Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review

Degani, Gláucia Costa; Mendes, Karina Dal Sasso; Storti, Luana Baldin; Marques, Sueli

doi:10.1590/0034-7167-2018-0079

Brasil

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REVIEW • Rev. Bras. Enferm. 72 (suppl 2) • Nov 2019 • https://doi.org/10.1590/0034-7167-2018-0079 linkcopy

Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review

Atención prehospitalaria móvil avanzada de enfermería a ancianos postrauma: una revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to identify scientific evidences available on the literature on nursing interventions on advanced mobile prehospital care for elderly people post-trauma.

Method: an integrative review of literature on the databases PubMed, CINAHL, and LILACS, from 2012 to 2017.

Results: a sample composed by 26 studies, grouped into six thematic categories: circulation with hemorrhage control (n=11); dysfunction, neurological state (n=7); airway with protection of the cervical spine (n=3); secondary evaluation (n=3); ventilation and breathing (n=1), and environment exposition/control (n=1).

Conclusion: Despite having identified nursing interventions, there was no description of specific nursing interventions related to advanced mobile prehospital care for elderly people post-trauma.

Descriptors:
Emergency Medical Services; Aged; Ageing; Wounds and Injuries; Nursing

Thematic area	Name of the journal	n	%
Nursing	Journal of Trauma Nursing	4	15.4
	Critical Care Nursing Quarterly - Journals	1	3.9
	Iranian Journal of Nursing and Midwifery Research	1	3.9
	Nursing Midwifery Studies Journal	1	3.9
	Revista de Enfermagem UFPE On Line	1	3.9
	International Journal of Orthopaedic and Trauma Nursing	1	3.9
	Australasian Emergency Nursing Journal	1	3.9
	Journal of Clinical Nursing	1	3.9
Trauma/ surgery	Journal of Trauma and Acute Care Surgery	3	11.5
	The American Surgeon	1	3.9
	Trauma Monthly (An International Journal in the Field of Trauma and Emergency Medicine)	1	3.9
	Injury - International Journal of the Care of the Injured	1	3.9
Prehospital	Prehospital Emergency Care Journal	5	19.2
Prehospital	Prehospital and Disaster Medicine Journal	1	3.9
Geriatrics	Journal of the American Geriatrics Society	1	3.9
Other	South African Medical Journal	1	3.9
Other	Iranian Red Crescent Medical Journal	1	3.9

Title	Objective	Outline/Sample	Publication year /Level of evidence
Evidence-basedthermoregulation for adult trauma patients⁽¹⁷⁾	To develop a protocol for implementing the evaluating care with thermoregulation, based on evidence, for adult patients with trauma during the treatment in the emergency department.	Cohort -	2012/V
Development of a geriatric resuscitation protocol, utilization compliance, and outcomes⁽¹⁸⁾	To develop a protocol for geriatric resuscitation based on lactate measures, to consult geriatric trauma surgeons to assess the compliance to the protocol and analyze the outcomes before and after implementing the protocol	Cohort Pre-implementation n=1157 Post-implementation n=585	2012/IV
High-risk geriatric protocol: improving mortality in the elderly⁽¹⁹⁾	To asses the efficiency of a protocol for high-risk geriatric patients used during the last five years	Transversal n=4.534	2012/IV
Assessing guidelines for the discontinuation of prehospital peripheral intravenous catheters⁽²⁰⁾	To identify the period in which peripheral intravenous catheters (PVC) punctured during Prehospital Care (PHC) of trauma patients were removed and to determine the complication rate at the moment of discontinuing the PVC.	Transversal n=365	2012/IV
A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures⁽²¹⁾	To determine and compare the effects of using traction and simple splints over pain intensity immediately after, and one, six, and twelve hours after, for patients with femur fractures care for in medical centers of an Iranian university.	Quasi-experimental n=32	2012/IV
Association between a Geriatric Trauma Resuscitation Protocol using venous lactate measurements and early trauma surgeon involvement and mortality risk⁽²²⁾	To investigate if the implementation of a geriatric resuscitation protocol using lactate-guided therapy with the involvement of trauma surgeons is connected to lower mortality during the precocious recognition of occult hypoperfusion.	Prospective Cohortn=1.998	2013/IV
The quality of pre-hospital oxygen therapy in patients with multiple trauma: a cross-sectional study⁽²³⁾	To investigate the quality of prehospital oxygen therapy for multiple trauma patients.	Transversal n=350	2014/IV
Efficacy of prehospital spine and limb immobilization in multiple trauma patients⁽²⁴⁾	To investigate the epidemiology of trauma and the quality of cervical spine and limb immobilization in multiple trauma patients in Iran	Transversaln=400	2014/IV
Utilization of prehospital intravenous access⁽²⁵⁾	To describe the use of intravenous therapy (IV) in the South-African prehospital scenario and to determine the proportion of intravenous access considered unnecessary when classified into the South-African triage classification chart.	Transversal n=242	2014/IV
Cervical Spine Fractures in elderly patients with hip fracture after low-level fall: an opportunity to refine prehospital spinal immobilization guidelines?⁽²⁶⁾	To explore the prevalence of cervical spine fracture in elderly population with fracture of long bones due to low-level falls, in the state of Minnesota, United States	Transversal n=1.394	2014/IV
The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the National Prehospital Evidence-based Guideline Model Process for Emergency Medical Services⁽²⁷⁾	To access the impact of adopting a handling protocol in PHC, Maryland Institute for Medical Emergency, United States.	Transversal n=19.910	2017/IV
Initial emergency nursing management of patients with severe traumatic brain injury: development of an evidence-based care bundle for the Thai emergency department context⁽²⁸⁾	To describe the development of an evidence-based care bundle for initial nursing evaluation of patients with severe traumatic brain injury (TBI) for a Thai emergency context	Transversal -	2014/ IV
Infrequent assessment of pain in elderly trauma patients⁽²⁹⁾	The study's main objective was to identify and describe patterns for pain evaluation for a geriatric trauma population (≥ 65 years). Specific objectives: to describe the frequency of pain evaluation and to determine if the evaluations are being performed in the intervals demanded by hospital protocols. To describe pain evaluation methods to verify if self-reporting and behavioral tools were fit.	Transversal n=587	2014/IV
Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90⁽³⁰⁾	To assess the impact on mortality by substituting for systolic blood pressure SBP < 110 mmHg in the triage of adult and elderly patients of The National Trauma Triage Protocol.	Retrospective cohort n=1.555.944	2015/IV
Using an evidence-based care bundle to improve initial emergency nursing management of patients with severe traumatic brain injury⁽³¹⁾	General objective: to test the feasibility of an evidence-based care bundle in a Thai emergency service.Specific objective: to examine the impact of implementing the care bundle on initial nursing care for patients with severe traumatic brain injury (TBI).	Cohort Pre-test n=20 Post-test n=25	2015/II
Activation of massive transfusion for elderly trauma patients⁽³²⁾	To revise the use of massive transfusion protocol (MTP) for elderly patients. To compare results after activating MTP in elderly trauma patients for their younger counterparts to determine whether older age predicts higher mortality after activating the MTP.	Transversal n=66	2015/IV
Intravenous access in the prehospital settings: what can be learned from point-of-injury experience⁽³³⁾	To analyze prehospital data on peripheral venous access and to validate the clinical practice guidelines by the Israel Defense Forces Medical Corps.	Cohort n=1082	2015/IV
Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline⁽³⁴⁾	To evaluate id the current pain handling practice is in compliance to the Pain managements for trauma patients in the chain of emergency care of the Association for Emergency Nurses, in Dutch, Netherlands. And to assess the precocious pain treatment for traumatized adults in emergency care.	Transversal n=1.066	2015/IV
Identification of a neurologic scale that optimizes EMS detection of older adult traumatic brain injury patients who require transport to a trauma center⁽³⁵⁾	To identify a scale or its components that may enhance the detection of elderly patients with EMS, who need to be transported to a trauma center, regardless of the trauma mechanism.	Transversal n=15	2015/V
Patients immobilized with a long spine board rarely have unstable thoracolumbar injuries⁽³⁶⁾	To determine the prevalence of unstable thoracolumbar injuries among patients who underwent spine immobilization during PHC.	Transversal n=5.593	2016/IV
The quality of pre-hospital circulatory management in patients with multiple trauma referred to the trauma center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013⁽³⁷⁾	To investigate the quality of treatment for circulation priority in PHC of multiple trauma patients.	Transversal n=400	2015/IV
The use of broad geriatric evaluation by nurses from an emergency hospital⁽³⁸⁾	To identify whether the Broad Geriatric Evaluation (BGE) is used as a tool by nurses in geriatric triage.	Transversal n=15	2016/IV
Delta Alerts: changing outcomes in geriatric trauma⁽³⁹⁾	To stablish a third level trauma alert for geriatric trauma.	Transversal -	2016/VI
Prehospital fluid administration in trauma patients: a survey of state protocols⁽⁴⁰⁾	To characterize emergency medical services protocols for intravenous fluid administration during the initial treatment of hypotensive trauma patients.	Transversal n=27	2017/IV
Initial testing of a behavioral pain assessment tool within trauma units⁽⁴¹⁾	To assess the results of initial test of the Bolton Pain Assessment Tool (BPAT).	Transversal n=46	2017/IV
Do EMS providers accurately ascertain anticoagulant and antiplatelet use in older adults with head trauma?⁽⁴²⁾	To identify if health professionals have evaluated the use of anticoagulant and antiplatelet for severe brain injury elderly patients.	Transversal n=2.110	2016/IV

Thematic category	Nursing interventions identified in the studies of the integrative review
Nursing interventions: circulation with hemorrhage control	Measuring blood pressure (BP) and heart rate (HR)⁽¹⁸^-¹⁹^,²²^,²⁸^,³⁰⁾; controlling active bleeding through an adequate bandage on the injury⁽⁴⁰⁾; Guaranteeing antisepsis for inserting the intravascular device. Inserting a thick intravascular device away from the wounded area. Limiting attempts to insert the intravascular device⁽²⁰^,²⁵^,³³⁾; Initiating volume replacement therapy⁽³²⁾ and controlling infusion volume⁽²⁸^,³⁷^,⁴⁰⁾; Examining the injured limb (feeling, movement, distal pulse and color)⁽³⁷⁾; Immobilizing fractured limbs⁽²¹⁾, one articulation above and the other below the injured area and selecting the right splint size to fixate fractures⁽²⁴⁾; Removing clothing from injured limbs, without handling fractures in the trauma scene⁽³⁷⁾.
Nursing interventions: disfunction, neurological state	Evaluating pain in elderly people through evaluation scales⁽²⁹^,⁴¹⁾ and treating pain⁽²⁸⁾ in patients with fractures, contusions, soft tissue injuries with rest, ice, compression, and elevation⁽²⁷^,³⁴⁾; Evaluating the level of consciousness with the Glasgow Comma Scale (GCS), emphasizing the alertness level and whether the patient responds to commands⁽²⁸^,³⁵⁾; Evaluating pupil response⁽²⁸^,³¹⁾.
Nursing interventions: airways with cervical spine protection	Selecting the appropriate cervical collar⁽³⁶⁾; Keep the patient's head in a neutral position (without rotation, flexion or extension); aligning head, body and limbs in a neutral position⁽²⁴^,²⁸⁾; Being attentive to cervical being reports by elderly people⁽²⁶⁾.
Nursing interventions: secondary evaluation	Collecting data on the mechanism of trauma⁽³⁹⁾, use of medicines⁽⁴²⁾ and age⁽³⁸⁾.
Nursing interventions: ventilation and breathing	Performing pulmonary auscultation. Assessing breathing rhythm. Evaluating oxygen saturation. Administrating oxygen⁽²³^,²⁸⁾.
Nursing interventions: environment exposition/control	Document environmental temperature. Providing blankets and warming fluids⁽¹⁷⁾.

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