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Across the developed world, demographic change is having a profound impact on emergency care,1 with recognition that older people have different needs, and may need different services.2 The article by Hawley et al 3 in this edition, and the recent publication of a report4 on major trauma in older people from the Trauma Audit and Research Network (TARN), suggest that we may also need to think differently about our major trauma systems. In England and Wales, recent improvements in data collection from trauma units (hospitals that are not major trauma centres) means that in 2016 the ‘typical’ case of major trauma is no longer a young male admitted after a road traffic accident, but is an older male admitted after a fall of less than 2 …
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