Geriatrics Trauma Update 2024 Rom Duckworth

Geriatric Trauma Update: 2025 is a dynamic and cutting-edge program designed to equip EMS professionals with the essential skills and knowledge to tackle the unique challenges of geriatric trauma care. With the aging population on the rise, this session dives deep into the critical factors that make initial emergency care for elderly trauma patients so complex—from age-related physiological changes and comorbidities to frailty and polypharmacy. Through engaging case studies, interactive discussions, and evidence-based strategies, participants will learn how to integrate multifactorial data into real-time decision-making, ensuring accurate triage, effective treatment, and seamless handover. Whether you’re a seasoned paramedic or an EMS leader, this session will revolutionize your approach to geriatric trauma, helping you optimize outcomes for some of the most vulnerable patients in the field.
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1. The Prehospital Perspective Capt. Rommie L. Duckworth, MPA, LP, EFO, FO

2. Capt. Rommie L. Duckworth, MPA, LP, EFO, FO @ RomDuck [email protected] www.RomDuck.com

3. My Connection…

4. Appreciate

5. Improve

6. Senescence

7. Skin Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

8. Muscle & Bone Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

9. Brain Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

10. Eyes & Ears MD, H. M. F., FRCP, K. R. M. F., & FRCP, J. B. Y. M. (2016). Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 8e (8 edition). Elsevier.

11. Heart Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

12. Lungs Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

13. GI System Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

14. Kidneys & Liver Bone & Blood Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

15. Psycosocial MD, H. M. F., FRCP, K. R. M. F., & FRCP, J. B. Y. M. (2016). Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 8e (8 edition). Elsevier.

16. Grounding

17. Frailty “a clinical syndrome of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday acute stress is compromised.”

18. Lewandowicz , A., Skowronek , P., Maksymiuk-Klos , A., & Piątkiewicz , P. (2018). The Giant Geriatric Syndromes Are Intensified by Diabetic Complications. Gerontology and Geriatric Medicine , 4 , 233372141881739. https://doi.org/10.1177/2333721418817396 National Council on Aging. (2024, May 30). Top 10 Chronic Conditions Affecting Older Adults . NCOA.Org . https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults/

19. Polypharmacy +

20. Trauma Informed Care Emergency Care

21. Falls Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

22. Falls Eichinger , M., Robb, H. D. P., Scurr , C., Tucker, H., Heschl, S., & Peck, G. (2021). Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 29 (1), 100. https://doi.org/10.1186/s13049-021-00922-1

23. Falls Eichinger , M., Robb, H. D. P., Scurr , C., Tucker, H., Heschl, S., & Peck, G. (2021). Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 29 (1), 100. https://doi.org/10.1186/s13049-021-00922-1

24. S.P.L.A.T.T. National Association of Emergency Medical Technicians. (2024). Geriatric Education for Emergency Medical Services Course Manual (3rd ed.). Jones and Bartlett Public Safety Group. https://www.psglearning.com/catalog

25. Motor Vehicle Collisions Southern, A. P., Lopez, R. A., & Jwayyed , S. (2024). Geriatric Trauma. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK442020/

26. Awareness

27. EMS Wizards

28. Management

29. Abuse National Institute on Aging. (2023, July 21). Elder Abuse . National Institute on Aging. https://www.nia.nih.gov/health/elder-abuse/elder-abusNate

30. Assessment/Treatment

31. A: Airway with Cervical Spine Protection • ATLS/PHTLS Focus: Immediate assessment of the airway while maintaining cervical spine precautions. • Prehospital (EMS) Perspective: Geriatric patients often present with challenges such as dental prosthetics, reduced airway reflexes, and altered mental status. Airway obstruction from trauma is common and may be complicated by dentures or facial fractures. • Geriatric Consideration: Be cautious when applying cervical collars, as older patients often have arthritis or other degenerative spine conditions. Difficulty securing an airway in the elderly may be exacerbated (e.g., dentures, neck rigidity ). Assessment/Treatment American College of Surgeons Committee on Trauma. (2024). ATLS ® Student Course Manual, 10th Edition . ACS Store. https://store.facs.org/atls-student-course-manual-10th-edition

32. B: Breathing and Ventilation • ATLS/PHTLS Focus: Ensure adequate oxygenation and ventilation, evaluate for chest trauma (e.g., pneumothorax, flail chest). • Prehospital (EMS) Perspective: Geriatric patients are at higher risk for rib fractures, pulmonary contusions, and compromised ventilation, even with seemingly minor chest trauma. • Geriatric Consideration: Age-related changes in lung elasticity and chest wall compliance make ventilation more difficult. These patients may deteriorate quickly, so early recognition of compromised breathing is crucial. Assessment/Treatment American College of Surgeons Committee on Trauma. (2024). ATLS ® Student Course Manual, 10th Edition . ACS Store. https://store.facs.org/atls-student-course-manual-10th-edition

33. C: Circulation with Hemorrhage Control • ATLS/PHTLS Focus: Evaluate circulation and control bleeding. Early recognition of shock is essential, with emphasis on stopping external bleeding and ensuring tissue perfusion. • Prehospital (EMS) Perspective: Geriatric patients may present with atypical signs of shock due to medications like beta-blockers that mask tachycardia. Blood pressure may appear deceptively normal (pseudo-stability). • Geriatric Consideration: Hypotension in geriatric patients should be treated more aggressively. Even “normal” blood pressure can indicate shock in older adults, and these patients are more prone to hemorrhagic shock with internal injuries due to anticoagulants. Assessment/Treatment American College of Surgeons Committee on Trauma. (2024). ATLS ® Student Course Manual, 10th Edition . ACS Store. https://store.facs.org/atls-student-course-manual-10th-edition

34. D: Disability (Neurological Evaluation) • ATLS/PHTLS Focus: Rapid assessment of neurological status (GCS) to quantify neurological deficit. • Prehospital (EMS) Perspective: Geriatric patients may have pre-existing cognitive impairment (e.g., dementia), making it harder to determine changes in mental status following trauma. • Geriatric Consideration: A sudden change in neurological status, even subtle, should prompt suspicion of traumatic brain injury, especially if the patient is on anticoagulants. Be aware of the “talk and deteriorate” phenomenon where older patients may seem neurologically stable initially but worsen rapidly due to cerebral atrophy. Assessment/Treatment American College of Surgeons Committee on Trauma. (2024). ATLS ® Student Course Manual, 10th Edition . ACS Store. https://store.facs.org/atls-student-course-manual-10th-edition

35. E: Exposure and Environmental Control • ATLS/PHTLS Focus: Expose the patient fully to identify hidden injuries while preventing hypothermia. • Prehospital (EMS) Perspective: Geriatric patients are more susceptible to hypothermia due to reduced body fat, altered thermoregulation, and prolonged exposure times. • Geriatric Consideration: Hypothermia can exacerbate coagulopathy and impair resuscitation efforts. In elderly trauma patients, preventing further heat loss is critical in the prehospital setting, especially after falls or long-duration extrication. Assessment/Treatment American College of Surgeons Committee on Trauma. (2024). ATLS ® Student Course Manual, 10th Edition . ACS Store. https://store.facs.org/atls-student-course-manual-10th-edition

36. Secondary Survey • ATLS/PHTLS Focus: A more detailed head-to-toe examination is performed once the primary survey is completed. This includes reassessing vital signs, identifying additional injuries, and obtaining a thorough patient history (AMPLE: Allergies, Medications, Past medical history, Last meal, and Events leading to injury). • Prehospital (EMS) Perspective: EMS providers should focus on gathering pertinent medical history, especially for geriatric patients who are more likely to have comorbid conditions and be on multiple medications. • Geriatric Consideration: Medications like anticoagulants (e.g., warfarin, aspirin) and antihypertensives (e.g., beta-blockers) play a significant role in the patient’s trauma response. The assessment should consider these medications’ impact on shock and bleeding. Assessment/Treatment American College of Surgeons Committee on Trauma. (2024). ATLS ® Student Course Manual, 10th Edition . ACS Store. https://store.facs.org/atls-student-course-manual-10th-edition

37. Assessment/Treatment

38. Situational Awareness

39. Delirium vs Dementia

40. Trauma Triad of Death

41. Trauma Alert

42. Hand Over Opportunity for fresh eyes on a shared mental model Failure point for critical information to be lost and patient care errors to occur Eye contact Environment Ensure ABCs Structured Report Supply Documents Duckworth, Rommie. (2018). Development of a program to mitigate loss of critical information during patient handover [Executive Fire Office Applied Research Project, National Fire Academy]. https://usfa.bibliovation.com/app/work/247291

43. Appreciate

44. Improve

45. Objective E ffectively integrate interrelated elements, such as senescence, comorbidities, polypharmacy, frailty, and more, for the initial emergency care of geriatric victims of trauma to improve triage accuracy, streamline the continuum of care, and enhance patient outcomes.

46. Family & Community

47. Capt. Rommie L. Duckworth, MPA, LP, EFO, FO @ RomDuck [email protected] www.RomDuck.com

48. Your Questions