title: [Entrapped motorists and air rescue services: analysis of tactical rescue approach, rescue techniques, and emergency medical services illustrated by a helicopter emergency medical service].
abstract: BACKGROUND
  Analysis of the results and presentation of a treatment concept of a helicopter emergency medical service (HEMS) in prehospital acute care of entrapped motorists.
  
  
  METHODS
  Consecutive patient data collection from primary rescue missions of a helicopter emergency medical service (HEMS) from the years 2000-2004. Evaluation based on data collected regarding emergency medical care, rescue techniques, and tactical rescue approach.
  
  
  RESULTS
  A total of 359 cases of entrapped motorists were documented: 237 patients were male, 122 were female, and the average age was 37 (range: 2-82 years). The motor vehicle accidents (MVA) occurred in 21% of the cases on the highway, in 29% on a main road, in 43% on a rural road, and in 7% in city/urban areas. Concerning the vehicle types, 86% were automobiles, 5% vans, and 9% trucks. Drivers accounted for 86% of the patients, front seat passengers for 10.1%, and back seat passengers for 3.9%. The average length of motorist entrapment amounted to 17 min with an average on-scene time of 27 min for the HEMS. The total rescue time averaged 56 min. A Glasgow Coma Scale (GCS) score between 3 and 8 was recorded in 33.7% of the patients; in 24% of the cases the shock index was <1; a respiratory rate of <10/min or >20/min was documented in 25.2% of the patients. An NACA score between I and III was recorded in 34.2% of the cases, NACA IV in 18.9%, and NACA >/=V in 46.8%; 11.9% of the patients died before hospital admission.
  
  
  CONCLUSIONS
  For both the emergency control center personnel and the emergency medical technicians (EMT), a case of motorist entrapment must be considered as a trigger mechanism of injury, activating a sophisticated and time-sensitive prehospital acute care and transportation service. In the German emergency medical service this involves primarily the HEMS. Even in cases of potentially critically injured entrapped motorists, the prehospital adherence to"the golden hour of shock" is made possible, despite the resulting higher personnel and equipment expenses.
authors.affiliation: Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Strass1, 30625 Hannover. joern.westhoff@web.de
authors.forename: J
authors.initials: J
authors.lastname: Westhoff
authors.forename: C
authors.initials: C
authors.lastname: Kröner
authors.forename: R
authors.initials: R
authors.lastname: Meller
authors.forename: T
authors.initials: T
authors.lastname: Schreiber
authors.forename: S
authors.initials: S
authors.lastname: Zech
authors.forename: V
authors.initials: V
authors.lastname: Hubrich
authors.forename: C
authors.initials: C
authors.lastname: Krettek
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances / Q000458:organization & administration / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality*; D018635:Rescue Work / Q000458:organization & administration / Q000639:trends*; D012769:Shock / Q000401:mortality*; D016019:Survival Analysis; D014600:Utilization Review