[Learning from mistakes. Thoughts on preclinical care of accident victims based on 10-year experience in a large city of West Germany]. / Aus Fehlern lernen. Uberlegungen zur präklinischen Versorgung Unfallverletzter anhand der 10-Jahre-Analyse einer westdeutschen Grossstadt.

On the occasion of the 25th anniversary of preclinical emergency medicine a review of the last decade of preclinical treatment of polytraumatized patients was performed. Initially preclinical emergency medical services were established for the immediate care of victims in road accidents. Therefore these services were first usually stationed in Centers for Surgery or Traumatology. Emergency physicians in these were inevitably well trained in the emergency treatment of trauma patients. The Achilles tendon then was their limited ability to cope with differentiated internal problems. Whereas the quality of preclinical treatment in non-traumatic emergencies gradually increased during the last 10 years due to compulsory postgraduate training courses and due to the fact, that the percentage of physicians and anesthetists among the emergency crews also gradually increased, the average emergency physician no longer possessed enough practical experience with the early treatment of trauma patients, a disadvantage, which could not be sufficiently compensated in compulsory postgraduate training courses. This could be demonstrated in our 10 year quality control. Only physicians of Search and Rescue helicopter teams and residents of surgical and trauma departments made significantly few mistakes in the early treatment of polytraumatized patients. Typical mistakes of less experienced physicians could be sorted into 5 groups: --volume treatment: incorrect estimation of the severity of polytrauma/incorrect estimation of the amount of blood loss/insufficient substitution of volume/logistical mistakes. --O2 treatment: incorrect estimation of the degree of blunt thoracic trauma/hesitant indication for early artificial respiration/hesitant indication for thoracic drainage. --local treatment: incorrect estimation of the severity of soft tissue trauma/incorrect treatment of amputated limbs. --logistics and transport: additional iatrogenic laceration of soft tissues due to insufficient reposition and retention/logistical mistakes in choosing in the best means of transport and the best suited hospital for the patient. --special types of trauma: incorrect estimation of the severity of burn trauma/lack of experience in triage in cases of major accidents. To get better results in the early treatment of polytraumatized patients, the installation of a specialized emergency medical service for trauma patients in the main trauma centers of major cities combined with the function of the surgeon in charge for major accidents and catastrophies is to be discussed.