Pre-hospital trauma assessment and management of older patients and their association with patient outcomes: challenges and barriers

BACKGROUND: Saudi Arabia faces an increasing prehospital healthcare burden from older people with injuries, but little is known about their characteristics and current treatment. METHODS: This was a sequential explanatory mixed-methods design, preceded by a scoping review on the prehospital geriatric trauma care. A retrospective quantitative study was conducted using registry data from older patients (≥55 years) admitted by ambulances from 01/08/2017 to 31/10/2021 at a major trauma centre in Saudi Arabia. A qualitative study was conducted using a purposive sample of Saudi paramedics and ambulance technicians from Riyadh and Makkah using online semi-structured interviews and analysed using the framework method. The quantitative and qualitative findings were integrated. RESULTS: The quantitative study recruited 452 eligible cases and found most of them were admitted with low falls (53.7%), normal physiology, and extremities injuries (53.1%). The study identified no significant predictors of in-hospital death (p>0.05 for all predictors), although statistical power was limited. The qualitative study recruited twenty participants and identified that they reported age-related challenges including physiological changes, polypharmacy, and communication difficulties. They all wanted training and guidelines to improve their knowledge. They reported struggling with communication difficulties, inaccurate adverse outcomes predictions, difficult intravenous cannulations, and cultural restrictions affecting care provision for female patients. I identified organisational barriers (e.g. lack of shared patient records and lack of guidelines) and cultural barriers (e.g. barriers to assessing women, attitudes towards older people, and attitudes towards paramedics) that influenced implementation of knowledge. This study also found that the participants' perceptions aligned with the retrospective study’s cohort, and they acknowledged the difficulty of predicting death in older trauma patients. CONCLUSION: Ambulance clinicians in Saudi Arabia want guidelines and training in managing older trauma patients but these need to take into account the characteristics of older trauma patients and the cultural barriers that I identified.