Geriatric Trauma and Airway Management: A Few Tips for EMTs

As an EMS professional, you know that the elderly make up a large percentage of your patients, especially if you work in one of the more common retiree zones (Florida or Arizona, for example). According to the CDC, that number is only increasing. In the last century, our country has seen unprecedented growth in the number of geriatrics. Longer life spans and aging Baby Boomers are the leading factors in this increase, and by 2030, elderly people are expected to account for roughly 20 percent of the U.S. population.¹ Which for you means that the number of geriatric patients you run on each year will only increase.

The Aging Patient

Geriatrics pose unique challenges for emergency responders. The aging body responds differently to illness and injury compared to someone who is younger and, most likely, healthier. Anatomical and physiological changes that take place with aging include²:

• Loss of elasticity in vessels
• Reduced oxygen exchange
• Loss of total number of cells
• Osteoporosis and associated skeletal complications
• Rigidity of joints, loss of flexibility, especially in the chest wall
• Brain shrinkage secondary to decrease in number of neurons
• Dementia
• Increase in pain threshold
• Inability to regulate temperature

These changes can affect patient response and outcome, especially in the case of trauma.

Managing the Elderly Trauma Patient—Airway Comes First!

There are many special considerations when treating geriatric trauma patients. Your patient will most likely have underlying medical conditions, such as heart disease or emphysema, which may complicate his or her situation. This is especially critical when managing the patient’s airway.

As an EMT, you must rely on the fundamentals of airway management. Yes, there are some excellent airway adjuncts that allow you to control a tenuous airway, but be sure to consider the unique complications that the geriatric patient may present. They include:

• Less flexibility in the neck
• Rigidity of the chest
• The presence of extensive dental hardware, including dentures, bridges, and false teeth
• The absence of teeth, which can hamper your seal
• Inability to effectively swallow
• Dementia, impeding communication

Each of these factors will affect your ability to manage the airway of the geriatric trauma patient, especially if the trauma includes the face. You already have numerous challenges in managing the patient’s airway; if you add in the effects of blood, tissue, and vomit, these challenges may become insurmountable.

So, be sure you always have your portable suction unit on hand. Suction can overcome many of these challenges associated with the geriatric. Not only can it remove blood, tissue, and vomit, but it can also assist the patient having difficulty swallowing and those with limited range of motion, who are unable to effectively position themselves. The use of large suction catheters can also clear the airway of broken teeth or shattered hardware, so be sure to keep an array of catheters on hand, tailor-made for each situation.

The geriatric population will continue to grow and, as an EMT, your number of elderly patients will only increase. So, be prepared for the unique challenges that these patients pose and be sure to always have the right equipment on hand.

¹2013, The State of Aging & Heath in America 2013, Centers for Disease Control and Prevention, http://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf

²2015, Dalton, T., M. Rushing, M. Escott, and B. Monroe

Complexities of Geriatric Trauma Patients, JEMS, http://www.jems.com/articles/print/volume-40/issue-11/features/complexities-of-geriatric-trauma-patients.html