388 The Journal of Emergency Medicine

Four key stages in resuscitation were identified and measured prospectively in 257 trauma patients. The type of patient seen i.e. their age, sex, cause and severity of injury were record4 as well as the structure and organisationof the trauma team.

A one-way analysis of variance, including the Scheffe’s test, confirmed that there was a wide, statistically significant, variation between the centres in all the stage times studied. Analysis of covariance indicated that these time variations were mainlyduetodifferences in trauma team organisation and were not due to variations in type of patient seen or team structum.

This hypothesis was tested by studying 26 patients before and 24 patients after the intnxluction of organisational changes in a trauma team. The type of patient seen and the team suucture were statistically similar in both groups. The results showed a time reduction greater than or equal to 50% in all stage times (except the time taken to examine the patient). This study indicates that time taken to resuscitate a trauma patient is dependentonthelraumateamolganisation.

73 PRIORITIES IN TRAUMA WITH BOTH A HEAD AND ABDOMINAL INJURY Driscoll, PA, Accident Department, St. Bartholomew’s Hospital, London, England

“Iwo commonly used tests, the Glasgow coma scale (GCS) and diagnostic peritoneal lavage were studied to establish their specificity in predicting the need for neuro and abdominal surgery in head injured patients who had a positive lavage but were haemodynamically stable. These trauma victims were selected because they have the potential of becoming rapidly unstable when intra-w haemostasis is lost.

171 patients were investigated at the Shock Trauma Institute in Baltimore. ‘lhe incidence for necessary laparotomies ranged between 87% - 75.8% depending on the GCS. Although the craniotomy rate increased with a fall in GCS, it was always much lower than the necessary lapaxotomy rate. Even with patients with a GCS of 3-8 the craniotomy rate was only 10.6% compared with the need for an abdominal operation of 75.8%. These Rndings were supported by both Chisquare and Pearson’s product moment correlation analysis.

Theseresultscanbeusedasguidelinesinthemanagement ofthistypeofpatientwhentheypresentatahospitalwith~ experienced General Surgeon available but no readily available Neuro=mIeon

74 TORSO INJURY PATTERNS AND MECHANISMS IN CAR CRASHES - AN ADDITIONAL DIAGNOSTIC TOOL Dave, SH, Pattimore. D, Thomas, P, Queens Medical Centre. Nottingham, UK, Accident Research Unit, ICE Ergonomics. Loughborough. UK

When car occupants are involved in severe collisions the torso can be a frequent site of life threatening injuries. A rapid diagnosis of these injuries can be important in determining the survival of casualties. Knowledge concerning the ways in which~~~arecausedincarcrashesandthe~u~ofthe type of the impact to the vehicle can provide an additional diagnosticresoumeintheBmergencyroom. Thispaperusesthe injury data collected by the UK Cooperative Crash Injury Study to examine the patterns and mechanisms of torso injuries to

restrained front seated car occupants in both frontal and side impacts.

The study from which the data are drawn has been examining the injuries sustained by car occupants involved in collisions since 1983 with a view to producing guidelines for car design and new regulations. The data on over 6200 occupants is currently available for analysis and The Abbreviated Injury Scale (AIS), 1985 version, is used to describe each injury.

75 COMPARISON OF RIGID CERVICAL IMMOBILIZATION COLLARS: EVALUATION OF FACILITY OF APPLICATION Garrison, HG, Whitley, TW, Cline, KA, McCabe, JB, Hunt., RC, Allison ET, Department of Emergency Medicine, School of Medicine, East Carolina University, Greenville, North Carolina, USA

The purpose of this study was to assess the facility of application of three different rigid cervical immobilization collars representative of the types commonly used in p&o&al care. One hundred emergency care providers independently placed the collars on the same immobilized manikin in randomly assigned order. They then designated their preference of collar for various assessment categories. The majority of providers indicated that a one-piece plastic collar with foam padding (the Stifneck) was the easiest to apply (70%. p < .OOl), required the least manipulation of the neck (71%. p c .OOl), took the least time to apply (69%. p c .OOl), and was easiest to tell front from back (59%. p < .OOl). The majority also indicated that a two-piece. foam collar with plastic support (PhEadelphia collar) was the most di&ult to apply (67%. p < .OOl), required the most manipulation (69%. p < .OOl) and took the most time (72%. p < .OOl). Gpinion was divided evenly between the Philadelphia collar (45%) and a one-piece foam collar with plastic support (the E-Collar) (44%) as to which was most difticult to tell front from back. The majority of providers (92%) regularly use the Philadelphia collar. The results demonstrate that in terms of facility of application a one-piece plastic collar with foam padding is preferred by most providers.

76 DEATH BY ELECTROCUTION: A REVIEW OF ELECTROCUTION DEATHS IN WESTERN AUSTRALIA, MU-8 Ftafovich, DM, Royal Perth Hospital, Perth, Westem Australia, Australia

Death by electrocution is uncommon. This study was undenaken to characterize the features of electrocution deaths, especially the circumstances surrounding each death and to review postmortem findings. To understand the pathophysiology, the basic physics of electricity and lightning will be outlined. The ws files of all electrocution deaths in Western Australia from 1986-8 inclusive were reviewed. There were 13 patients which included 4 suicides, 4 deaths in the workplace and 1 due to lightning. Six of the 13 cases had documented evidence of the presence of water at the scene, a factor well known to decrease resistance and hence increase current flow through the body. Graphic photographs illustrating the nature of the injuries received will be presented.