The German model for rescue of traumatized patients.

Accidents and their sequelae are the main cause of death in Germany among people under 40 years of age. The cost in disability payments and lost work averages $40 000 per injury. The author describes the German system for trauma rescue. The aims of rescue care in Germany are to reduce the interval between injury and hospital admission and to bring the patient to the right hospital, bypassing smaller hospitals if necessary. Ambulance rescue systems are of two types: the stationary, in which the physician travels with the ambulance, and the rendezvous, in which the physician and ambulance, travelling separately, meet at the accident site. At the beginning of the 1970s the air-rescue system was started and now comprises 32 stations and 25 BO-105 helicopters. The Hannover experience shows that of the initial diagnoses made at the accident site by helicopter rescue service, 51.9% of victims had head injuries, 35.5% fractures of extremities, 17.0% thoracic trauma, 10.2% abdominal trauma and 7.6% spinal fractures. Because of respiratory insufficiency or unconsciousness with danger of aspiration, 12.0% of the patients had to be intubated endotracheally. One hundred and twenty-two patients with a clinical diagnosis of death were successfully resuscitated at the accident scene. A study comparing the efficiency of the helicopter and ambulance systems showed that as the severity of the injuries increases, the death rate is greater in the group rescued by ambulance. Of 22 accidents involving rescue helicopters, 7 (32%) resulted in at least one death. Between 1973 and 1983, 16 doctors, pilots or attendants were killed.