Extrication of entrapped victims from motor vehicle accidents: the crew concept.

During the extrication process the trauma victim is at high risk for additional injuries or aggravation of existing lesions. Improper handling during extrication with poor concern and knowledge of the ongoing resuscitation process may increase the time spent at the scene and expose the patient to unnecessary risks. Earlier studies report a significant number of neurological injuries that appear to be a result of the extrication process, or of inadequate immobilization during transport. Recent work also underlines the need for appropriate and situation adapted Advanced Life Support (ALS) procedures to improve outcome after prehospital trauma resuscitation. In this paper we present a method for training advanced extrication of trauma victims and the results obtained after five consecutive courses. The training focuses on enhanced liaison between medical and technical team members to optimize synchronization of operations. The course consists of both theoretical lectures and practical training in different crash scenarios. The complexity of the scenarios increases throughout the course and different extrication techniques and strategies are practised. Both the times to extrication and on-scene times were reduced during the 3-day course. Therapeutic interventions and handling of the patient were also improved, in terms of early recognition of medical and technical risks and reduction of the time of no therapy.