The John Graham extrication prize: Its history and importance

Background: The Early Management of Severe Trauma (EMST) course is unique i n providing instructive exposure to techniques used in the extrication of s everely injured victims from difficult locations using a role play method. Dr John C. Graham FRACS, vascular surgeon in Lismore, was responsible for t he initiation of this concept in 1989. Since this component of the trauma c ourse is not used in the Advanced Trauma Life Support (ATLS)(R) course in t he USA, from which the EMST course was derived, the purpose of the present study is to determine the opinions of all EMST course directors as to the v alue of including an extrication scenario station in the EMST course in its current form in Australia and New Zealand. Methods: The extrication station as devised by John Graham consists of four 40 min scenarios offered to all 16 participants of an EMST course in group s of four. The participants are required to extricate a moulaged victim fro m a difficult location within the time available in the most skilful and ex peditious manner. A prize is offered for the group performing the task best . A survey of the 45 EMST course directors was undertaken by questionnaire. Replies were anonymous. Results: There was a good response rate of 87%. Ninety-two per cent of resp onding directors routinely used an extrication station. Two directors used the station occasionally and only one director never used it. The most freq uently cited reason for use was that the participants come to appreciate co mmonly encountered problems in extrication, and how EMST principles are app lied in the field. Second, the station allows the use of teamwork. Third, i t adds entertainment to the course overall. There was a prize awarded by ev ery course director for the winning group of participants. Ninety per cent of these prizes were named the 'John Graham Extrication Prize'. Conclusions: The extrication station is considered constructive by the grea t majority of EMST directors. Both historical and competitive aspects are i mportant since most directors still award a named prize for this station. T he extrication station promotes a feeling of cohesion among Faculty and par ticipants on an EMST course. The station is a memorable event for many part icipants and should be retained as a uniquely Australasian contribution to the course.