Trauma in elderly people: access to the health system through pre-hospital care1

Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.

represents new challenges for the emergency services, especially in the pre-hospital care context, as a result of elderly people's particularities, which make them more vulnerable to trauma events and their consequences, with the necessary access to a universal and high-quality health system that has been structured to respond to this reality (14) .
As an emergent health problem, the understanding of trauma in the elderly population enables the multiprofessional team, which nursing is part of, to plan and implement strategies for more specific geriatric care and, hence, to contribute to the reduction of the chances of temporary or permanent sequelae, as well as to the prevention of these events, with a view to balancing the health system as a whole.
In emergency health services, nursing plays a fundamental role to achieve universal access to these services by applying its knowledge and fundamentals in the use of critical and reflexive reasoning on this care, considering its presence at the different complexity levels of health care (15) . MPHC is part of the care modalities not only in terms of care, but also in management.
To analyze the problem, in this study, the following question was raised: what is the prevalence of trauma in elderly people and how do they access the health system through MPHC?
The objective was to identify the prevalence of trauma in elderly people and how this population gets access to the health system through MPHC. It is relevant because studies on the magnitude, dynamics and understanding of trauma in elderly people are increasingly necessary in the health area, as they permit broadening the knowledge on this problem, with strong economic and social impacts. It should also be highlighted that the expansion of knowledge permits the enhancement of strategies to improve health service care.

Method
Descriptive and cross-sectional study with a The data were surveyed between July and September 2013. The sample size was estimated as follows: n 0 =Z 2 P 2 / E 2 0 , with n indicating the sample size, Z the 95% confidence interval (Z=1.96), P the probability of finding the study phenomenon (P=0.5) and E the tolerated sampling error (E=0.05). Thus, a minimum sample size of 384 trauma victims was obtained, which was rounded off to 400 to minimize the risks of sampling error.
The sample was selected through systematic random sampling, whose first element was drawn and the remainder followed the interval K=N/n, in which N corresponded to the population (N=2080) and n to the sample (n=400), revealing the constant K=5.2, rounded off to 5. Hence, for every five trauma events in elderly people, the fifth was selected for the study sample.
The following eligibility criteria were adopted: age 60 years or older, trauma victims, attended between January 2011 and December 2012. Records that were illegible were excluded, which made it difficult to reach the study objective. The variables considered in this research excerpt were: sex and age of the victims, trauma mechanism, care service, team actions and destination of the victim.
To collect the data, a form was used the researchers had elaborated, which was validated by expert judges, for the sake of retrospective analysis of the care records, which the nursing team from the service had completed during the selected period. The results displayed in Table 2 evidence that the BLS are the most used services for care delivery to elderly trauma victims, corresponding to more than 85% and present in care delivery to the different trauma mechanisms, despite being more represented in cases of falls, the prevalent mechanism in elderly people.
ALS were the most used services in traffic accidents, in some cases associated with BLS, as shown in Table 2.
The X 2 test evidenced a significant association between the trauma mechanism and the care service.

Discussion
The results achieved in this study in terms of the prevalence of trauma, sex, age and mechanism partially converge with the reports in the literature. In a similar study at an emergency service, it was evidenced that the elderly victims' mean age was 72.6 years, with sd±9.3 years, close to the present findings (10) .
The elderly's profile differs from the young population, as they are more affected by falls, traffic accidents (mainly collisions), burns and violence, as identified in this study and also appointed in the literature (4,(9)(10) .
The prevalence of the mechanism differs according to sex and age, as women over 69 years of age are the main victims of falls, due to the higher degree of frailty associated with osteoporosis, as a result of the post-menopause period, while men are more exposed to traffic accidents and in the age group between 60 and 69 years, due to the exposure to risk factors like greater circulation in the urban perimeter, leisure activities and the job market (4)(5)(16)(17) .
In the Regulation Central, the regulatory physician guides the citizen who summons the service and assesses the need to send the care resource and which is the most appropriate service in view of the severity of the situation (11) . In this study, it was evidenced that the BLS service delivered most of the care, pointing towards less severe injuries, linked to the prevalent trauma mechanisms which were falls, as well as the fact that, in many cases, ALS is summoned after the BLS team assessed the victim. These data converge with other similar results, in which BLS represents more than 80% of the pre-hospital care provided (4,10,18) .
The motor ambulances, as rapid intervention vehicles, are used to overcome obstacles related to intense traffic in the urban area and to get access to borderline areas (11) . Thus, they guarantee support