In recent years, the growing aging population has led to a significant rise in the demand for prehospital services globally, including in Saudi Arabia. This shift has resulted in increased resource allocation to meet the specific needs of older adults (1, 2). In Saudi Arabia, as in other nations, the provision of trauma care for older patients is becoming an increasingly critical aspect of emergency medical services. Despite the efforts of ambulance workers to effectively assess and manage trauma cases involving older patients, providing comprehensive and specialized care for these individuals presents numerous challenges (3–5). The unique characteristics of trauma incidents among older adults, such as falls from lower heights and road traffic collisions, complicate emergency response efforts and contribute to high rates of disability and mortality (6, 7).

The Saudi healthcare system faces distinct challenges in providing trauma care for older adults due to factors such as rapid population growth, an insufficiently developed trauma care infrastructure, and limited geriatric-specific prehospital training. This highlights the importance of understanding the current state of trauma care for older people in Saudi Arabia. Developing a comprehensive understanding of the characteristics of older trauma patients, the existing protocols for managing their care, and the outcomes associated with prehospital interventions is critical for improving patient outcomes and reducing the burden on healthcare services (8). The aim of this review is to highlight the current status of trauma care for older adults in Saudi Arabia, focusing on the unique challenges faced by emergency medical personnel. By shedding light on the consequences of aging for healthcare services, outlining the implications for clinicians, and examining the gaps within the trauma system, this review seeks to enhance the understanding and preparedness of emergency clinicians, ultimately paving the way for future improvements in the quality of prehospital trauma care for older adults.

This narrative review synthesized current literature to evaluate the status of trauma care for older adults in Saudi Arabia. The methodology is described across the following subsections.

The global population is experiencing rapid aging due to advancements in chronic disease management, healthier lifestyles, and improvements in living conditions such as housing and nutrition. While these factors have led to longer life expectancy, they have also resulted in a rise in injuries among older adults (4, 9–11). Bala et al. (12) estimated that the global population of older adults will reach 2 billion by 2050, based on statistics from the World Health Organization. Studies on population demographics show that by 2030, 20% of the United States’ population will be over the age of 65. Similarly, 23% of the United Kingdom’s population will be over 65 by 2035, with Europe and Australia projecting that 30 and 21% of their populations will be over 65 by 2050 and 2054, respectively (4, 13–15).

Aging has been identified as a key factor contributing to the increased incidence of injuries among older adults (16, 17). This trend has led to growing demand for ambulance services and emergency department care (18), placing additional challenges on ambulance personnel when attending to injured older adults (19). In the United States, older patients represent 25% of all injury-related hospital admissions (20), reflecting a significant and increasing burden on healthcare systems. As a result, healthcare costs, both in prehospital and in-hospital settings, are expected to rise due to increased complication rates and extended hospital stays (20–22).

This section outlines three categories of implications resulting from injuries sustained by older patients.

Saudi Arabia is the largest country in the Middle East, covering approximately 2,150,000 square kilometers, which is twice the size of the United Kingdom, France, and Germany combined (53). The population in Saudi Arabia has grown rapidly, with an average annual growth rate of 2.38%, reaching a total population of 34,110,821 across the 13 Saudi regions (54). In Saudi Arabia, 72% of the population falls within the 15–64 age group, 24.5% are under 15, and only 3.5% are over 65 (54). Reporting and comparing injury and death rates as proportions of the population, as seen in countries like the United Kingdom and the United States, can provide valuable insights. However, the current estimates from the Saudi Ministry of Health only present raw numbers without providing percentages or rates that would offer a clearer understanding to the readers. Furthermore, these estimates focus solely on motor vehicle collisions (MVCs), despite the existence of other injury mechanisms, as MVCs remain the leading cause of mortality and disability among trauma patients in Saudi Arabia according to World Health Organization statistics (55). The lack of a national trauma database in Saudi Arabia poses a significant challenge in identifying and estimating all trauma cases and their respective mortality rates (55). Alferdaus and Shaher (2021) reported that some Saudi hospitals do not provide comprehensive data on injuries, highlighting the absence of an injury surveillance mechanism or injury registry, as well as the lack of quality assurance measures. They further noted that trauma research in Saudi Arabia is limited, primarily due to the lack of a trauma registry (56).

Most recent trauma-related studies in Saudi Arabia have emphasized the burden of MVCs on both younger and older populations. For example, Abolfotouh et al. (2018) found that 52% of 3,786 injured patients admitted to the King Abdulaziz Medical City (KAMC) trauma center were MVC cases, followed by 25% who were fallers (72). Another study showed that 81.2% of 335 trauma patients admitted to KAMC were involved in MVCs, followed by 9.6% involved in pedestrian collisions, with fallers accounting for 3.9% (57). The emphasis on MVC data by the Ministry of Health may be an attempt to address the economic impact of MVCs, which account for 4.7% of the gross financial product and exceed 5.85 billion US dollars annually, according to government statistics (55, 58).

A trauma system is defined as a planned, systematic, and coordinated network that integrates all facilities with the capacity to manage injured patients, involving collaboration with the local public health system (59). It comprises four key components: injury prevention, prehospital care, acute care units, and post-hospital care (60). Injury prevention is the first component, aimed at reducing disability and mortality rates by focusing on contributory factors that increase mortality and identifying high-risk age groups (61). The Saudi government has made significant efforts to implement and improve public safety and high-quality healthcare to mitigate injury events (62). Despite these efforts, the rate of mortality and trauma events remains high, imposing substantial burdens on the government and healthcare systems (62).

Two recent Saudi studies have indicated that motor vehicle collisions remain the leading cause of death among trauma patients (63, 64). Effective emergency care in the trauma system involves the coordination of communication, activation of healthcare teams, and implementation of interventions at the scene. These actions include managing resources and providing care until patients are transported to a definitive care facility (59). The concept of the “golden hour” highlights the importance of swift trauma management from the scene to hospital arrival (59).

The acute care and post-hospital care components focus on delivering multidisciplinary interventions to manage major trauma patients from the emergency department (ED) until rehabilitation (62). In Saudi Arabia, large cities typically have one or two tertiary hospitals that manage major trauma patients, with only two trauma centers (King Saud Medical City KSMC and King Abdulaziz Medical City KAMC in Riyadh) maintaining trauma registries and meeting the criteria for level I trauma centers (55, 65). Post-hospital care involves rehabilitation that aims to restore mental and physical function, reduce disability, and improve patient independence (59). There are currently three rehabilitation centers in Saudi Arabia under the Ministry of Health administration (55).

A recent study argued that the trauma system in Saudi Arabia is currently unorganized and lacks integration, making it inadequate for the complexity and urgency of trauma care (66). The vast geographical distances, harsh climate, and lack of communication infrastructure are among the key obstacles hindering the development of a national trauma system. The Saudi trauma system currently faces several challenges: (1) Variability in trauma care across regions and differences in trauma care expertise (67). (2) Only two centers in Riyadh qualify as level I trauma centers, leaving other regions without sufficient major trauma centers (56). (3) Lack of a formal trauma registry for collecting and analyzing data to improve trauma care (56). (4) No clear guidelines for hospital referral, which contributes to ambiguity regarding the role of tertiary hospitals in treating trauma patients (55). These issues contribute to the overall difficulty of understanding patient characteristics and outcomes following injury events due to the absence of a robust national trauma system (67).

Furthermore, (5) the trauma system in Saudi Arabia lacks efficient prehospital networking, including connecting prehospital triage information with receiving hospitals and integrating data across prehospital and in-hospital settings (67). (6) The absence of clear trauma activation protocols aligned with the American College of Surgeons (ACS) criteria and (7) the lack of research investments further exacerbate challenges in developing standardized care protocols (55). (8) Trauma bypass and field triage guidelines are missing in Saudi Arabia, which hinders optimal decision-making regarding the level of care and destination of trauma patients (55).

To address these gaps, Saudi Arabia has established a clinical advisory group for trauma care as part of its Vision 2030, involving multidisciplinary members from EMS, emergency and disaster management, emergency departments (ED), trauma surgery, nursing, pediatric emergency, trauma research, and rehabilitation (66). However, challenges such as a shortage of transport resources, lack of collaborative networks, and inadequate rural trauma care coverage remain to be addressed before the full-scale implementation of an integrated trauma care system can be realized (66).

Prehospital care in Saudi Arabia is provided primarily by the Saudi Red Crescent Authority (SRCA), established in 1934 and funded by the government, which offers free healthcare both domestically and for humanitarian relief efforts abroad (55). The emergency medical services (EMS) system follows an Anglo-American model, with ambulances staffed by trained Emergency Medical Technicians (EMTs) and Paramedics employed by the SRCA (68). The formalization of EMS education began in the early 2000s, focusing on improving service quality and reinforcing public trust. The Emergency Medicine Institute in Riyadh, established in 2002 by the Saudi Council for Health Specialties, remains the first and only specialized institute for training EMS personnel (68). Subsequently, Saudi universities have introduced Bachelor of Science programs in EMS, reflecting the rising demand for skilled and qualified personnel (68).

Despite these developments, recent studies have indicated significant gaps in EMS personnel knowledge, including awareness of critical symptoms such as those related to stroke (69). This gap highlights the need for improved educational programs and screening tools (69). AlShammari et al. (70) argued that this lack of knowledge is indicative of underdeveloped EMS education in Saudi Arabia, pointing to a need for broader curriculum development and enhanced training.

Training remains the most crucial component of prehospital care, as it equips EMS personnel to handle emergencies effectively (59). EMTs provide basic life support, including skills like airway management, cardiopulmonary resuscitation, automated defibrillator use, hemorrhage control, and rapid patient transport (55). Paramedics, on the other hand, are trained to deliver advanced life support, which includes administering medications, handling high-risk trauma, and managing major incidents (55). Due to their higher skill levels, the SRCA prefers hiring paramedics with bachelor’s degrees, typically trained in Saudi universities.

Continuous education is mandatory for EMS personnel, who undergo courses such as Basic Life Support (BLS), Prehospital Trauma Life Support (PHTLS) or International Trauma Life Support (ITLS), and Advanced Cardiac Life Support (ACLS), as required for professional accreditation by the Saudi Commission for Health Specialties (55). However, despite the availability of these courses, EMS personnel in Saudi Arabia are still not meeting the local and national needs in terms of competency and skills (59).

The evolution of EMS education in Saudi Arabia can be categorized into three stages: (1) workplace training of first aid providers (1934–2005), (2) the professional technician diploma (2005–2012), and (3) the academic transition to a bachelor’s degree in EMS (2007–present) (70). As for trauma care education, its goal is to enhance knowledge, skills, attitudes, and professional relationships (71). However, it is still unclear whether existing trauma training programs significantly affect trauma-related mortality outcomes (62). Research is needed to evaluate how trauma training in Saudi Arabia impacts healthcare providers’ competencies, confidence, and trauma outcomes, as no data currently exists to confirm these effects (62).

The national clinical advisory group for trauma care which operates under the Vision Realization Office of the Ministry of Health, aiming to develop a comprehensive trauma care system in Saudi Arabia (66). Several workshops have been conducted with over 300 healthcare professionals in Riyadh to assess the new trauma system, which is set to be initially implemented in the Riyadh region (66).

These workshops identified several gaps that hinder the development of a trauma care system in Saudi Arabia, including insufficient prehospital transport resources and capabilities, the absence of collaborative networks, hospital transportation limitations, inadequate staffing, a public awareness gap for rehabilitation and community discharge, limited trauma care networks in rural areas, and shortages in pediatric trauma care centers (66). As a result, an initial standard trauma care pathway was proposed, which will first be implemented and refined in Riyadh before regional application (66).

It is noteworthy that most trauma-related studies in Saudi Arabia have primarily focused on the general trauma population. A recent study highlighted that high rates of mortality and trauma incidents continue to impose significant burdens on the government due to increased healthcare costs (62). Moreover, another Saudi study reported increased in-hospital mortality and disability among trauma patients and recommended preventive injury measures to mitigate these issues (72).

The trauma care system in Saudi Arabia faces significant challenges due to the complexities involved in managing the aging population and the unique needs of older patients. Despite the growing elderly population, the healthcare infrastructure remains insufficient, with gaps in the trauma care pathways, such as the absence of robust prehospital transport resources, collaborative networks, and specialized trauma centers, which hinder effective management and timely interventions. The Saudi Vision 2030 presents a promising future for an improved and integrated trauma care system. However, before its full-scale implementation, there is an urgent need to address the specific gaps identified during workshops, such as limitations in transportation, rural trauma care capabilities, and community rehabilitation services. These measures are essential to ensure that the trauma care system can respond effectively to the increasing demand for geriatric-specific services. It is crucial that ambulance workers receive enhanced geriatric-specific education to expand their roles and make high-level decisions for older patients. Furthermore, comparing the Saudi system with international examples, such as the United Kingdom’s trauma system, shows the necessity of establishing a comprehensive trauma registry, prehospital protocols, and trauma activation procedures in line with the American College of Surgeons (ACS) criteria. Such systems have been shown to significantly improve patient outcomes and reduce mortality rates in similar contexts.

The increasing burden of trauma among older people necessitates strategic policy interventions in Saudi Arabia. Establishing a national trauma registry would be a significant step in collecting and analyzing data to improve trauma care quality. The introduction of clear referral guidelines between hospitals, prehospital networking for triage, and training modules based on the ACS guidelines would also contribute to more coordinated and effective care. Moreover, research focusing on understanding the impact of aging changes on prehospital care and identifying factors that contribute to a lack of awareness among ambulance clinicians will be crucial to closing existing knowledge gaps. In summary, trauma in older people increases the healthcare burden in Saudi Arabia, and the age factor has a substantial impact on trauma care. Research is required to identify the impacts of aging changes on prehospital care and patient outcomes in Saudi Arabia and explore factors that lead to a lack of awareness of ambulance clinicians regarding these impacts. By adopting a structured approach, incorporating international best practices, and investing in targeted education and system improvements, Saudi Arabia can significantly enhance trauma care outcomes for its growing elderly population, ultimately improving the quality of care and reducing the healthcare burden on the system.