Stroop R, Schöne Ch, Grau Th
University Witten-Herdecke, Faculty of Medicine, Witten, Germany; Emergency-Department, Academic Hospital, Barbara-Hospital, Hamm, Germany.
TÜV SÜD Industrie Service GmbH, Filderstadt, Germany; Voluntary Fire Brigade, Gütersloh, Germany.
Injury. 2019 Feb;50(2):308-317. doi: 10.1016/j.injury.2018.10.021. Epub 2018 Oct 24.
Vehicle extrication of crash victims is a highly-demanding challenge, due to the frequently life-threatening injuries of entrapped occupants. In this phase, crash victims are often exposed to the outdoor-temperature, with the risk of sustained hypothermia. Hypothermia can significantly raise the morbidity and mortality rates of crash victims. Therefore, we have correlated the incidence of severe car accidents with entrapped patients, the outdoor conditions, and expenditure of time for extrication. Furthermore, different warming strategies have been evaluated regarding their integrability within the rescue procedure.
To estimate the incidence of severe car accidents with entrapped patients, we performed retrospective data mining for the cold season of a three-year period in a rural district in Germany. We evaluated the integrability of a chemical heated blanket, its combined application with a forced-air warmer, or with an infrared radiator for patient warming. Therefore, we analysed the time tracking of extrication reference points during extrication exercises undertaken by the rescue services, simulating a severe vehicle accident and evaluated questionnaires administered to rescue personnel and subjects. Furthermore, we monitored subjects' physiologic parameters to estimate the warming effect.
Incidence analysis resulted in extrication times of up to 80 min, representing two severely-entrapped patients per month in the cold seasons, corresponding to about four entrapments per 100.000 inhabitants every year. Of the different warming strategies analysed, the chemical blanket and the combination infrared radiator/chemical blanket were favoured regarding the items 'operator convenience', 'weight/size/handling', 'stability in positioning', 'time needed for installation', 'manpower requirement', 'hindrance during extrication operation', 'versality during extrication process', and 'robustness' by the rescue personnel; the forced-air warmer and the infrared radiator were preferred with regard to 'warming effect', the forced-air warmer and the chemical blanket was advantageous with regard to 'physical protection'.
Vehicle extrication procedures are time consuming, a relevant finding that provides a rationale for discussing and optimising the rescue procedure to prevent sustained hypothermia. We determined that combined application of an infrared radiator and a chemical blanket is advantageous in terms of integration into the rescue process. However, a more detailed investigation, focussing on warming efficacy, must be performed.
由于被困车内人员的伤势往往危及生命，从事故车辆中解救车祸受害者是一项极具挑战性的任务。在此阶段，车祸受害者常常暴露在室外温度下，存在持续体温过低的风险。体温过低会显著提高车祸受害者的发病率和死亡率。因此，我们将严重车祸中被困患者的发生率与室外条件以及解救所需时间进行了关联分析。此外，还评估了不同的保暖策略在救援过程中的适用性。
为了估算严重车祸中被困患者的发生率，我们对德国一个农村地区三年寒冷季节的数据进行了回顾性挖掘。我们评估了化学加热毯、其与强制空气加热器或红外辐射器联合应用于患者保暖的适用性。为此，我们分析了救援服务部门在模拟严重车辆事故的解救演练中解救参考点的时间跟踪情况，并评估了向救援人员和受试者发放的问卷。此外，我们监测了受试者的生理参数以评估保暖效果。
发生率分析得出解救时间长达80分钟，这意味着在寒冷季节每月有两名被困严重的患者，相当于每年每10万居民中约有四起被困事件。在所分析的不同保暖策略中，救援人员在“操作便利性”“重量/尺寸/操作”“定位稳定性”“安装所需时间”“人力需求”“解救操作过程中的阻碍”“解救过程中的通用性”以及“耐用性”等方面更倾向于化学加热毯以及红外辐射器/化学加热毯组合；在“保暖效果”方面，强制空气加热器和红外辐射器更受青睐，在“物理保护”方面，强制空气加热器和化学加热毯更具优势。
车辆解救程序耗时较长，这一相关发现为讨论和优化救援程序以防止持续体温过低提供了依据。我们确定，红外辐射器和化学加热毯联合应用在融入救援过程方面具有优势。然而，必须针对保暖效果进行更详细的研究。
