EMS Geriatric Emergencies - Common Ailments & Injuries

Geriatric patients represent a significant demographic in the field of prehospital emergency care. 

Due to the complexities that come with aging, older adults are more susceptible to certain medical and traumatic emergencies, often presenting with unique challenges that EMS providers must be prepared to address. 

These cases require a nuanced understanding of age-related physiological changes, atypical symptom presentation, and the impact of comorbidities. 

By recognizing the specific needs of geriatric patients, EMS providers can enhance the quality of care, improve patient outcomes, and better navigate the intricacies involved in emergency scenarios involving this vulnerable population.

Below are some of the most common ailments and injuries EMS providers can expect to encounter when responding to geriatric patients.

1. Cardiovascular Emergencies

- Myocardial Infarction (Heart Attack)

• Geriatric patients often present with atypical symptoms, such as weakness, shortness of breath, confusion, or syncope, rather than the classic chest pain.
• EMS providers should maintain a high index of suspicion for cardiac events, even in the absence of typical symptoms.

- Congestive Heart Failure (CHF)

• Common symptoms include dyspnea, orthopnea, peripheral edema, and pulmonary crackles.
• Many CHF patients take diuretics, which can lead to dehydration and electrolyte imbalances, further complicating their condition.

- Hypertension and Hypotension

• Uncontrolled hypertension increases the risk of strokes, heart attacks, and aneurysms.
• Conversely, geriatric patients are also prone to orthostatic hypotension, which can contribute to falls and syncopal episodes.

2. Respiratory Emergencies

- Chronic Obstructive Pulmonary Disease (COPD)

• COPD, including chronic bronchitis and emphysema, is common in older adults, particularly those with a history of smoking.
• EMS providers should assess for hypoxia, wheezing, or diminished breath sounds and be cautious with oxygen administration in long-term COPD patients.

- Pneumonia

• In geriatric patients, pneumonia may present with confusion, weakness, or decreased appetite rather than fever or cough.
• EMS should assess oxygenation and be prepared for respiratory support.

- Pulmonary Embolism (PE)

• A life-threatening condition that can present with sudden-onset shortness of breath, chest pain, or unexplained hypoxia.
• Risk factors include immobility, recent surgery, and a history of deep vein thrombosis (DVT).

3. Neurological Emergencies

- Stroke / Cerebrovascular Accident

• Stroke symptoms may include unilateral weakness, facial droop, slurred speech, confusion, or altered mental status.
• EMS should perform a rapid stroke assessment and transport patients to a stroke center as quickly as possible for potential thrombolytic treatment.

- Altered Mental Status (AMS)

• AMS can be caused by various conditions, including infection (e.g., sepsis or urinary tract infection), medication interactions, dehydration, or metabolic disorders.
• It is critical for EMS providers to investigate the underlying cause rather than dismissing confusion as normal aging.

- Dementia and Delirium

• Dementia is a progressive cognitive decline, while delirium is a sudden change in mental status, often due to infection, medication effects, or metabolic disturbances.
• EMS should gather history from caregivers and assess for contributing factors.

4. Traumatic Injuries

- Falls and Fractures

• Falls are one of the most common geriatric emergencies and are often caused by balance issues, vision impairment, hypotension, or medication side effects.
• Common fractures include hip, wrist, and vertebral fractures, which can lead to long-term immobility and complications.

- Head Injuries

• Older adults are at higher risk for subdural hematomas, particularly those on anticoagulants.
• Even minor head trauma can result in serious complications, necessitating careful assessment and monitoring.

- Spinal Injuries

• Osteoporosis and degenerative changes increase the likelihood of spinal injuries, even with low-impact trauma.
• Providers should be cautious when performing extrication and spinal immobilization in older patients.

5. Metabolic and Endocrine Emergencies

- Diabetic Emergencies (Hypoglycemia and Hyperglycemia)

• Older diabetics may present with vague symptoms, such as confusion or dizziness, rather than typical signs of hypo- or hyperglycemia.
• Polypharmacy and comorbidities can complicate glucose regulation, increasing the risk of emergency events.

Dehydration and Electrolyte Imbalances

• Older adults often have a diminished thirst response and may not drink adequate fluids, leading to dehydration and imbalances in sodium or potassium levels.
• Dehydration can contribute to confusion, hypotension, and an increased risk of falls.

6. Gastrointestinal Emergencies

Gastrointestinal Bleeding

• Geriatric patients taking anticoagulants or NSAIDs are at higher risk for GI bleeds.
• Signs include hematemesis, melena, or unexplained hypotension and anemia.

- Bowel Obstruction and Constipation

• Decreased motility and medication side effects can lead to severe constipation or bowel obstructions.
• Symptoms include abdominal pain, bloating, nausea, and vomiting.

7. Sepsis and Infection

• Older adults may present with atypical signs of infection, such as confusion, lethargy, or decreased appetite instead of fever or localized pain.
• Urinary tract infections (UTIs) are common and can lead to sepsis, especially in catheterized or immobile patients.
• EMS providers should assess vital signs and be aware that sepsis can progress rapidly in the elderly.

8. Behavioral and Psychiatric Emergencies

- Depression and Suicide Risk

• Depression is frequently underdiagnosed in older adults and may present as withdrawal, appetite changes, or worsening medical conditions.
• Geriatric suicide risk is significant, particularly in men over 65, necessitating thorough screening and intervention.

- Elder Abuse and Neglect

• EMS providers should be vigilant for signs of abuse or neglect, including malnutrition, pressure ulcers, unexplained injuries, or inconsistent histories from caregivers.
• Suspicious findings should be reported to the appropriate authorities for further investigation.

Conclusion:

When providing prehospital care for geriatric patients, it is essential for EMS professionals to remember that while aging brings unique challenges, it does not diminish the value, aspirations, or agency of an individual. 

Utilizing systems like the GEMS diamond can aid in ensuring thorough, empathetic assessments that respect the patient's holistic well-being. 

Approaching geriatric care with the awareness that older patients are driven by the same motivations as their younger peers helps in fostering trust and delivering high-quality, patient-centered care. 

Ultimately, treating older adults with respect and understanding is key to enhancing their experience in prehospital emergencies and supporting their independence and dignity.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS Geriatric Emergencies - Key Considerations

The aging process is frequently misunderstood, leading to varied experiences among clinicians when working with older populations. 

While some EMS Providers excel in managing the complex needs of geriatric patients, others may find it challenging due to the distinct and multifaceted nature of geriatric care. 

To effectively address these challenges, tools such as the GEMS Diamond Assessment System offer an accessible framework for understanding and responding to the key needs of this demographic. 

Recognizing that older patients share the same values — such as independence, freedom, and autonomy — as their younger counterparts is crucial. 

One of the most significant missteps a provider can make is treating older adults in a manner that undermines their dignity or infantilizes them.

EMS providers should be aware that geriatric prehospital emergencies often present differently than those involving younger populations. 

Here are some key considerations:

Atypical Presentations: Older adults may not show classic symptoms of certain medical conditions. For instance, heart attacks may present as general weakness, shortness of breath, or confusion rather than chest pain. 

Similarly, infections like pneumonia or urinary tract infections might lead to altered mental status or fatigue without a fever.

Comorbidities and Polypharmacy: Geriatric patients frequently have multiple chronic conditions, such as hypertension, diabetes, or heart disease. 

This, combined with the common use of multiple medications, can affect how symptoms manifest and complicate diagnosis.

EMS providers should be mindful of potential drug interactions and the effects of medications on vital signs or cognition.

Age-Related Physiological Changes: The aging body undergoes changes such as decreased cardiovascular reserve, reduced lung capacity, and impaired temperature regulation. 

These changes can make older patients more vulnerable to shock, respiratory distress, or hypothermia and can affect their response to treatment.

Falls and Trauma: Falls are a leading cause of injury in older adults, often leading to fractures, head trauma, or spinal injuries. Due to bone density loss and the risk of osteoporosis, even minor trauma can result in significant injury. 

Conclusion

In managing geriatric prehospital emergencies, EMS Providers must integrate knowledge of the distinctive aspects of aging with careful, compassionate care. 

This includes staying vigilant for atypical presentations and being prepared to adapt assessment and treatment strategies to suit the complex health profiles of older adults. 

Prioritizing a patient-centered approach while maintaining strong clinical judgment will ultimately help in delivering efficient, effective, and empathetic care. 

By honing these skills, EMS professionals contribute not only to the immediate health and safety of their geriatric patients but also to the broader goal of fostering a healthcare system that meets the needs of its aging population.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS Emergencies - Geriatric Patients

EMS providers should be well-versed in managing common geriatric emergencies, as elderly patients often present with unique challenges due to age-related physiological changes and comorbidities. Here are some key points EMS providers should know:

1. Recognition of Geriatric Syndromes: Understand common geriatric syndromes such as delirium, falls, urinary incontinence, and frailty. These may not present as typical medical emergencies but can significantly impact the overall health and well-being of older adults.

2. Comprehensive Assessment: Perform a thorough assessment, considering the potential for atypical presentations of illness. Geriatric patients may not exhibit classic signs and symptoms of illness, so a high index of suspicion is crucial.

3. Polypharmacy: Recognize the impact of polypharmacy on geriatric patients. Elderly individuals often take multiple medications, increasing the risk of drug interactions, adverse effects, and medication non-compliance.

4. Dementia & Cognitive Impairment: Be prepared to manage patients with dementia or cognitive impairment. Communicate effectively, use clear and simple language, and involve family members or caregivers in the assessment and decision-making process.

5. Mobility & Functional Status: Consider the patient's mobility and functional status when assessing and managing emergencies. Reduced mobility and functional limitations can affect the patient's ability to participate in care and may require adaptations in treatment approaches.

6. Fall Prevention: Assess for fall risk factors and implement appropriate fall prevention strategies. Falls are a leading cause of morbidity and mortality in older adults and can result in serious injuries such as fractures, head trauma, and soft tissue injuries.

7. Cardiovascular Emergencies: Be vigilant for cardiovascular emergencies such as myocardial infarction, heart failure, and arrhythmias, which are common in the elderly population. Older adults may present with atypical symptoms, so consider a broad differential diagnosis.

8. Respiratory Emergencies: Recognize respiratory emergencies such as pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD), and pulmonary embolism. Aging-related changes in the respiratory system can predispose older adults to respiratory infections and other pulmonary conditions.

9. Sepsis: Be aware of the increased susceptibility of geriatric patients to infections and sepsis. Early recognition and prompt initiation of treatment are crucial to improve outcomes in this population.

10. End-of-Life Care: Provide compassionate end-of-life care when appropriate. Understand the patient's wishes regarding resuscitation and advanced directives, and involve palliative care services as needed to ensure optimal symptom management and support for both the patient and their family.

By incorporating these considerations into their practice, EMS providers can effectively assess, manage, and optimize outcomes for geriatric patients experiencing emergencies.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Particular Patient Populations - Geriatric Emergencies

EMS providers play a crucial role in managing geriatric emergencies, as the elderly population often presents with unique medical challenges.

Here are some key considerations, common presentations, and possible treatment plans for geriatric emergencies in the prehospital setting:

Key Considerations:

Physiological Changes: Aging leads to physiological changes, such as decreased organ function, altered drug metabolism, and reduced reserve capacity. Be mindful of these changes when assessing and treating elderly patients.

Atypical Presentations: Geriatric patients may present with atypical symptoms, making diagnosis challenging. For example, myocardial infarction may manifest as confusion or weakness rather than classic chest pain.

Polypharmacy: Elderly individuals often take multiple medications, increasing the risk of drug interactions and adverse effects. Obtain an accurate medication history and be alert to potential complications.

Frailty and Fall Risk: Falls are a common geriatric emergency. Assess for frailty, perform fall risk assessments, and address environmental factors that may contribute to falls.

Cognitive Impairment: Cognitive conditions like dementia can complicate patient assessment and communication. Collaborate with family members or caregivers for additional information.

Common Presentations:

Falls: Assess for injuries, especially head injuries and fractures. Consider the possibility of syncope, medication-related issues, or environmental factors contributing to the fall.

Chest Pain and Cardiac Issues: Look beyond classic symptoms; consider fatigue, shortness of breath, or altered mental status. Monitor for signs of heart failure or arrhythmias.

Respiratory Distress: Evaluate for pneumonia, chronic obstructive pulmonary disease (COPD) exacerbation, or heart failure. Be aware of potential complications related to decreased respiratory reserve.

Altered Mental Status: Determine the cause, considering infectious, metabolic, or neurological etiologies. Hypoglycemia, infections, and medication side effects are common contributors.

Abdominal Pain: Assess for gastrointestinal issues, urinary tract infections, or other abdominal pathologies. Consider the possibility of atypical presentations.

Common Treatment Plans:

Airway Management: Be prepared for airway management challenges, especially if the patient has altered anatomy or decreased respiratory reserve.

Pain Management: Manage pain appropriately, considering the potential for undertreatment due to fears of side effects or drug interactions.

Medication Administration: Administer medications cautiously, considering altered pharmacokinetics and potential drug interactions. Be aware of medications that may cause or exacerbate falls.

Fluid Management: Monitor fluid status carefully, especially in patients with heart failure. Adjust fluid administration based on the patient's hemodynamic status.

Transport to Appropriate Facilities: Consider transporting geriatric patients to facilities with expertise in the care of the elderly, as they may have specialized resources and staff.

Collaboration with Family and Caregivers: Communicate effectively with family members or caregivers to gather crucial information and involve them in the decision-making process.

Prevention Strategies: Provide education on fall prevention, medication management, and strategies to maintain overall health and well-being.

Conclusion:

EMS providers should approach geriatric emergencies with a comprehensive understanding of the unique challenges associated with the elderly population.

By considering the physiological changes, atypical presentations, and specific needs of geriatric patients, EMS providers can deliver more effective and tailored prehospital care.

Ongoing education and training in geriatric emergency medicine are essential for improving outcomes in this vulnerable population.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell