By Suzanne Hoholik
The Columbus Dispatch
COLUMBUS, Ohio — When it comes to deciding where critically injured patients are sent for emergency treatment, paramedics divide people into two groups: pediatric patients and everyone else.
But yesterday, the Ohio Emergency Medical Services board created a third category when it approved trauma triage criteria for geriatric patients.
Now, paramedics will look for injuries specific to patients age 70 or older. Pediatric patients are from birth to 16 years old. Adults are now 17 to 69.
The state trauma committee recommended the change to the EMS Board based on studies that show that injuries that might not be serious in most adults can be fatal to older patients.
These include simple falls.
Regular standing falls can create as much, or greater, injury “for someone who’s 70 as would sliding into third base for someone who’s 20 or 17,” said Dr. David Lindsey, assistant professor of clinical surgery in the Trauma Department at Ohio State University Medical Center.
Falls are the No. 1 injury among older patients, whose bones are more prone to breaking.
“Geriatric patients, just by nature, have worse outcomes,” said Dr. Howard Werman, a state trauma committee member and medical director at MedFlight of Ohio.
“Once you get in the elderly population, they are just a different breed. They respond differently.”
Werman, who helped write the protocols, said Ohio is the first state to create geriatric trauma criteria.
Other differences include pedestrians struck by vehicles and systolic blood pressure.
Paramedics will automatically send patients 70 or older to a trauma center if they are struck by a car or their blood pressure drops below 100.
Right now, the standard for adults is 90.
“If you wait for a geriatric patient’s blood pressure to get below 90, you’re going to have a worse outcome,” said Jason Kinley, a paramedic with the Xenia Fire Division and a trauma committee member.
Many people 70 or older have higher blood pressure, and a drop below 100 could mean blood loss or shock, Lindsey said.
Kinley said the new rules, which could take effect this fall, will help paramedics statewide quickly determine where patients should go.
“In the past, it was hard to determine if they were hurt really bad or not,” he said. “We’d think, ‘Should we drive 30 minutes to the trauma center?’
“This helps paramedics distinguish injured and the not-so-injured geriatric patients.”
shoholik@dispatch.com
Many people 70 or older have higher blood pressure, and a drop below 100 could mean blood loss or shock.