• trauma, majot trauma mnanagement
• non accidental injury
• geriatrics
• accidental falls
• major trauma management

In the UK, reports from the Trauma Audit Research Network (TARN)1 2 have shown that the very young and the very old now outnumber higher profile trauma groups, such as road accidents and stabbings. Other countries have seen similar demographic shifts. The very young and the very old share many societal and medical traits, including late diagnosis of severe injuries that may not be apparent on initial presentation.3 This could be described as ‘stealth trauma’.

Many countries have established major trauma networks,4 5 with the English system showing incremental improvements in patient outcomes.6 However, these systems rely on early identification by prehospital services of the ‘major trauma patient’ (usually by application of a trauma triage tool by ambulance staff). This identifies patients for immediate transfer to a major trauma centre (MTC), however this system does not work at the extremes of age. The TARN reports show that the old and the very young have a delayed process of care.

The mechanism of injury …