J Trauma
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This study was designed to examine the results of emergency room resuscitative thoracotomy (ERRT) and to formulate cost-effective indications for this procedure. A retrospective study was performed of 28 patients who had ERRT at St. Elizabeth Hospital Medical Center, Youngstown, Ohio, during the 4 years from July 1985 through June 1989. ⋯ There were no survivors in the group of patients with no SOL at the scene, and there were no neurologically intact survivors among blunt trauma patients with no SOL upon arrival at the ER. An algorithm based on mechanism of injury and presence or absence of SOL at the scene and in the ER is proposed. This algorithm would decrease the number of ERRTs performed by 41% without decreasing the number of neurologically intact survivors.(ABSTRACT TRUNCATED AT 250 WORDS)
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Data from patients treated in Pennsylvania-accredited trauma centers during 1989 were analyzed. TRISS expected and unexpected survivors (1.6% of all survivors) differed in many ways. Unexpected survivors were more than twice as likely to have been transferred from a nondesignated trauma center (45.8% vs. 22.8%, p < 0.001). ⋯ The percentage of unexpected survivors discharged to rehabilitation centers (61.9%) was significantly greater than that for expected survivors (8.7%), (p < 0.001). Unexpected survivors were more frequently judged "completely dependent" in five measures of functional disability than expected survivors. We conclude that unexpected survivors are a seriously injured and clinically relevant patient set, not just a statistical phenomenon.
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Swiss Air Rescue (REGA) teams execute more than 3000 aeromedical missions annually, of which some require the use of a winch. To evaluate the need for early medical intervention at sites where landing is impossible, we analyzed retrospectively 100 consecutive operations (10.8% of all primary missions, 110 patients) accomplished by the REGA base at Lausanne with an emergency physician of the Centre Hospitalier Universitaire Vaudois (CHUV) on board. In such difficult rescue conditions, time to call, response times, and scene times were particularly long (mean delay to admission: 114 minutes). ⋯ Seventeen required major intervention at the site or during rescue. We conclude that in our European pre-alpine region 22% of patients rescued by winch are severely injured. Since rescue actions are particularly long and difficult, the performance of advanced procedures at the scene and during transportation is of great value.