Volume 13, Issue 2: Major trauma in the older person – slip, splosh, 2SPLAT

Major trauma in the older person – slip, splosh, 2SPLAT

Blurb

Your next call is upgraded due to the length of time the patient has been waiting. On arrival you find a 78-year-old female lying on the floor at the bottom of some steps, she has been waiting 4 hours in this position. Some of your observations cause concern but do you take this patient to the major trauma centre, even though she doesn’t meet criteria?

CPD benefit

The mechanism of injury for older person’s major trauma can be much lower, with up to 50% of patients admitted to major trauma centres (MTCs) across the UK because of a fall from standing. The Injury Severity Scoring (ISS) system is complex and cannot guide management in the pre-hospital environment. Therefore, teams must act on the suspicion of a high ISS using trauma triage tools or clinical suspicion. This article outlines the terminology and epidemiology of major trauma in the older person and provides guidance on some key anatomical and physiological differences that may alter the response to major trauma and mask traditional signs. It also discusses useful triage tools and the 2SPLAT acronym to help you assess and manage the patient and make an informed judgement call on decisions such as transport to a major trauma centre (MTC) instead of a trauma unit (TU).