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Achatz G, Franke A, Friemert B, Hoth P, Hube P, Bieler D. [Initial in-hospital treatment of patients with penetrating trauma due to violence and war]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:500-508. [PMID: 38864909 DOI: 10.1007/s00113-024-01443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Current political and social developments have brought the topics of violence, in this context attributable to terrorism and sabotage, and since February 2022 awareness of war in particular has again greatly increased. This article aims to present the contextualized dealing with penetrating injuries in terms of initial in-hospital treatment. OBJECTIVE The question remains to be answered as to what extent penetrating injuries require special attention and to what extent the treatment priorities, options and strategies as well as surgical treatment require adaptation of the usual approach in routine clinical practice in Germany. MATERIAL AND METHOD The experience of the authors in this field from military operations in Afghanistan, Iraq, the Republic of Mali, Kosovo and Georgia as well as the core content of the Terror and Disaster Surgical Care (TDSC®) course on this topic, have been contextualized and incorporated. In addition, aspects of a comprehensive systematic literature review and current data from a national evaluation on the topic of preparing hospitals in Germany for such scenarios are taken into account. RESULTS AND DISCUSSION The clinical systems need to be well-prepared for such casualties, especially if they require treatment in large numbers. This is precisely so because the majority of patients are in a relevantly threatening situation (usually in the sense of a hemorrhage), treatment must be very urgently provided and in such scenarios a lack of resources must always be overcome, at least temporarily, especially for example for blood transfusions.
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Affiliation(s)
- Gerhard Achatz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Axel Franke
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Benedikt Friemert
- Zentrales Klinisches Management, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Patrick Hoth
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Philipp Hube
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Dan Bieler
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive Chirurgie, Handchirurgie und Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
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Franke A, Bieler D, Lehmann W, Pohlemann T, Friemert B, Achatz G. [National challenges for trauma surgery in Germany due to violence and war]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:492-499. [PMID: 38860995 DOI: 10.1007/s00113-024-01442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/12/2024]
Abstract
Due to the war in Ukraine and the treatment of patients with war wounds in the hospitals of the TraumaNetworks of the German Society for Trauma Surgery (TraumaNetzwerke DGU®), injuries from life-threatening mission situations (LebEL), terrorism, violence and war have become a matter of daily professional life. Furthermore, the societal and global feeling of security has fundamentally changed. The much-cited term "turning point in history", the reorientation of the Armed Forces and the investigation of the resilience of the healthcare system with respect to the "fitness for war", approximate to the description of the current challenges for trauma surgery (UCH) in Germany. Based on the developments following the terrorist attacks in Paris in 2015 and in Brussels in 2016, a clarification is given as to which adaptations have already been successful and how quickly an improvement could successfully be achieved. In this context, the concept of tactical care and the course on Terror and Disaster Surgical Care (TDSC), for example, have been game changing. The main challenge currently lies in overcoming the structural alterations in the German healthcare system and professionally in the treatment of war wounded personnel from Ukraine. The knowledge gained from these two national tasks must be analyzed for the future development and adaptation of established treatment structures, e.g., of the TraumaNetzwerke DGU®, under the requirements of the increased resilience against war, terrorism and violence. The aim is to name that which has already been achieved with respect to the national challenges for UCH and at the same time to outline or discuss further necessities for improvements and elimination of possible gaps in capabilities.
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Affiliation(s)
- Axel Franke
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland.
- Sektion Septische‑, Rekonstruktive- und Handchirurgie, Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie am Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Dan Bieler
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive Chirurgie, Handchirurgie und Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Tim Pohlemann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Benedikt Friemert
- Zentrales Klinisches Management, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Gerhard Achatz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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Franke A, Lehmann W, Wurmb T. [Inpatient surgical treatment in mass casualty situations and disasters-Principles, targets, concepts, preparation]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:42-51. [PMID: 37946023 PMCID: PMC10781850 DOI: 10.1007/s00104-023-01976-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The war in Ukraine and the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic have moved the resilience of the healthcare system in Germany into the focus of a broad discussion. The preparation for such a damage situation is characterized by the relationship between the available treatment capacity and needs which go far beyond the norm. The aim of a resilient healthcare system must be to adequately react to such exceptional situations. Particularly in acute disaster and mass casualty situations, medical standards and an individualized surgical treatment must be maintained for as long as possible. MATERIAL, METHOD AND OBJECTIVE The aim of this article is to elucidate the current terminology on medical treatment of patients in disasters from a surgical perspective, to further develop available concepts and possible concepts of crisis management based on three schematically presented scenarios. Furthermore, the general reaction possibilities for mobilization of treatment capacities are described. RESULTS In order to uniformly collate the quality of medical treatment in a damage situation, it is meaningful to include the stages of individualized treatment, compensated crisis care and decompensated crisis care. Within the framework of a mass casualty situation or a disaster, traumatological and surgical patients are predominant and the aim must be to maintain or restore the stage of a compensated crisis management. Depending on the extent of the damage situation, this can only be realized in a timely manner independent of state boundaries and by a superordinate central management structure. For a comprehensive provision of surgical treatment capacities, the depiction of a continuous overview of the situation with current resources and structural data of the hospitals in the affected region is necessary. CONCLUSION The aim of all efforts and preparations must therefore be to durably strengthen hospitals and to train and develop this with respect to coping with a damage situation in disaster medicine. In this respect it is important to establish a consensus on terminology, the type of treatment and the tactical strategic principles of surgical treatment to cope with a disaster or damage situation.
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Affiliation(s)
- Axel Franke
- Sektion Unfallchirurgie, Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Straße 170, 56072, Koblenz, Deutschland.
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
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Franke A, Lehmann W, Wurmb T. [Inpatient surgical treatment in mass casualty situations and disasters-Current treatment capacities depending on alarm status of the hospital and treatment concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:52-62. [PMID: 37947800 PMCID: PMC10781816 DOI: 10.1007/s00104-023-01975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The functionality and treatment capacity of hospitals are decisive components to safeguard the in-hospital treatment of patients in crises and catastrophes. This is shown by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic and the war in Ukraine. The aim of this study is the elicitation of treatment capacities of hospitals in the trauma network of the German Society for Trauma Surgery (DGU) assuming a damage situation with a multitude of trauma patients needing treatment. MATERIAL AND METHOD The 622 hospitals in the trauma network were surveyed to elicit the current treatment capacities depending on the principles and standards of treatment. For this purpose, a questionnaire for voluntary participation in the survey was placed online via the Academy of Trauma Surgery (AUC) of the DGU and an electronic platform (SurveyMonkey). The data presented in this article represent an extract of the total data focussed on the issues involved in the study. RESULTS A total of 252 of the 622 hospitals certified in December 2022 (40%) participated in the survey and 250 datasets could be utilized. Local, regional and supraregional trauma centers were equally represented. Using a tactical abbreviated surgical control (TASC) focussed on survival, the treatment capacities in the individual triage categories could be increased with respect to the scenarios in question. It was also clear that the availability of teams skilled in the surgical treatment of body cavity injuries still represents a challenge. CONCLUSION The results of the survey demonstrate the extent to which treatment capacities for the care of injured and wounded patients are currently available in the hospitals of the DGU trauma network and to what extent they can be increased. In this way, due the dynamics a mass casualty incident can initially lead locally and temporarily to a decompensated crisis management. The aim of all efforts and preparations must therefore be to durably strengthen hospitals so that this can be avoided as reliably as possible and to include these considerations in the hospital structural reform.
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Affiliation(s)
- Axel Franke
- Sektion Unfallchirurgie, Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
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Moeller RT, Gebhard F, Friemert B, Achatz G, Holsträter T, Bauknecht S. [Keeping the big picture in Terror-MASCAL-A new hospital concept]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:662-668. [PMID: 37450024 DOI: 10.1007/s00113-023-01350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Two key positions have been defined for the in-house management of patients in the context of a terrorism-related mass casualty incident (Terror-MASCAL). The senior triage coordinator (LArS) categorizes the injured according to injury severity using algorithms. The central operational and medical coordinator (ZONK) disposes and prioritizes the injured for treatment measures, considering the injury severity and the available treatment capacities. The dynamics and complexity of a Terror-MASCAL combined with the high number of patients requires comprehensible documentation. MATERIAL AND METHODS The evaluation of an incident exercise of a Terror-MASCAL revealed deficits in its documentation. Based on the deficits identified, requirements have been defined. The article presents the management and documentation aids of a German national trauma center. RESULTS The hospital with its currently available resources is abstractly represented via the Trauma Tactics Board (TTB). Patients with their individual injuries are represented by identification cards on the TTB. The ZONK can prioritize and dispose further treatment based on the information about the available resources and the patient-specific injury pattern. The patient registry continues to document the patient's other medical findings. Important external and internal information is noted in an event register. The entire documentation process on the TTB is documented by camera. CONCLUSION Documentation aids are required to fulfil the core tasks of the ZONK. By using the documentation aids, a hospital can prepare for a Terror-MASCAL within a short time. Lack of daily practical application of the documentation aids should be compensated for by regular practice and interdisciplinary exchange of experience.
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Affiliation(s)
- Richard-Tobias Moeller
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Florian Gebhard
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Benedikt Friemert
- Zentrales Klinisches Management, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Gerhard Achatz
- Zentrales Klinisches Management, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Thorsten Holsträter
- Klinik für Anästhesie, Intensiv- und Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Simon Bauknecht
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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Franke A, Bieler D, Achatz G, Suda AJ, Hoth P, Paffrath T, Friemert B. [Care of the severely injured in mass casualty incidents : What is the difference compared to emergency room management?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01332-x. [PMID: 37270728 DOI: 10.1007/s00113-023-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/05/2023]
Abstract
The management of a severely injured patient according to the standards and principles of individualized trauma care is a well-established procedure in many hospitals. The process is structured and standardized by the content of several course formats. In contrast, a mass casualty incident (MCI, MANV) is a rare and exceptional situation. In this case the treatment priorities and approaches are changed. The main aim in this situation is to ensure the best possible chance of survival for every casualty by organizational measures to mobilize rooms, personnel and material and to temporarily abandon the standards of individualized trauma care. To be prepared for a MCl situation it is necessary to know the realistic scenarios, to update the hospital emergency plan and to adapt all treatment procedures to the transient lack of resources. This article gives an overview of this process and summarizes the current clinical concepts to cope with a MCl situation and the current principles for the care of the severely injured involving many casualties.
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Affiliation(s)
- Axel Franke
- Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacherstr. 170, Koblenz, Deutschland.
| | - Dan Bieler
- Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacherstr. 170, Koblenz, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Gerhard Achatz
- Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Arnold J Suda
- Abteilung für Orthopädie und Traumatologie, Unfallkrankenhaus Salzburg, Salzburg, Österreich
| | - Patrick Hoth
- Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Thomas Paffrath
- Klinik für Unfallchirurgie, Krankenhaus der Augustinerinnen - Severinsklösterchen, Köln, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie, Orthopädie, Hand- und Rekonstruktive Chirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacherstr. 170, Koblenz, Deutschland
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Hoth P, Roth J, Bieler D, Friemert B, Franke A, Paffrath T, Blätzinger M, Achatz G. Education and training as a key enabler of successful patient care in mass-casualty terrorist incidents. Eur J Trauma Emerg Surg 2023; 49:595-605. [PMID: 36810695 PMCID: PMC10175327 DOI: 10.1007/s00068-023-02232-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE The increase in terrorist attacks with sometimes devastating numbers of victims has become a reality in Europe and has led to a fundamental change in thinking and a reorientation in many fields including health policy. The purpose of this original work was to improve the preparedness of hospitals and to provide recommendations for training. MATERIAL AND METHODS We conducted a retrospective literature search based on the Global Terrorism Database (GTD) for the period 2000 to 2017. Using defined search strategies, we were able to identify 203 articles. We grouped relevant findings into main categories with 47 statements and recommendations on education and training. In addition, we included data from a prospective questionnaire-based survey on this topic that we conducted at the 3rd Emergency Conference of the German Trauma Society (DGU) in 2019. RESULTS Our systematic review identified recurrent statements and recommendations. A key recommendation was that regular training should take place on scenarios that should be as realistic as possible and should include all hospital staff. Military expertise and competence in the management of gunshot and blast injuries should be integrated. In addition, medical leaders from German hospitals considered current surgical education and training to be insufficient for preparing junior surgeons to manage patients who have sustained severe injuries by terrorist events. CONCLUSION A number of recommendations and lessons learned on education and training were repeatedly identified. They should be included in hospital preparations for mass-casualty terrorist incidents. There appear to be deficits in current surgical training which may be offset by establishing courses and exercises.
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Affiliation(s)
- Patrick Hoth
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - Johanna Roth
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany.,Department of Radiotherapy and Radiooncology, Hospital of the State Capital Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, and Burn Medicine, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany.,Department of Orthopedics and Trauma Surgery, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Benedikt Friemert
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Axel Franke
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, and Burn Medicine, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany
| | - Thomas Paffrath
- General-, Visceral-, Thoracic and Trauma Surgery, Severinsklösterchen-Hospital Köln, Jacobstr. 27-31, 50678, Cologne, Germany
| | - Markus Blätzinger
- AUC (Academy for Trauma Surgery) of the German Trauma Society, Wilhelm-Hale-Str. 46B, 80639, Munich, Germany
| | - Gerhard Achatz
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany
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Thies N, Zech A, Kohlmann T, Biberthaler P, Bayeff-Filloff M, Kanz KG, Prückner S. Preparation of hospitals for mass casualty incidents in Bavaria, Germany: care capacities for penetrating injuries and explosions in TerrorMASCALs. Scand J Trauma Resusc Emerg Med 2021; 29:156. [PMID: 34717723 PMCID: PMC8557545 DOI: 10.1186/s13049-021-00970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background In a terror attack mass casualty incident (TerrorMASCAL), compared to a “normal” MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL. Methods To answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta. Results In the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers. Conclusion The results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers.
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Affiliation(s)
- Nina Thies
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, Munich, Germany.
| | - Alexandra Zech
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, Munich, Germany
| | - Thorsten Kohlmann
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Michael Bayeff-Filloff
- Bayerisches Staatsministerium des Innern für Sport und Integration, Ärztlicher Landesbeauftragter Rettungsdienst, Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, Munich, Germany
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Important learning points arising from the focused issue dedicated to the Terror and Disaster Surgical Care (TDSC®) course on mass casualty incident management. Eur J Trauma Emerg Surg 2021; 48:3593-3597. [PMID: 33486541 DOI: 10.1007/s00068-021-01600-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/02/2021] [Indexed: 02/03/2023]
Abstract
The Terror and Disaster Surgical Care (TDSC®) course on mass casualty incident management was formulated in Germany by military medical personnel, who have been deployed to conflict areas, but also work in hospitals open for the lay public. In this manuscript we discuss different concepts and ideas taught in this course as these are described in a focused issue recently published in the European Journal of Trauma and Emergency Surgery. We provide reinforcement for some of the ideas conveyed. We provide alternative views for others. Injuries following explosions are different from blunt and penetrating trauma and at times demand a different approach. There are probably several ways to manage a mass casualty incident depending on the setup of the organization. An open discussion on the topics presented in the manuscripts included in the focused issue on military and disaster surgery should enrich everyone.
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Terror preparedness as a service of general interest: the Terror and Disaster Surgical Care (TDSC®)-course. Eur J Trauma Emerg Surg 2020; 46:671-672. [DOI: 10.1007/s00068-020-01454-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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