SLIDE 1:
Evaluation of Extrication After Motor Vehicle Crash

Frank A. Pintar, PhD
N. Yoganandan, PhD
Thomas A Gennarelli,  MD

Department of Neurosurgery
Medical College of Wisconsin
and VA Medical Center

John Olshanski
Safe and Fast Extrication, Inc
New Berlin, Wisconsin


SLIDE 2:
Goals of Extrication after Motor 
Vehicle Crash (MVC) 
* Patient management 
* Optimize / minimize time 
* Rescue personnel safety

SLIDE 3:
First Responders
Golden Hour is the is the golden rule 

[photo - caption] Sizing-up the scene


SLIDE 4:
First Responders
Move or remove metal to release victim 


SLIDE 5:
Extrication after MVC 
[photo - caption] Using hydraulic spreaders to do a Noahs Ark to open jammed doors


SLIDE 6:
First Responders
- Extricate as fast as possible
[photo]


SLIDE 7:
First Responders
[photo]
Removal of patient from crashed vehicle


SLIDE 8:
First Responders
[photo]
Prolonged extrication is > 20 minutes


SLIDE 9:
Questions for Study

* What crash characteristics are associated 
with need for extrication? 
*  What part of extrication procedure is Wassociated with highest risk of secondary
injury to the occupant? 



SLIDE 10:
Methods

* Survey US DOT NHTSA databases
* Fatality Analysis Reporting System (FARS)
	 approx. 37,000 fatal crashes yearly
* National Automotive Sampling System (entrapment)
*  Crash Injury Research and Engineering Network (CIREN)
* Conduct full-scale vehicle crash and extrication procedures with sensor monitoring


SLIDE 11:

Total Extrications from Fatal Vehicle Crashes
by PDOF, FARS data

[scatter chart 1983 - 2001]


SLIDE 12:
Extrications Risk in Fatal Vehicle Crashes
by PDOF, FARS data

[scatter chart 1983 - 2001]


SLIDE 13:
Total Extrications from Fatal Vehicle Crashes
by Car Vehicle Weight, FARS data

[scatter chart 1983 - 2001]



SLIDE 14:

Extrications Risk in Fatal Vehicle Crashes
by Car Vehicle Weight, FARS data

[scatter chart 1983 - 2001]


SLIDE 15:
Extricated Occupants in Left- Side Crashes
FARS data 93 - 99
[bar chart]

	percent of occupants in:
Striking Car = 12.1%
Striking Truck = 2.5%
Struck Car = 76.5%
Struck Truck = 8.9%
SLIDE 16:


SLIDE 17:
CIREN Database 

Medical Data 
	EMS treatment
	Surgical decisions
	Recovery process
	Follow-up

Engineering Data 
	Crash reconstruction
	Physics of occupants
	Mechanics of injury
	Vehicle causation
	250 entries
	600 entries


SLIDE 18:
CIREN Data on Extrication

1996 to 2003 
6 bar charts - evaluating by:
	Average MAIS score
	Average ISS score
	Average Delta V
	% side Impacts
	% hit by truck/SUV
	Side Intrusion (cm)


SLIDE 19:
Full-Scale Vehicle Crash 
[overhead CAD drawing indicating a driver's side impact; photo of crash dummy in driver position in test vehicle


SLIDE 20:
SIDE IMPACT EVENT DATA
HIC - 698
[graph]



SLIDES 21-23:

Extrication Event Data 
Upper Neck Load Cell 
[graphs]


SLIDE 24:
Extrication Protocol
 * Incident Commander 
 * Team approach 
 * Task approach 
 * Inner and outer circles 
 * Multiple options for same task 
 * Power tools and hand tools 


SLIDE 25:
[photos]
Optimize Extrication Procedures

SLIDE 26:
Summary

* Extrications characterized by 
	Increase over last several years
	High risk for side crashes
	Truck into car
	High risk for small cars

* Relatively low forces during actual occupant 
extrication procedures 

* Variations exist by extent of team training 



SLIDE 27:
ACKNOWLEDGEMENT

This research was supported in part by
 * US Centers for Disease Control (CDC)
 * National Spinal Cord Injury Association
 * Wisconsin CIREN Center
 * Dept. of Veterans Affairs Medical Research