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A fall of <2m is the commonest mechanism of injury in older patients. Prehospital triage to aid early identification of severe injuries in older patients should be available to allow quick transfer from TU to a MTC for specialist investigation and intervention.53
Staff assigned to the role of anaesthetic assistant should not have any other duties that would prevent them from providing dedicated assistance to the anaesthetist during anaesthesia.5
Comprehensive geriatric assessment and frailty screening tools may facilitate more informed early decision making in older trauma patients.54 Protocols for end of life care should be in place for management of elderly patients with frailty that may prove unsurvivable days or weeks after the initial trauma by a multidisciplinary team.55
All anaesthetists providing anaesthesia for trauma and orthopaedics should have appropriate knowledge, skills, attitudes and behaviour in accordance with the RCoA training standards.
Anaesthetists with responsibility for the intraoperative care of trauma patients should ensure that their skills and knowledge of current recommendations are up to date, particularly in the management of major haemorrhage.
Anaesthetists who manage patients with major trauma should consider undertaking advanced trauma life support (ATLS), European Trauma Course (ETC) or equivalent training, and should update their training at regular intervals.
Anaesthetists providing anaesthesia for trauma and orthopaedic surgery should learn and maintain expertise in a wide range of regional anaesthetic techniques, including central and peripheral neural blockade.57
All anaesthetists involved in the management of major trauma should understand the principles and techniques of damage control resuscitation to prevent lethal triad of hypothermia, acidosis and coagulopathy using low volume fluid resuscitation, blood products and damage control surgery.7
Anaesthetic trauma theatre teams should be trained in the correct use of all essential anaesthetic theatre equipment used for trauma surgery.
Staff in the recovery area and in the wards who receive patients after surgery with epidural infusions, nerve blocks or intravenous opioid infusions (including patient controlled analgesia) should have received up to date formal training in caring for these forms of analgesia.
