Notfallmedizinische Versorgung von Schuss- und Stichverletzungen

[Development of violence-associated penetrating trauma in the Düsseldorf metropolitan region over a 5-year period (GewPen study)]

INTRODUCTION

Penetrating injuries are a rare but recurring emergency situation in the out-of-hospital and in-hospital emergency settings. The purpose of this study was to determine the incidence and characteristics of injuries associated with penetrating violence across a German metropolitan region over a 5-year period.

MATERIAL AND METHODS

In the retrospective study, a database query of the control center of the Düsseldorf rescue service area was used to identify and descriptively analyze all rescue service operations with penetrating violence-associated injuries in the years 2015, 2017, and 2019. For those patients who were transferred to the major trauma center, a further analysis of the in-hospital course was performed.

RESULTS

In the 3 years 2015, 2017 and 2019 a total of 266 patients (age: 33 ± 14 years, male: 79%) could be recorded (2015 vs. 2017 vs. 2019: n = 81 vs. n = 93 vs. n = 92, respectively). The most common age group involved had an age range of 15-34 years. A particularly higher frequency of emergency calls was found for the areas of Old Town, City Center, and one other district (Oberbilk). A high frequency of rescue missions was found in the nights from Saturday to Sunday between 20.00 p.m. and 04.00 a.m. Rescue missions with emergency physicians on board increased over the years (2015 vs. 2019: 27 vs. 42%, p = 0.04). The primary weapons used were knives (56%), broken glass bottles (18%) and broken glasses (6%). Out of all patients 71 (27%, injury severity score 11 ± 14) were admitted to the major trauma center. Among these patients, the proportion of immediate surgical care (2015 vs. 2019: 20% vs. 35%, p < 0.05) and positive alcohol detection increased over the years (2015 vs. 2019: 10% vs. 43%, p < 0.05). The 30-day mortality in the 3 years studied was 1.1% (n = 3).

CONCLUSION

Penetrating injuries associated with violence are relevant but rare rescue missions. Future care strategies should focus on deployment of rescue resources close to the scene of the incident ("old town guard", central station), and prevention strategies should focus on weapon prohibition zones. A control of alcohol consumption should be discussed.

[Gunshot Wounds and Penetrating Injuries]

The acute medical care in Germany after gunshot and stab wounds in the pre-hospital and in-hospital setting is a rarity in an international comparison. The resulting lack of routine in the acute care of critically injured people after penetrating trauma should therefore be countered with regular theoretical and practical training. In addition to standardized care algorithms for the care of severely injured people, knowledge of kinetics and wound ballistics is required for focused treatment. The article focuses mainly on the early treatment phase.

[Terrorist attack trauma - an individual entity of polytrauma : A 10-year update]

The incidence of terrorist attacks is increasing worldwide, and they have also become a permanent threat in European cities. Due to its complexity, terrorist attack trauma places high demands on the strategy of surgical treatment. The combination of various mechanisms, explosions and gunshot injuries, with the characteristic pressure (blast) damage and a high proportion of penetrating trauma with simultaneous burns are characteristic features. Unlike in military conflicts, injuries to people of all ages and without ballistic body protection (body armor) are to be expected. The mechanism of the attack and its local conditions are of relevance for the assessment of the situation and the expected injury patterns. Thus, suicide attacks result in several times higher numbers of fatalities and casualties. Explosions on free ground lead to different types of injury than those in closed or semi-enclosed spaces. The treatment principles of the Advanced Trauma Life Support (ATLS®) are based on the intrahospital care of casualties as well as damage control strategies with trigger factors. In order to prepare and educate clinics and surgeons in Germany for such scenarios, various course formats of the professional societies, the German Society for General and Visceral Surgery (DGAV) and the German Society for Trauma Surgery (DGU) have now been established.