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da Cunha Neto J, Pereira Dos Santos LM, Issa JPM. Terminal ballistics performance of 9 × 19 mm cartridges in 10% ballistic gelatin: FBI Protocol based analysis of Brazilian-made law enforcement ammunition. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00870-z. [PMID: 39180655 DOI: 10.1007/s12024-024-00870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Understanding that a projectile entering the human body can cause damage or destruction to live tissues through a variety of wounding mechanisms - permanent cavity, temporary cavity, and fragmentation - is crucial for researching terminal ballistics and understand the patterns of gunshot wound configuration. METHODS The present work tested four different types of ammunition in caliber 9 × 19 mm (Full Metal Jacketed, Gold Hex, Copper Bullet Tactical and Bonded), using ballistic gelatin at 10% as soft tissue surrogate. The tests were based on the Federal Bureau of Investigation Protocol and included shots through bare gelatin, heavy clothing, plywood, steel sheets and auto glass. As a comparison parameter, the American-made Federal™ HST, used by several law enforcement agencies in the USA, was also tested in the same conditions. RESULTS The Full Metal Jacketed cartridge had a uniform performance throughout the experiment, showing high penetration levels and no expansion, as expected. Gold Hex demonstrated a strong tendency to fragment with low levels of penetration and weight retention. Copper Bullet Tactical did not achieve the 12" minimum penetration in the soft barrier phases but expanded aggressively. Finally, Bonded only failed to achieve the 12" mark of penetration in phase 5 (auto glass), the hardest barrier in the whole Protocol. Tested for comparison purposes, Federal HST showed aggressive expansion in the initial phases (over 100%), after surpassing the 12" threshold. CONCLUSION The study concluded that heavier projectiles (CBC Bonded and Federal HST) performed better than lighter and faster bullets in terms of terminal ballistics.
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Affiliation(s)
- Joao da Cunha Neto
- Department of Pathology and Legal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, 14049-900, SP, Brazil
| | - Lucas Meciano Pereira Dos Santos
- Department of Pathology and Legal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, 14049-900, SP, Brazil
| | - João Paulo Mardegan Issa
- Department of Basic and Oral Biology, School of Dentistry of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, 14040-904, SP, Brazil.
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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; 73:543-552. [PMID: 39052084 PMCID: PMC11310230 DOI: 10.1007/s00101-024-01434-0] [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: 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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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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Achatz G, Franke A, Friemert B, Forstmeier V, Andres T, Wendlandt M, Grunert M, von Lübken F, Bieler D. [Challenge of limb care after violence and war with a special focus on imaging procedures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:515-521. [PMID: 38860994 DOI: 10.1007/s00113-024-01449-7] [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: 05/27/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Injury patterns in the area of the extremities following violence and war harbor many special features and require special attention. Destructive and complex defect injuries are often present, which necessitate elaborate and special reconstruction approaches, predominantly as part of a staged and multistaged procedure. RESEARCH QUESTION In this context, special attention must be paid to the diagnostic options as an essential aspect, as a clear diagnosis means that targeted treatment steps can be planned and implemented. MATERIAL AND METHOD The authors' experience 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 interdisciplinary cooperation with radiological and, in particular, nuclear medicine disciplines are taken into account in the daily routine. RESULTS AND DISCUSSION Extremity injuries in the context of violence and war are accompanied by complex bone and surrounding soft tissue defects due to the high energy impact. The principles of reconstruction familiar from everyday life can only be transferred one-to-one to a limited extent. The treatment pathways are often very long and complex and the questions of infection and tissue vitality must be answered again and again in stages. Interdisciplinary collaboration with the disciplines specialized in imaging procedures, particularly in the field of nuclear medicine, is one of the key building blocks for a successful treatment pathway.
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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
- Bundeswehrkrankenhaus Ulm, Zentrales Klinisches Management, Ulm, Deutschland
| | - Vinzent Forstmeier
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Torsten Andres
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Meike Wendlandt
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Michael Grunert
- Bundeswehrkrankenhaus Ulm, Klinik für Nuklearmedizin, Ulm, Deutschland
| | - Falk von Lübken
- Bundeswehrkrankenhaus Westerstede, Klinik für Orthopädie und Unfallchirurgie, Westerstede, Deutschland
| | - Dan Bieler
- Bundeswehrzentralkrankenhaus Koblenz, Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive Chirurgie, Handchirurgie und Verbrennungsmedizin, Koblenz, Deutschland
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Schürmann J, Michael M, Picker O, Bieler D, Heitkötter K, Tremmel T, Schnäbelin B, Bernhard M. [Development of violence-associated penetrating trauma in the Düsseldorf metropolitan region over a 5-year period (GewPen study)]. DIE ANAESTHESIOLOGIE 2024; 73:444-453. [PMID: 38777920 PMCID: PMC11222214 DOI: 10.1007/s00101-024-01420-6] [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: 01/11/2024] [Revised: 03/25/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- Jutta Schürmann
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Mark Michael
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Olaf Picker
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - Dan Bieler
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | | | | | - Bernd Schnäbelin
- Referat für Rettungswesen und Gesundheitlicher Bevölkerungsschutz, Ministerium für Arbeit, Gesundheit und Soziales des Landes Nordrhein-Westfalen, Düsseldorf, Deutschland
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
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Levi H, Givaty G, Ovadia YS, Alon Y, Saban M. Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict. BMC Emerg Med 2024; 24:47. [PMID: 38515061 PMCID: PMC10956292 DOI: 10.1186/s12873-024-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire. OBJECTIVES To describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site. METHODS A retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed. RESULTS Patients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation. CONCLUSION Insights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.
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Affiliation(s)
- Hezi Levi
- Management, Barzilai University Medical Center, 7830604, Ashkelon, Israel
| | - Gili Givaty
- Management, Barzilai University Medical Center, 7830604, Ashkelon, Israel
| | - Yaniv S Ovadia
- Research and Development Authority, Barzilai University Medical Center, 7830604, Ashkelon, Israel
| | - Yaniv Alon
- Nursing Department, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Mor Saban
- Nursing Department, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 69978, Israel.
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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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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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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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Budema PM, Murhega RB, Tshimbombu TN, Toha GK, Cikomola FG, Mudekereza PS, Mubenga LE, Maheshe-Balemba G, Badesire DC, Kanmounye US. Fatal and nonfatal firearm injuries in the eastern Democratic Republic of Congo: a hospital-based retrospective descriptive cohort study assessing correlates of adult mortality. BMC Emerg Med 2021; 21:116. [PMID: 34641813 PMCID: PMC8506075 DOI: 10.1186/s12873-021-00506-3] [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: 06/14/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The Eastern Democratic Republic of Congo (DRC) has been the battleground for multiple armed conflicts, resulting in many fatal and nonfatal firearm injuries (F&NFFIs). Chronic insecurity has stressed the health system’s resources and created barriers to seeking, reaching, and receiving timely care further increasing the F&NFFI burden. Our institution is the largest trauma center in the region and receives the bulk of F&NFFI cases. We aimed to identify correlates of mortality in Congolese F&NFFI patients. Methods We included all F&NFFI patients admitted to our institution between 2017 and 2020. We extracted data from patient charts and admission logs. We identified mortality correlates using the two-sample t-test, Chi-square test, and multivariable regression analysis. A P-value of less than 0.05 was considered statistically significant. Results This study included 814 adult patients, mostly male (86%) with an average age of 34.5 years and living 154.4 km away from the hospital on average. The most affected anatomical sites were the lower limbs (48.2%) and upper limbs (23.2%). The median length of stay was 34.0 days, and the in-hospital mortality rate was 3.6%. In addition, mortality was negatively correlated with diastolic blood pressure (P = 0.01), SaO2 (P < 0.001), and hemoglobin concentration (P = 0.002). Conclusion F&NFFIs cause an enormous burden in the region, and mortality is correlated with some clinical and biological variables. Thus, the study findings will inform F&NFFI referral, triage, and management in low-resource and mass casualty settings.
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Affiliation(s)
- Paul Munguakonkwa Budema
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Roméo Bujiriri Murhega
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.,Research Department, Association of Future African Neurosurgeons, 37B Avenue des Marais, Forgeron, Funa, Kinshasa, Democratic Republic of Congo
| | - Tshibambe Nathanael Tshimbombu
- Research Department, Association of Future African Neurosurgeons, 37B Avenue des Marais, Forgeron, Funa, Kinshasa, Democratic Republic of Congo.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Georges Kuyigwa Toha
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Fabrice Gulimwentuga Cikomola
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Paterne Safari Mudekereza
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Léon-Emmanuel Mubenga
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ghislain Maheshe-Balemba
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.,Department of Radiology, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo
| | - Darck Cubaka Badesire
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ulrick Sidney Kanmounye
- Research Department, Association of Future African Neurosurgeons, 37B Avenue des Marais, Forgeron, Funa, Kinshasa, Democratic Republic of Congo.
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Anipchenko AN, Allakhverdyan AS, Levchuk AL, Panin SI, Fedorov AV. [Koblenz algorithm for open abdomen management]. Khirurgiia (Mosk) 2021:65-70. [PMID: 34270196 DOI: 10.17116/hirurgia202107165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The issue of laparostomy treatment is still controversial, since there are insufficient evidence-based data. German military surgeons have developed and implemented the «Koblenz algorithm» of laparostomy treatment into everyday practice. The algorithm was developed at the Bundeswehr Central Hospital in Koblenz (Germany). Today, approximately 50% of German civilian hospitals use the «Koblenz algorithm». The database for laparostomy treatment was created on the basis of international platform European Registry of Abdominal wall Hernias (EuraHS) in May 2015. These data will be valuable for further multipla-center studies. This manuscript is devoted to analysis of clinical effectiveness of the «Koblenz algorithm» in the treatment of patients with laparostomy. Searching of Russian, English and German studies devoted to «Koblenz algorithm» in the treatment of patients with laparostomy was carried out in the eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the PubMed databases. The authors comprehensively described «Koblenz algorithm». Mortality in the group of VAC - therapy was 57% (31/54), in case of «Koblenz algorithm» - 33% (33/100). Between-group differences were significant (OR 0.36, 95% CI 0.18-0.72, p=0.003). However, an efficacy of «Koblenz algorithm» should be confirmed in further multiple-center studies including national evidence-based trials.
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Affiliation(s)
- A N Anipchenko
- Moscow Regional Research Clinical Institute, Moscow, Russia
| | | | - A L Levchuk
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - S I Panin
- Volgograd State Medical University, Volgograd, Russia
| | - A V Fedorov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Penetrating injuries in Germany - epidemiology, management and outcome an analysis based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med 2021; 29:80. [PMID: 34120631 PMCID: PMC8201843 DOI: 10.1186/s13049-021-00895-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5 % of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment. Materials and methods Since 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. Results From 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5 %, and 4333 patients with stab wounds (1.8 %), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41 % for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8 %). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3 % required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit. Conclusions In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.
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13
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Evaluation of the Terror and Disaster Surgical Care course. Eur J Trauma Emerg Surg 2020; 46:709-716. [DOI: 10.1007/s00068-020-01418-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/15/2020] [Indexed: 01/06/2023]
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14
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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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15
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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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16
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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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Franke A, Bieler D, Friemert B, Kollig E, Flohe S. [Preclinical and intrahospital management of mass casualties and terrorist incidents]. Chirurg 2019; 88:830-840. [PMID: 29149359 DOI: 10.1007/s00104-017-0489-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Due to the recent terrorist attacks in Paris, Brussels, Ansbach, Munich, Berlin and more recently Manchester and London, terrorism is realized as a present threat to our society and social life, as well as a challenge for the health care system. Without fueling anxiety, there is a need for sensitization to this subject and to familiarize all concerned with the special kind of terrorist attack-related injuries, the operational priorities and tactics and the individual basic principles of preclinical and hospital care. There is a need to adapt the known established medical structure for a conventional mass casualty situation to the special requirements that are raised by this new kind of terrorist threat to our social life. It is the aim of this article, from a surgical point of view, to depict the tactics and challenges of preclinical care of the special kind of terrorist attack-related injuries from the site of the incident, via the advanced medical post or casualty collecting point, to the triage point at the hospital. The special needs of medical care and organizational aspects of the primary treatment in the hospital are highlighted and possible decisional options and different approaches are discussed.
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Affiliation(s)
- A Franke
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland.
| | - B Friemert
- Klinik Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland
| | - S Flohe
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städt. Klinikum Solingen, Solingen, Deutschland
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Abstract
While intestinal injury is relatively rare in blunt abdominal trauma, it is common in penetrating abdominal trauma. Intestinal injury cannot be detected effectively by computed tomography (CT); therefore penetrating abdominal injury or abdominal signs in blunt trauma require liberal indications for explorative laparotomy. In mass casualty situations patients with hemodynamic instability and abdominal signs should be prioritized for surgery. Besides intra-abdominal hemorrhage the major issue is septic complications due to intestinal perforation. The current surgical strategy should reflect the number of injured patients and the individual pattern of injuries. Damage control surgery is not an effective strategy to improve survival rates in severely injured patients or in mass casualty situations. Damage control surgery focuses on lifesaving procedures especially bleeding control and control of contamination. This includes an open abdomen strategy with later definitive repair and abdominal wall closure.
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Affiliation(s)
- J F Lock
- Klinik & Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - F Anger
- Klinik & Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik & Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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Algorithmus für das initiale klinische Management bei einem Massenanfall von Verletzten. Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Historical Case of Cervical Penetrating Wound: From First Aid to Surgical Intervention. Case Rep Otolaryngol 2017; 2017:2415679. [PMID: 29201478 PMCID: PMC5671697 DOI: 10.1155/2017/2415679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/27/2017] [Accepted: 09/17/2017] [Indexed: 11/18/2022] Open
Abstract
Objective We report a case of cervical penetrating wound by posing the problem of its support and by analyzing the chain of survival of a patient to human sacrifice. Case Report It was an 11-year-old boy admitted to the hosting service of cervical penetrating wound emergency occurring in a context of human sacrifice by weapon (knife). On admission, the conscious patient had a left cervical hematoma at the level of the cervical zone II and severe signs of acute anemia. The exploratory cervicotomy, carried out 12 hours after the trauma under transfusion, allowed us to highlight a section of the front edge of the sternocleidomastoid and previous jugular muscles under hyoid. We noted the presence of a linear wound of 1 cm at the level of the left internal jugular vein. The wound of the internal jugular vein has been repaired with the Prolene 4.O. The outcome was good, allowing the exit 10 days after cervicotomy. Conclusion The causal circumstances of cervical penetrating wounds are diverse. Their importance or their severity depends on the causative circumstances dominated by aggression and attempts to autolysis. Human sacrifice, with use of the weapon, is an exceptional circumstance.
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Stavrou GA, Lipp MJ, Oldhafer KJ. [Approach to liver, spleen and pancreatic injuries including damage control surgery of terrorist attacks]. Chirurg 2017; 88:841-847. [PMID: 28871350 DOI: 10.1007/s00104-017-0503-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Terrorist attacks have outreached to Europe with more and more attacks on civilians. Derived from war surgery experience and from lessons learned from major incidents, it seems mandatory for every surgeon to improve understanding of the special circumstances of trauma following a terrorist attack and its' management. METHOD A short literature review is followed by outlining the damage control surgery (DCS) principle for each organ system with practical comments from the perspective of a specialized hepatobiliary (HPB) surgery unit. CONCLUSION Every surgeon has to become familiar with the new entities of blast injuries and terrorist attack trauma. This concerns not only the medical treatment but also tailoring surgical treatment with a view to a lack of critical resources under these circumstances. For liver and pancreatic trauma, simple treatment strategies are a key to success.
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Affiliation(s)
- G A Stavrou
- Allgemein- und Viszeralchirurgie, Chirurgische Onkologie, Asklepios Klinik Barmbek, Medizinische Fakultät, Semmelweis Universität, Campus Hamburg, Rübenkamp 220, 29221, Hamburg, Deutschland.
| | - M J Lipp
- Allgemein- und Viszeralchirurgie, Chirurgische Onkologie, Asklepios Klinik Barmbek, Medizinische Fakultät, Semmelweis Universität, Campus Hamburg, Rübenkamp 220, 29221, Hamburg, Deutschland
| | - K J Oldhafer
- Allgemein- und Viszeralchirurgie, Chirurgische Onkologie, Asklepios Klinik Barmbek, Medizinische Fakultät, Semmelweis Universität, Campus Hamburg, Rübenkamp 220, 29221, Hamburg, Deutschland
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Kiesewetter H. Measures for Bleeding Control. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:562. [PMID: 28855054 PMCID: PMC5596158 DOI: 10.3238/arztebl.2017.0562a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Holger Kiesewetter
- *Hämostaseologicum Berliner Zentrum für Blutgerinnungserkrankungen, Germany
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Franke A. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:563. [PMID: 28855056 PMCID: PMC5596160 DOI: 10.3238/arztebl.2017.0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Axel Franke
- *Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin Bundeswehrzentralkrankenhaus Koblenz, Germany
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Dickinson A, Gunning M. Structured Approach in Prehospital Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:561. [PMID: 28855052 PMCID: PMC5596156 DOI: 10.3238/arztebl.2017.0561a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Andrew Dickinson
- *The Institute of General Practice and Multi-Disciplinary Healthcare Universitätsklinikum Tübingen, Germany
| | - Matt Gunning
- **Netcare Umhlanga Hospital, Durban, South Africa
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Zack F, Büttner A. Supplement to Forensic Analysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:562-563. [PMID: 28855055 PMCID: PMC5596159 DOI: 10.3238/arztebl.2017.0562b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Fred Zack
- *Institut für Rechtsmedizin der Universitätsmedizin Rostock, Germany
| | - Andreas Büttner
- *Institut für Rechtsmedizin der Universitätsmedizin Rostock, Germany
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Dolscheid-Pommerich R, Stoffel-Wagner B, Gräff I. Hospital Preparedness. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:561-562. [PMID: 28855053 PMCID: PMC5596157 DOI: 10.3238/arztebl.2017.0561b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Ingo Gräff
- **Interdisziplinäres Notfallzentrum Universitätsklinikum Bonn, Germany
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