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Pfenninger EG, Hammer TO, Holsträter T, Weiß S. [Terror attacks : Recommendations for cooperation between police, hospitals and non-police security services]. DIE ANAESTHESIOLOGIE 2024:10.1007/s00101-024-01434-0. [PMID: 39052084 DOI: 10.1007/s00101-024-01434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The risk of terrorist attacks in the Federal Republic of Germany is present and is currently increasing. Publicly funded acute care hospitals and their owners are involved in disaster control as part of their remit and are responsible for taking comprehensive precautions to ensure their operational capability in the event of disasters. This mandate must also be ensured in the event of terrorist attacks and amok incidents. For this purpose, an optimal cooperation between preclinical and clinical care is indispensable. AIM Recommended actions for collaboration between nonclinical and clinical planning to manage a mass casualty incident in terrorist life-threatening response situations are presented. MATERIAL AND METHODS The Inter-Hospital Security Conference Baden-Württemberg (IHSC BW) is an association of representatives of acute hospitals in Baden-Württemberg, the Ministry of the Interior, Digitalization and Migration Baden-Württemberg, the Ministry of Social Affairs and Integration Baden-Württemberg, the State Police Headquarters Baden-Württemberg and the Baden-Württemberg Hospital Association. From 2018 to 2020, the IHSC BW developed recommendations for action on cooperation between police, hospitals and non-police emergency response. The recommendations for action were agreed by the group members in 6 working sessions and initialled in two subsequent video conferences. A recommendation was considered adopted when the IHSC BW plenary assembly finally gave its approval with an absolute majority. RESULTS AND DISCUSSION Competence-based interface solutions for a smooth cooperation between prehospital and hospital management in the care of patients who have become victims of a terrorist attack are to be demanded. For preliminary planning, the establishment of a local safety conference at the county disaster control authority level with the following participants is recommended: disaster control authority, fire department, regional police headquarters, chief emergency physician, rescue services and disaster control officers of affected clinics. It is recommended to set up a joint command and situation center (CSC), where management personnel from the police, rescue service, fire department and disaster control can meet to organize the handling of the incident jointly, competently and without loss of time. From this CSC, a liaison officer should then provide the clinics with information at regular intervals. Exercises should take place regularly. Cross-organizational exercises are particularly important, and this is one of the tasks of the local safety conference.
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Affiliation(s)
- E G Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Ulm, Deutschland, Albert-Einstein-Allee 29, 89081.
| | - T O Hammer
- Stabsstelle Katastrophenschutz, Risiko- und Gefahrenabwehr Universitätsklinikum, Freiburg, Deutschland
| | - T Holsträter
- Abteilung für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - S Weiß
- Zentralbereich Katastrophenschutz RKH Kliniken Ludwigsburg, Ludwigsburg, Deutschland
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Pfenninger EG, Schmidt SA, Rohland C, Peters S, McNutt D, Kaisers UX, Königsdorfer M. [Resilience against IT attacks in hospitals : Results from an exercise in a German university hospital]. DIE ANAESTHESIOLOGIE 2023; 72:852-862. [PMID: 37725142 PMCID: PMC10691995 DOI: 10.1007/s00101-023-01331-y] [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] [Received: 03/24/2023] [Revised: 07/03/2023] [Accepted: 07/30/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND According to the legal definition healthcare systems and their components (e.g., hospitals) are part of the critical infrastructure of modern industrial nations. During the last few years hospitals increasingly became targets of cyber attacks causing severe impairment of their operability for weeks or even months. According to the German federal strategy for protection of critical infrastructures (KRITIS strategy), hospitals are obligated to take precautions against potential cyber attacks or other IT incidents. OBJECTIVE This article describes the process of planning, execution and results of an advanced table-top exercise which took place in a university hospital in Germany and simulated the first 3 days after a cyber attack causing a total failure of highly critical IT systems. MATERIAL AND METHODS During a first stage lasting about 8 months IT-dependent processes within the clinical routine were identified and analyzed. Then paper-based and off-line back-up processes and workarounds were developed and department-specific emergency plans were defined. Finally, selected central facilities such as pharmacy, laboratory, radiology, IT and the hospitals crisis management team took part in the actual disaster exercise. Afterwards the participants were asked to evaluate the exercise and the hospitals cyber security using a questionnaire. On this basis the authors visualized the hospital's resilience against cyber incidents and defined short-term, medium-term and long-term needs for action. RESULTS Of the participants 85% assessed the exercise as beneficial, 97% indicated that they received adequate support during the preparations and 75% had received sufficient information; however, only 34% had the opinion that the hospital's and their own preparedness against critical IT failures were sufficient. Before the exercise took place, IT-specific emergency plans were present only in 1.7% of the hospital facilities but after the exercise in 86.7% of the clinical and technical departments. The highest resilience against cyber attacks was not surprisingly reported by facilities that still work routinely with paper-based or off-line processes, the IT department showed the lowest resilience as it would come to a complete shutdown in cases of a total IT failure. CONCLUSION The authors concluded that the planning phase is the most important stage of developing the whole exercise, giving the best opportunity for working out fallback levels and workarounds and through this strengthen the hospitals resilience against cyber attacks and comparable incidents. A meticulous preparedness can minimize the severe effects a total IT failure can cause on patient care, staff and the hospital as a whole.
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Affiliation(s)
- E G Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland.
| | - S A Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - C Rohland
- Klinikumsapotheke, Universitätsklinikum Ulm, Ulm, Deutschland
| | - S Peters
- Zentrale Einrichtung Klinische Chemie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - D McNutt
- Zentrum für Information und Kommunikation, Universitätsklinikum Ulm, Ulm, Deutschland
| | - U X Kaisers
- Klinikumsvorstand, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Königsdorfer
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Ulm, 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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Königsdorfer M, Kaisers UX, Pfenninger E. Klinische Versorgung bei (Terror-)Anschlägen/lebensbedrohlichen Einsatzlagen. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:616-628. [DOI: 10.1055/a-1647-6865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kippnich M, Meybohm P, Wurmb T. [Prehospital and In-hospital Concepts for Disaster Response and Preparedness]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:111-123. [PMID: 33607672 DOI: 10.1055/a-1085-6671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Disaster medicine faces complex challenges and will play an increasing role in the future. Disaster medicine is dominated by a phased imbalance of available and required resources. Various factors, such as a possible hazard for the rescue forces, inaccessible terrain or even destroyed infrastructure increase the complexity enormously. For casualties, this can mean a concentration of medical care on life-threatening conditions. The primary goal of emergency planning is to ensure standard or contingency care and to avoid crisis care.Hospitals and the preclinical emergency organizations must prepare for possible major emergencies or disasters. Easy-to-understand and just as easy to apply emergency plans are an important prerequisite for successful emergency management. These plans can only be guiding structures; the adaptation to the actual circumstances of the incident and the situation-adapted interpretation of the plans is the responsibility of the operational commanders. A clear leadership structure is essential for both preclinical and clinical operations. In this article, we describe important basic principles of disaster medicine mission planning and management.
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Franke A, Bieler D, Friemert B, Hoth P, Pape HC, Achatz G. Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products. Eur J Trauma Emerg Surg 2020; 46:695-707. [PMID: 32676714 PMCID: PMC7364295 DOI: 10.1007/s00068-020-01399-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. METHODS The Terror and Disaster Surgical Care (TDSC®) - Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. RESULTS The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1-T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). CONCLUSION The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. mass-casualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed.
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Affiliation(s)
- Axel Franke
- Department for Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany
| | - Dan Bieler
- Department for Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany.
- Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Benedikt Friemert
- Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Patrick Hoth
- Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Gerhard Achatz
- Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
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Franke A, Bieler D, Paffrath T, Wurmb T, Wagner F, Friemert B, Achatz G. [ATLS® and TDSC®: how it fits together : A treatment concept for mass casualty and terrorist-related mass casualty situations, life-threatening and special scenarios]. Unfallchirurg 2020; 123:453-463. [PMID: 31690983 DOI: 10.1007/s00113-019-00735-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Terrorist-related mass casualty incidents represent a medical and organizational challenge for all hospitals. The main reasons are the special patterns of injuries, the onset and development of the scenario, the lack of information at the beginning, the overall number of casualties and the number of uninjured but involved patients presenting at the hospital.Due to these circumstances and the high percentage of penetrating injuries with a permanent risk of uncontrollable bleeding and other life-threatening complications, a strategic and tactical initial surgical care is necessary.For these special terrorist-related mass casualty (MasCal) situations, the Terror and Disaster Surgical Care (TDSC®) course was developed and imparts special medical and surgical knowledge as well as a scenario-based training in surgical decision-making. The TDSC® course focusses on the scenario-related provision of surgical care and distribution of the limited resources to enable survival for as many patients as possible.To improve individualized trauma care course formats, such as the Advanced Trauma Life Support (ATLS®) were established and are nowadays widespread in Germany. It could be shown that standardized approaches and algorithm-based treatment could improve the outcome of trauma victims. Faced with the present day permanent risk of a possible terrorist-related MasCal situation, the question arises how and to what extent elements and principles of both course formats (TDSC® and ATLS®) could be used to improve and organize the initial care in a terrorist-linked MasCal incident.For the first time it is shown that the key elements of both courses (primary survey of the ATLS® and the TDSC® principles: categorization, prioritization, disposition and realization) could be established and integratively used to structure the initial intrahospital medical and surgical care.
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Affiliation(s)
- A Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellung- und Handchirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellung- und Handchirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
| | - T Paffrath
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Klinikum Köln-Merheim, Köln-Merheim, Deutschland
| | - Th Wurmb
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - F Wagner
- Klinik für Rekonstruktive Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - B Friemert
- Klinik Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - G Achatz
- Klinik Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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Pfenninger EG, Klingler W, Keiloweit T, Eble M, Wenzel V, Krüger WA. [Terrorist attack training exercise-What can be learned? : Baden-Württemberg counterterrorism exercise (BWTEX)]. Anaesthesist 2020; 69:477-486. [PMID: 32488534 DOI: 10.1007/s00101-020-00797-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a risk of terror attacks in the Federal Republic of Germany, which might increase in the future. A timely comprehensive strategy for treatment and care of a large number of casualties helps minimize chaos and improve the outcome of patients. Adequate training is vital for successful implementation of an emergency plan. Therefore, the effectiveness of training should be assessed and evaluated; however, data collection capabilities for training events are extremely limited, so that publications on the topic are almost impossible to find. OBJECTIVE This study aimed to collect data from a simulated terrorist attack in order to draw conclusions from a clinical point of view concerning the improvement of preclinical and clinical management, taking interface problems into consideration. MATERIAL AND METHODS On 19 October 2019 the Ministry of the Interior, Digitalization and Migration of Baden-Württemberg conducted a large-scale simulation of a terrorist attack in the city center of Constance, called the Baden-Württemberg counterterrorism exercise (BWTEX). The simulation included an explosion of a car bomb as well as the use of firearms by terrorists. The large scale of the simulation with the high number of participants in combination with close cooperation between military and civil forces was unprecedented. The police force, the armed forces, civil protection forces, air rescue teams and staff from Constance, Friedrichshafen and Sigmaringen regional hospitals in southwest Germany worked together to treat simulated injuries to victims of the attack. The following parameters were recorded when the injured patients arrived at the hospital: prehospital triage time, prehospital triage score, initial treatment and quality of documentation on site as well as triage time, triage score, injury severity scale (ISS) score based on the specified injury pattern, treatment, and quality of documentation on hospital arrival. RESULTS Out of a total of 84 "injured patients" 55 were admitted to hospital and 80% were triaged at the scene. Injured patients of triage category 1 (TK1 red: life-threatening injury, immediate treatment) arrived at the hospital 198 ± 50 min after the attack, injured patients of triage category 2 (TK2 yellow: severely injured, urgent treatment) after 131 ± 44 min and injured patients of triage category 3 (TK3 green: slightly injured, non-urgent treatment) arrived after 157 ± 46 min. There was no significant difference in terms of arrival time at the hospital between the triage scores (r = 0.2) or between the ISS scores (r = 0.43). The authors assume that approximately 44% of TK1 patients would have died due to avoidable time delays. Prehospital medical documentation was insufficient in 78% and insufficient in 65% in the hospitals. CONCLUSION A mass casualty incident resulting from a terrorist attack differs greatly from a conventional mass casualty incident. The scene of the attack has to be evacuated as quickly as possible, which means that a large number of patients arrive untreated at the nearest hospitals. The setting up of treatment facilities in city centers and areas close to the city seems to be counterproductive because the time delay may result in higher mortality rates of victims. The particularities of mass casualties caused by a terrorist attack have to be incorporated into terrorist attack training.
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Affiliation(s)
- E G Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland. .,Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, SRH Kliniken Sigmaringen, Sigmaringen, Deutschland.
| | - W Klingler
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, SRH Kliniken Sigmaringen, Sigmaringen, Deutschland
| | - Th Keiloweit
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
| | - M Eble
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Medizin Campus Bodensee, Klinikum Friedrichshafen, Friedrichshafen, Deutschland
| | - V Wenzel
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Medizin Campus Bodensee, Klinikum Friedrichshafen, Friedrichshafen, Deutschland
| | - W A Krüger
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
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Emergency response to terrorist attacks: results of the federal-conducted evaluation process in Germany. Eur J Trauma Emerg Surg 2020; 46:725-730. [PMID: 32206880 PMCID: PMC7429537 DOI: 10.1007/s00068-020-01347-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/10/2020] [Indexed: 11/04/2022]
Abstract
Purpose Rescue missions during terrorist attacks are extremely challenging for all rescue forces (police as well as non-police forces) involved. To improve the quality and safety of the rescue missions during an active killing event, it is obligatory to adapt common rescue mission goals and strategies. Methods After the recent attacks in Europe, the Federal Office of Civil Protection and Disaster Assistance started an evaluation process on behalf of the Federal Ministry of the Interior and the Federal Ministry of Health. This was done to identify weaknesses, lessons learned and to formulate new adapted guidelines. Results The presented bullet point recommendations summarise the basic and most important results of the ongoing evaluation process for the Federal Republic of Germany. The safety of all the rescue forces and survival of the greatest possible number of casualties are the priority goals. Furthermore, the preservation and re-establishment of the socio-political integrity are the overarching goals of the management of active killing events. Strategic incident priorities are to stop the killing and to save as much lives as possible. The early identification and prioritised transportation of casualties with life-threatening non-controllable bleeding are major tasks and the shortest possible on-scene time is an important requirement with respect to safety issues. Conclusion With respect to hazard prevention tactics within Germany, we attributed the highest priority impact to the bullet points. The focus of the process has now shifted to intense work about possible solutions for the identified deficits and implementation strategies of such solutions during mass killing incidents.
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Wurmb T, Schorscher N, Justice P, Dietz S, Schua R, Jarausch T, Kinstle U, Greiner J, Möldner G, Müller J, Kraus M, Simon S, Wagenhäuser U, Hemm J, Roewer N, Helm M. Structured analysis, evaluation and report of the emergency response to a terrorist attack in Wuerzburg, Germany using a new template of standardised quality indicators. Scand J Trauma Resusc Emerg Med 2018; 26:87. [PMID: 30340516 PMCID: PMC6194622 DOI: 10.1186/s13049-018-0555-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background Until now there has been a reported lack of systematic reports and scientific evaluations of rescue missions during terror attacks. This however is urgently required in order to improve the performance of emergency medical services and to be able to compare different missions with each other. Aim of the presented work was to report the systematic evaluation and the lessons learned from the response to a terror attack that happened in Wuerzburg, Germany in 2016. Methods A team of 14 experts developed a template of quality indicators and operational characteristics, which allow for the description, assessment and comparison of civil emergency rescue missions during mass killing incidents. The entire systematic evaluation process consisted of three main steps. The first step was the systematic data collection according to the quality indicators and operational characteristics. Second was the systematic stratification and assessment of the data. The last step was the prioritisation of the identified weaknesses and the definition of the lessons learned. Results Five important “lessons learned” have been defined. First of all, a comprehensive concept for rescue missions during terror attacks is essential. Furthermore, the establishment of a defined high priority communication infrastructure between the different dispatch centres (“red phone”) is vital. The goal is to secure the continuity of information between a few well-defined individuals. Thirdly, the organization of the incident scene needs to be commonly decided and communicated between police, medical services and fire services during the mission. A successful mission tactic requires continuous flux of reports to the on-site command post. Therefore, a predefined and common communication infrastructure for all operational forces is a crucial point. Finally, all strategies need to be extensively trained before the real life scenario hits. Conclusion According to a systematic evaluation, we defined the lessons learned from a terror attack in 2016. Further systematic reports and academic work surrounding life threatening rescue missions and mass killing incidents are needed in order to ultimately improve such mission outcomes. In the future, a close international collaboration might help to find the best database to report and evaluate major incidents but also mass killing events.
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Affiliation(s)
- T Wurmb
- Subsection Emergency and Disaster Relief Medicine, Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Oberdürrbacherstrasse 6, 97080, Würzburg, Germany.
| | - N Schorscher
- Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - P Justice
- Emergency Medical Services and firebrigade alerting for the counties of Kitzingen, Main-Spessart and the city of Wuerzburg, Wuerzburg, Germany
| | - S Dietz
- Emergency Medical Service of the Bavarian Red Cross, Würzburg, Germany
| | - R Schua
- Medical Department, Government of Lower Franconia, Wuerzburg, Germany
| | - T Jarausch
- Emergency Medical Service of the Maltese Cross, Wuerzburg, Germany
| | - U Kinstle
- The Johanniter Rescue Emergency Services, Wuerzburg, Germany
| | - J Greiner
- Emergency Medical Service of the Bavarian Red Cross, Würzburg, Germany
| | - G Möldner
- Fire and Rescue Integrated Control Centre Wuerzburg, Wuerzburg, Germany
| | - J Müller
- Fire and Rescue Integrated Control Centre Wuerzburg, Wuerzburg, Germany
| | - M Kraus
- Medical Head of the Emergency Medical Services of Lower Fraconia, Wuerzburg, Germany
| | - S Simon
- Emergency Medical Service of the Maltese Cross, Wuerzburg, Germany
| | - U Wagenhäuser
- Head of emergency pastoral care in the diocese of Würzburg, Wuerzburg, Germany
| | - J Hemm
- Department of danger prevention and police operation by the police department of Lower Franconia (Chief Police Officer i.R.), Würzburg, Wuerzburg, Germany
| | - N Roewer
- Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - M Helm
- Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Medical Hospital, Ulm, Germany
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