Geriatric Trauma
Objective: Stop giving older trauma patients a pass because the wreck “wasn’t that fast” — their blood pressure, brain, and blood thinners lie.
Why This Is Hard
A ground-level fall looks like a lift assist. ACS/CDC 2021 Field Triage: in adults ≥65 years, SBP <110 mm Hg may already represent shock. Beta-blockers hide tachycardia. Anticoagulants turn a scalp lac into an ICH. Undertriage to a non-trauma hospital is the quiet failure mode. See also trauma triage.
- Age ≥65 — the shock floor may be 110, not 90
- What blood thinner? What was their last well?
- Head strike + anticoagulant = time-critical even if GCS is 15
- Mechanism can be “just a fall” and still be red-criteria anatomy later
Why Older Adults Lie
- BP: “Normal” 118 systolic can be a crash from a baseline of 160. ACS 2021 explicitly lowered the hypotension threshold for ≥65.
- HR: beta-blockers and pacemakers erase the tachycardic clue.
- Brain: brain atrophy + anticoagulants + even moderate mechanism = delayed ICH. Serial mentation matters.
- Chest: rib fractures and pulmonary contusion decompensate in hours. Do not shrug “just ribs.”
- Bones: pelvic and hip fractures hide blood. Binder thinking still applies if the mechanism and shock fit (pelvic binder).
Street Sequence
- Same MARCH priorities. Do not skip hemorrhage because they are “fragile.”
- History: anticoagulants/antiplatelets, advanced directives, baseline mentation, last seen well.
- Triage: apply ACS 2021 special considerations (age, anticoagulation, pregnancy, burns) — they can still bump destination even when vitals look “okay.”
- SMR: pad the kyphotic spine; longboards are still not a transport device (SMR).
- Keep them warm. Frail patients drop temperature in a hallway.
Field Pitfalls
- “BP is 108, they are fine.”
- No anticoagulant history on a ground-level fall with a scalp hematoma.
- Closest hospital because “it’s only a fall.”
Practice
60-second drill
Partner: 82-year-old on apixaban, ground-level fall, GCS 15, SBP 108, small scalp hematoma. Say shock interpretation, destination type, and one history item you will radio.
Related: Trauma Triage, TBI, Syncope.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACS/CDC 2021 National Guideline for the Field Triage of Injured Patients — in adults ≥65 years, SBP <110 mm Hg may already represent shock; anticoagulation is a special consideration that can still change destination
- Your state trauma plan may modify age and destination rules — protocol wins.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.