMA.
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Permalink Reply by Joe Stoltz on
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I think you did exactly the right thing. In our area patients past the age of 55 are to go to the trauma center, if they have sustained blunt force trauma. Here is a link to the regional ALS protocols, and you'll find it on or around page 10.
http://host31.spidergraphics.com/ems2/doc/FLREMSC_ALS_Protocols_200...
Several years ago we had a crash with several patients, one of whom was an elderly gentleman complaining of SOB. The paramedic in charge flew him to the trauma center as a precaution, unfortunately the patient died the next day of his injuries. I don't think you can be too careful with geriatric patients.
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Permalink Reply by Don 5271 on
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Thanks for the link Joe, it was very informative. As well thanks to you folks that have posted thus far. Don
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A freind sent me this article I thought was interesting, and sort of pertains to this subject. It's from seniorjournal.com. I'm a fanatic about always trying to learn more to better server those I'm called to help.
The link is: http://seniorjournal.com/NEWS/Health/2008/20080818-SeniorsMuchLessL...
Senior Citizen Health & Medicine
Seniors Much Less Likely Than Younger Patients to Be Rushed to Trauma Centers
Unconscious age bias in EMS and receiving trauma center personnel identified as a possible cause
Aug. 18, 2008 – If you are a senior citizen – age 65 or older – and suffer a trauma, your chances of getting emergency services to transport you to a trauma center are 52 percent less than for younger people. But, if you are 70 or older it gets even worse, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
There seems to be an unconscious age bias among emergency medical services personnel, the study finds.
This is particularly bad news when projections are that an estimated 39 percent of all trauma patients will be age 65 years or older by the year 2050.
“Evidence-based clinical practice guidelines strongly recommend that elderly trauma patients be treated as aggressively as non-elderly patients,” the authors write. “However, some studies have suggested that age bias may still exist in trauma care, even in the prehospital phase of that care.”
David C. Chang, Ph.D., M.P.H., M.B.A., of Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues analyzed 10 years of data from the statewide Maryland Ambulance Information System.
They also surveyed emergency medical services (EMS) and trauma center personnel after presenting them with the registry findings at EMS conferences and grand rounds between 2004 and 2006.
The registry identified 26,565 trauma patients, defined as those who met criteria set by the American College of Surgeons (ACS) and were declared level I status (critically ill or injured and requiring immediate attention) by EMS personnel.
More patients older than 65 were undertriaged, or not taken to a state-designated trauma center, than were younger patients (49.9 percent vs. 17.8 percent).
After adjusting for other related factors, the researchers found that being 65 years or older was associated with a 52 percent reduction in likelihood of being transported to a trauma center. This decrease in transports was found to start at age 50 years, with another decrease at age 70.
A total of 166 individuals, including 127 EMS personnel and 32 medical personnel (14 attending physicians, four residents, six medical students and eight nurses), responded to the follow-up surveys.
When asked about the most likely reasons for not transporting elderly patients to trauma centers, participants cited
● inadequate training for managing elderly patients (25.3 percent),
● unfamiliarity with protocol (12 percent) and
● possible age bias (13.4 percent) as the top three factors.
“The problem of age bias raised in this study may negate efforts to improve clinical care for elderly trauma patients within trauma centers if the system as a whole does not function properly and deliver patients appropriately to needed resources,” the authors write.
“However, it may be difficult to change attitudes of age bias and may require a broad societal campaign. Nevertheless, it may be possible to address this problem without directly addressing age bias. A focus on retraining the providers about triage protocols may be sufficient,” the authors conclude.
“Additionally, it may be helpful to highlight the literature that now suggests that elderly trauma patients do, in fact, return to productive lives after their injury, which can eliminate the perception of futility of care that may be used consciously or subconsciously to justify age bias.”
Editor's Note: Dr. Chang was supported by an Individual National Research Service Award from the National Institute of General Medical Sciences for a portion of this study and was awarded the Maryland EMS-Geriatrics Award by the governor of Maryland in 2005.
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Very interesting article, Don. Thanks for posting this.
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Well after talking to our Medcial Command Dr. The crews would have gotten into trouble had they not transported. As far as treating an older patient different than a younger one, I'm sorry, your dead wrong. People in their 80's are alot more fragile than someone in say their thirties. I have been in the field for many years. I have seen accidents claim the lives of older patients that were no where near as severe as ones that teenagers walk away from. Last but not least, those x-ray glasses never were much use trying to find internal injuries that are not presenting themselves to us.
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Permalink Reply by John on
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Going by any of the training I have had in my EMT class last fall and the Medics class I am in now suggests that they should by transported for evaluation, due to the damage to the vehicle glass and vehicle itself. They teach us as well that as we get older the nerve sensation for pain decreases and so does the brain, that being said opens up the possiblity for a brain bleed just from the impact alone. A good choice to have them transported just to be on the safe side Don
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In ending this conversation, I am not looking for help justifying the decision I made. I was 100% right in what I did. I was looking for information to show the newbie's on geriatric injuries to explain, in writting, why I did what I did, so they can learn. Lastly, you may want to looking into continuing education classes yourself. Have a wonderful day.
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