1
|
Cardiac Arrest Center – Zertifizierung stärkt Patientenzufluss durch den Rettungsdienst. Med Klin Intensivmed Notfmed 2022; 118:263-268. [PMID: 35821417 PMCID: PMC10160140 DOI: 10.1007/s00063-022-00939-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund
Seit 2015 empfehlen die internationalen Reanimationsleitlinien die Implementierung von spezialisierten Krankenhäusern (sog. Cardiac Arrest Center, CAC) für die Versorgung von Patienten mit außerklinischem Herz-Kreislauf-Stillstand.
Ziel
Ziel der Studie war es, den potenziellen Einfluss der Zertifizierung von Kliniken als CAC auf das Einweisungsverhalten von Notärzten und Rettungsfachpersonal bei prähospital reanimierten Patienten zu untersuchen.
Methoden
Eine webbasierte anonyme Befragung mit 20 Items wurde vom 15.05. bis zum 15.06.2018 in Deutschland durchgeführt. Zielgruppen waren im Rettungsdienst tätige Notärzte sowie Rettungsfachpersonal.
Wesentliche Ergebnisse
Von 437 Teilnehmern wurden die Ergebnisse von 378 Befragten (n = 292 Notärzte, n = 86 Rettungsfachpersonen) in die statistische Analyse eingeschlossen. 75,1 % (n = 284) gaben an, dass die CAC-Zertifizierung von Krankenhäusern bei ihrem künftigen Einweisungsverhalten von Patienten mit präklinischem Herz-Kreislauf-Stillstand eine Rolle spielen würde. 78,3 % (n = 296) erwarteten, dass die CAC-Zertifizierung zu einer Verbesserung der Patientenversorgung führen wird. 78,8 % (n = 298) befürworteten die Einführung der CAC-Zertifizierung. Die Befragten würden eine zusätzliche Transportzeit von 16,3 min (95 %-KI: 15,2–17,3) akzeptierten, um ein CAC zu erreichen.
Fazit
Die Zertifizierung von Kliniken als CAC hat das Potenzial, die Entscheidung des Rettungsdienstpersonals bei der Zuweisung von Patienten mit einem präklinischen Herz-Kreislauf-Stillstand zu beeinflussen. Aufgrund der limitierten zusätzlich akzeptablen Transportzeit zur Erreichung eines CAC bedarf es eines bundesweiten, engen Netzes zertifizierter Kliniken.
Collapse
|
2
|
Gesetzlich versicherter Arbeits- und Wegeunfall. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
Weinlich M, Martus P, Blau MB, Wyen H, Walcher F, Piatek S, Schüttrumpf JP. Competitive advantage gained from the use of helicopter emergency medical services (HEMS) for trauma patients: Evaluation of 1724 patients. Injury 2019; 50:1028-1035. [PMID: 30591228 DOI: 10.1016/j.injury.2018.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of the study was to analyze helicopter emergency medical service (HEMS) in comparison to EMS, in respect to patient's mortality and morbidity. DESIGN From a cohort of traumatized patients (n = 1724) prospectively enrolled in the German trauma registry (DGU-R) at Frankfurt University Hospital from 2009 to 2013, 1646 could be analyzed for in-hospital mortality and short-term outcome (GOS) at discharge and compared between HEMS and EMS. MEASUREMENTS AND MAIN RESULTS 129 patients (7.8%) died in the hospital. Unadjusted mortality was significantly lower in the HEMS group compared to EMS (p = 0.001). In a multiple logistic regression analysis after adjustment of variables including reanimation and age as the strongest predictors, in-hospital mortality was significantly reduced in HEMS (p = 0.014, OR = 0.21). Further predictors in the multiple logistic regression analysis were GCS > = 8 (p = 0.001), RRsys (p < 0.001), ISS at Head/Neck > = 3 (p = 0.003), and total ISS > = 9 (p < 0.001). Total rescue time and on scene time were associated with mortality (p < 0.001) but not included in the multiple logistic regression model. Without adjustment, short-term outcome (GOS) was significantly improved (p = 0.014). In a linear model, after adjusting for multiple variables including age, ISS Head/Neck > = 3, ISS Extremities > = 3, GCS > = 8, and RRsys as the strongest predictors (p < 0.001), the association remained significant (p = 0.043). Further predictors in the multiple linear regression analysis were total ISS > = 9 (p = 0.002), ISS abdomen (p = 0.001), and ISS Chest (p = 0.011). CONCLUSIONS A significant improvement for in-hospital survival for HEMS could be demonstrated. Especially in Germany, with a high number of secondary call outs (about 44%) after EMS has already reached the traumatized patient, HEMS must be the first choice for severely injured trauma patients. Dispatch criteria for immediate alarm of HEMS are recommended under practical considerations.
Collapse
Affiliation(s)
- M Weinlich
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - P Martus
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - M B Blau
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - H Wyen
- University of Frankfurt, Dept. of Traumatology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - F Walcher
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - S Piatek
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J P Schüttrumpf
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
4
|
Rezar R, Sandner G, Heschl S, Hallmann B, Prause G, Gemes G. Vorteile der Hubschrauberrettung am Beispiel eines österreichischen Notarzthubschraubers. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
5
|
Schweigkofler U, Hoffmann R. [Preclinical treatment of multiple trauma : what is important?]. Chirurg 2014; 84:739-44. [PMID: 23942888 DOI: 10.1007/s00104-013-2475-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Multiple trauma is still the most common cause of death in the age group below 40 years but rarely occurs in prehospital emergencies in Germany. Therefore, personal experience of emergency physicians in prehospital treatment of multiple trauma is often limited. Priority-based therapy according to standardized algorithms and advances in clinical and intensive care have reduced hospital mortality down to 13 %. Time factors, treatment and transport by Helicopter Emergency Medical Services seem to have had a significant impact on the outcome. The current German multiple trauma S3 guidelines provide algorithms for preclinical treatment. The underlying scientific evidence in this respect is, however, low.
Collapse
Affiliation(s)
- U Schweigkofler
- Notfall- und Rettungszentrum, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Deutschland,
| | | |
Collapse
|
6
|
Schweigkofler U, Reimertz C, Lefering R, Hoffmann R. Bedeutung der Luftrettung für die Schwerverletztenversorgung. Unfallchirurg 2014; 118:240-4. [DOI: 10.1007/s00113-014-2566-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Mand C, Müller T, Ruchholtz S, Künzel A, Kühne CA. [Organizational, personnel and structural alterations due to participation in TraumaNetworkD DGU. The first stocktaking]. Unfallchirurg 2013; 115:417-26. [PMID: 21069276 DOI: 10.1007/s00113-010-1886-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND By implementation of a nationwide trauma network in Germany a high quality standard of technical, personnel and scientific conditions should be attained in hospitals participating in care for severely injured patients. All hospitals audited within the framework of TraumaNetwork(D) DGU are also evaluated for the modifications undertaken by answering a questionnaire. Using this data it was possible to 1) obtain information about hitherto existing personnel and technical infrastructures of all participating hospitals and 2) to present first positive effects achieved by implementation and participating in TraumaNetwork(D) DGU. MATERIALS AND METHODS The questionnaire contained 41 questions concerning organizational, personnel and structural changes to justify the motivation for participating in TraumaNetwork(D) DGU and regarding the degree of confidence with reference to the work of the AKUT office. Analysis of data has been carried out and given as a percentage of all useable questionnaires. RESULTS Data of 138 hospitals has been evaluated. Regarding organizational changes 29% of national/supraregional trauma centers made fewer adjustments than local (44%) and regional (55%) trauma centers. Personnel changes mainly affected participation in ATLS courses, cooperation with a neurosurgical department and reorganization of work schedules. With respect to structural changes most frequently emergency operating sets for emergency surgery have been established, teleradiology systems have been implemented and in 25% of the cases a sonography unit has been acquired. The rarest, but also most cost-intensive, new acquisition has been a CT scanner in or close to the emergency trauma room (10%). The work of the AKUT office has been rated altogether more satisfying by local trauma centers (mean 2.4) than by regional and national trauma centers (mean 2.6). Prompt information by AKUT has been especially praised (mean 2.1). CONCLUSION Being organized in trauma networks motivates hospitals to optimize their operational sequences and personnel and structural conditions. How much the care for multiple injured patients can be improved nationwide in Germany will be shown over the next few years. Through compulsive participation in TraumaRegister(QM) DGU (quality management) as a measurement for quality assurance this will be analyzed and evaluated scientifically.
Collapse
Affiliation(s)
- C Mand
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland
| | | | | | | | | | | |
Collapse
|
8
|
Qualität der initialen Reanimationsmaßnahmen am Phantom durch Rettungsassistenten und Rettungssanitäter. Notf Rett Med 2013. [DOI: 10.1007/s10049-012-1645-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
9
|
Schneppendahl J, Lefering R, Kühne CA, Ruchholz S, Hakimi M, Witte I, Lögters T, Windolf J, Flohé S. [Interhospital transfer of severely injured patients in Germany. Evaluation of the DGU trauma register]. Unfallchirurg 2013; 115:717-24. [PMID: 21165586 DOI: 10.1007/s00113-010-1914-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The TraumaNetzwerk(D) DGU was founded 3 years ago and since then the majority of trauma centers have been registered and organized into regional trauma network services (TNW). Within these networks assessment criteria for transferring patients to higher level hospitals are defined. The purpose of this study was to evaluate the incidence, causes, implications and quality of care for patients with major trauma who were transferred for definitive treatment before implementation of the TraumaNetzwerk(D) DGU in Germany. PATIENT AND METHODS The data of 19,035 patients listed in the German Trauma Register of the German Society for Trauma Surgery (DGU, 2002-2007) were analyzed. Patients with an injury severity score (ISS) >9 and a blood pressure documented on admission were included into the study. Data were allocated according to patients where therapy was performed completely in the primary hospital of admission (group I; n=16,033; 84.2%) and patients transferred after primary care from one hospital to another centre for definitive care (group II; n=3,002; 15.8%). Comparative parameters were the pattern and severity of injury, physiological state on admission and clinical outcome. RESULTS Mean ISS and percentage of patients with an ISS ≥25 did not differ significantly between groups. Of the patients who were transferred to a higher level trauma centre (group II) 20.7% needed catecholamines on admission, 10.1% were in shock (blood pressure <90 mmHg) and 2.5% of the patients underwent resuscitation in the emergency department. Patients of group II had a considerably longer hospital stay (31.2±35.5 days) than patients of group I (24.8±27.1 days). Furthermore, treatment costs were significantly higher for group II (I: EUR 23,870; II: EUR 26,054). CONCLUSIONS A relevant percentage of patients transferred from one hospital to another were hemodynamically and clinically unstable. To what extent the quality of patient transfer and therefore major trauma care is improved by the implementation of regional trauma networks in Germany remains to be seen over the next years.
Collapse
Affiliation(s)
- J Schneppendahl
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Wyen H, Lefering R, Maegele M, Brockamp T, Wafaisade A, Wutzler S, Walcher F, Marzi I. The golden hour of shock - how time is running out: prehospital time intervals in Germany--a multivariate analysis of 15, 103 patients from the TraumaRegister DGU(R). Emerg Med J 2012; 30:1048-55. [PMID: 23258373 DOI: 10.1136/emermed-2012-201962] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although prehospital treatment algorithms have changed over the past years, the prehospital time of multiple trauma patients of some 70 min and the on-scene-treatment time (OST) of some 30 min have not changed since 1993. The aim of this study was to critically assess specific interventions and conditions at the scene in relation to their impact on prehospital rescue intervals. METHODS We performed a retrospective data analysis of all multiple injured patients from the TraumaRegister DGU (English: German Trauma Society) from January 1993 to December 2010. Exclusion criteria were missing or implausible data regarding prehospital timelines. With OST as an independent variable, different models of multivariate regression were performed to identify parameters with relevant impact on the OST. RESULTS 15 103 datasets were included in this study. Based on the mean OST of 32.7 (± 18.6) min and a constant absolute term of 16.2 (± 1.5) min, we identified seven procedures and nine environmental parameters with significant impact on OST. Intubation (9.3 ± 0.8 min) and being a car occupant (8.0 ± 0.8 min) were associated with the most prolonged OSTs. A Glasgow Coma Scale ≤ 8 (-4.5 ± 0.7 min) and cardiopulmonary resuscitation (-2.8 ± 1.7 min) resulted in its most relevant reduction. Admission to a Level III facility led to a reduced overall prehospital time (60.0 ± 24.6 min) compared with Level I (70.0 ± 28.5 min) and II (66.8 ± 27.4 min) trauma centres. CONCLUSIONS This study identified characteristic interventions and conditions with significant impact on prehospital treatment times. Current treatment concepts should be re-evaluated with respect to these results.
Collapse
Affiliation(s)
- Hendrik Wyen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, , Frankfurt, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Scherer G, Luiz T. [The White Paper on treating medical emergencies preclinically and at hospital : how can it be implemented?]. Anaesthesist 2011; 60:751-8. [PMID: 21818523 DOI: 10.1007/s00101-011-1915-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Up-to-date management of medical emergencies implies primarily that definitive diagnoses and treatment are performed in a timely manner. These claims have been reconfirmed in 2007 by the leading German language medical associations in their "White Paper on Emergency Treatment". To actually realize the demands described in this paper a timely, transsectoral and close collaboration of all involved organizations is mandatory. To illustrate this race against cell death the phrase relay of survival is proposed and launched to replace the hitherto used but rigid concept of chain of survival. The tasks of each member of this relay of survival are critically scrutinized one after the other from a patient perspective. The paper presents tangible recommendations for improving the respective individual performance as well as, in particular, the cooperation and coordination between the team members which is comparable to handing over the baton in a relay race.
Collapse
Affiliation(s)
- G Scherer
- Rettungsdienstbereiche Rheinhessen & Bad Kreuznach , Kreisverwaltung Mainz-Bingen, Georg-Rückert-Str. 11, 55218, Ingelheim, Deutschland.
| | | |
Collapse
|
12
|
Hilbert P, Lefering R, Stuttmann R. Trauma care in Germany: major differences in case fatality rates between centers. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:463-9. [PMID: 20644700 DOI: 10.3238/arztebl.2010.0463] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 10/12/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). METHODS The standardized mortality rate of each participating center was calculated on the basis of the RISC prognostic score (Revised Injury Severity Classification) and the observed case fatality rate of the center. Results were compared across centers for the years 2004 to 2007; only the centers that provided the primary treatment of at least 100 patients during this period were included in the analysis. Data from the ten highest-scoring centers, the ten lowest-scoring centers, and the ten centers in the middle of the group were compared, and differences between them were analyzed. RESULTS The case fatality rate in the top ten centers was 8.7%. The corresponding rate in the bottom ten centers was approXimately twice as high, even though the injuries treated there were of comparable severity. CONCLUSION It is evident that the fate of a trauma patient in Germany depends partly on the center in which he or she is treated. These data were drawn from a retrospective evaluation of a case registry and should be assessed in awareness of this fact.
Collapse
Affiliation(s)
- Peter Hilbert
- Klinik für Anästhesiologie, Intensiv- u. Notfallmedizin, BG-Kliniken Bergmannstrost, Merseburgerstrasse 165, Halle/Saale, Germany.
| | | | | |
Collapse
|
13
|
Taylor CB, Stevenson M, Jan S, Middleton PM, Fitzharris M, Myburgh JA. A systematic review of the costs and benefits of helicopter emergency medical services. Injury 2010; 41:10-20. [PMID: 19853251 DOI: 10.1016/j.injury.2009.09.030] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Helicopter emergency medical services (HEMS) are popular in first world health systems despite inconsistent evidence in the scientific literature to support their use. The aim of the current study was to perform a systematic review of economic evaluations of HEMS, in order to determine the economic cost of HEMS and the associated patient-centered benefits. METHOD A systematic review was performed of studies that provided a cost estimate of HEMS. The inclusion criteria consisted of English language articles that estimated both the costs and outcomes of a HEMS and fulfilled pre-specified criteria in relation to a cost analysis, cost-minimisation, cost-effectiveness or cost-benefit evaluation. Identified studies were synthesised according to the patient diagnosis (trauma, non-trauma or non-specific) and the type of HEMS transport under review (primary scene retrieval or secondary inter-facility transport). All costs were converted to US dollars and indexed for inflation. RESULTS Fifteen studies met the inclusion criteria. Among all studies the annual cost of HEMS ranged from $115,777 to $5,571,578. Five studies showed HEMS to be a more expensive transport alternative without an associated benefit while eight studies provided cost-effectiveness ratios of $3292 and $2227 per life year saved for trauma, $3258 per life saved and $7138 and $12,022 per quality adjusted life year for non-trauma and $30,365 and $91,478 per beneficial mission for non-specific patient populations. One study also evaluated the cost of HEMS to societal benefit, producing a ratio of 1:6. INTERPRETATION The cost and effectiveness of HEMS varied considerably between studies. Despite generally being more expensive than ground transport, a number of studies found HEMS to be cost-effective. However, given the variation in the intervention design, context and study methods between studies it was not possible to assess the cost-effectiveness of HEMS in general. Given the variation inherent in the health systems in which HEMS operate, synthesis and extrapolation of study findings across differing health environments is difficult. To address economic and clinical evidence in relation to HEMS, future research that is tailored to account for local system factors is required.
Collapse
Affiliation(s)
- Colman B Taylor
- The George Institute for International Health, Sydney, NSW, Australia.
| | | | | | | | | | | |
Collapse
|
14
|
Lackner CK, Bielmeier S, Burghofer K. [Emergency care for traffic accidents in Bavaria: current process analysis depending on hospital and emergency service structures]. Unfallchirurg 2009; 113:183-94. [PMID: 19629424 DOI: 10.1007/s00113-009-1640-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. The patients were primarily cared for by land-based rescue services and air rescue services were only used in 19.1% of the cases. Of the patients involved in a traffic accident 47.6% were transported to a primary health care hospital. A prehospital interval of more than 60 min occurred in 20% of the missions. Of the patients 96.2% were transported to tertiary or maximum care hospital by air rescue services but emergency facilities were, however restricted to daylight hours. There was a further limitation due to the routine duty hours in hospitals as only 36.7% of accidents occurred during this time intervall. An increase of admission post trauma in maximum care clinics occurred from 2002 until 2006 while simultaneously the prehospital period was extended. In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.
Collapse
Affiliation(s)
- C K Lackner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Ludwig-Maximilians-Universität München, Schillerstr. 53, 80336, München, Deutschland.
| | | | | |
Collapse
|
15
|
Probst C, Hildebrand F, Frink M, Mommsen P, Krettek C. [Prehospital treatment of severely injured patients in the field: an update]. Chirurg 2008; 78:875-84. [PMID: 17882391 DOI: 10.1007/s00104-007-1410-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Life or extremity threatening injuries have to be diagnosed and treated rapidly by emergency physicians during prehospital care for severely injured patients. The cooperation with other rescue services, the fire brigade and the police must be coordinated and early transportation has to be organized. Rapid sequence intubation by trained personnel for correct indications, such as head injury or severe chest trauma is recommended as well as prehospital chest tube placement in cases of severe or penetrating thoracic injury. Crystalloids and colloidal solutions remain the first choice for intravenous volume replacement. The amount of fluid depends on the individual response, such as palpable peripheral and central pulse for blunt or penetrating trauma. Ultrasound or near infrared spectroscopy could not be routinely implemented for extended prehospital diagnostic procedures. Transportation to the closest appropriate hospital has to be accomplished as early as possible. Helicopters show positive outcomes if the destination is a level I trauma center, even if secondary alarm calls or more extensive measures prolong the prehospital interval.
Collapse
Affiliation(s)
- C Probst
- Unfallchirurgische Klinik der Medizinischen Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Deutschland.
| | | | | | | | | |
Collapse
|
16
|
Hirschmann MT, Uike KN, Kaufmann M, Huegli R, Regazzoni P, Gross T. [Quality management of interdisciplinary treatment of polytrauma. Possibilities and limits of retrospective routine data collection]. Anaesthesist 2008; 56:673-8. [PMID: 17483913 DOI: 10.1007/s00101-007-1192-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the quality of interdisciplinary multiple trauma management using routinely taken data. METHODS A retrospective analysis of all multiple traumatized patients [Injury Severity Score (ISS)>15] in a university hospital (n=172; time period 01.01.1997-31.12.1999) was carried out concerning epidemiological and clinical variables and hospital outcome (p<0.05). RESULTS The overall mortality was 22% [n=38; expected Trauma Injury Severity Score (TRISS) mortality 29%]. Significant parameters for worse outcome in univariate analysis were age>74 years, hypotension, decreasing hemoglobin level and prothrombin time, decreased Glasgow Coma Scale and the number of erythrocyte or plasma concentrates received in the initial period of treatment. The comparison of our results with the data of the German Association for Trauma Surgery registry demonstrated comparable results with respect to management sequence and outcome. CONCLUSIONS In the quality management of multiple trauma patients retrospective analysis of routinely registered parameters can be a reliable and practical alternative to time-consuming prospective studies when based on prognostic relevant data. Such a procedure allows a preliminary critical comparison with other centers.
Collapse
Affiliation(s)
- M T Hirschmann
- Departemente Chirurgie, Universitätsspital Basel, Basel.
| | | | | | | | | | | |
Collapse
|
17
|
Karkhaneh M, Naghavi M, Rowe BH, Hagel BE, Jafari N, Saunders LD. Epidemiology of bicycle injuries in 13 health divisions, Islamic Republic of Iran 2003. ACCIDENT; ANALYSIS AND PREVENTION 2008; 40:192-199. [PMID: 18215548 DOI: 10.1016/j.aap.2007.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 04/15/2007] [Accepted: 05/18/2007] [Indexed: 05/25/2023]
Abstract
Bicyclists are vulnerable road users for severe injury all over the world. The nature and extent of such injuries are less well known in Iran. Using data from a comprehensive survey conducted by the Ministry of Health and Medical Education in 13 health divisions of Iran, in 2003, we examined circumstances around bicyclist injury and death. Trained health workers completed the survey instruments by interviewing patients who stayed more than 24h in hospitals and/or relatives, hospital personnel and by reviewing patient charts. Data were cross-matched with medico-legal documents to prevent missing deaths. The information that was collected from 64 cities/towns' emergency departments (EDs), over the study period, showed that 440 injured cyclists were hospitalized and/or died due to traffic collisions. Most injuries occurred in males (94.8%) and in the young (median age: 14 years with 75% </=18 years). Head injury occurred in 14% of all hospitalized and in 90% of fatally injured bicyclists. Striking a moving vehicle increased the odds of death (OR: 32.3; 95% CI 3.5-291.0) as well as the odds of severe injury (OR: 1.9; 95% CI 1.2-3.2) compared with other mechanisms of injury. As a conclusion, bicyclists in Iran, particularly males and young children, are vulnerable to severe injury and death when struck by moving vehicles on highways.
Collapse
Affiliation(s)
- Mohammad Karkhaneh
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Thoracic trauma, most often associated with other serious injuries, is the main cause of death in the first 45 years of life. The percentage of chest injuries in multiple trauma, mainly from blunt impact, has remained relatively constant at 80% during the last 30 years. Isolated thoracic injuries comprise only 25% of all trauma cases, 90% of chest injuries are due to blunt impact, while penetrating injuries make up 5-10%. Since 25% of deaths from trauma are attributable to chest injuries, they determine the survival rate in multiple trauma to a significant extent. The pattern of chest injuries is variable, frequently in different combinations comprising rib cage and diaphragm, lung parenchyma, airway and mediastinal organs. This article details the immediate simultaneous diagnostic and therapeutic procedures in the prehospital phase, management in the emergency room, the relative importance of computed tomography, ultrasound examination and endoscopy in the primary diagnostic evaluation and the principles of anaesthetic management of thoracic trauma.
Collapse
Affiliation(s)
- U Klein
- Klinik für Anaesthesie und operative Intensivtherapie, Südharz-Krankenhaus, Dr. Robert Koch-Strasse 39, 99734 Nordhausen.
| | | | | | | | | |
Collapse
|
19
|
Frink M, Probst C, Hildebrand F, Richter M, Hausmanninger C, Wiese B, Krettek C, Pape HC. [The influence of transportation mode on mortality in polytraumatized patients. An analysis based on the German Trauma Registry]. Unfallchirurg 2007; 110:334-40. [PMID: 17219188 DOI: 10.1007/s00113-006-1222-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thirty years after its introduction in Germany, the benefits of the helicopter emergency medical service (HEMS) compared to ground ambulances (GA) still remain unclear. The aim of this study was to evaluate the influence of helicopter transport on rescue time and mortality based on the data of the German Trauma Registry. METHODS Data from patients with multiple injuries were documented prospectively between 1993 and 2003 in different trauma centers in Germany, Switzerland, Austria and The Netherlands. From these data, patients with an injury severity score (ISS)<16 were excluded. Patients who were transported to the hospital without a physician were also excluded. The data from included patients were evaluated for time to hospital and influence of transportation service on mortality. RESULTS A total of 7,534 patients with multiple injuries were included. Of these, 3,870 patients were transported by HEMS and 3,664 reached the hospital by GA. There were 74.9% male patients in the HEMS group, and 71.3% male patients in the GA group. The mean ISS was higher in the HEMS group (31.4 vs 30.7; P<0.01); patients transported by GA were older (HEMS: 39.2; NEF:41.3; P<0.01). The GA arrived on the scene after 14.33 min, the HEMS after 18.18 min (P<0.01). Time at the scene was longer in the HEMS group (HEMS: 26:26 min; NEF: 22:29 min; P<0.01). Intubation rate in the HEMS group was about 80%, while patients transported by GA were intubated in 60% of cases. The overall mortality was 30.9%. Evaluation of the TRISS prediction of survival showed a benefit for patients transported with HEMS. In a multivariate analysis, intubated patients with ISS<or=60 had a lower mortality rate if transported with HEMS (NEF: 40.1%; HEMS 34.9%; P<0.01). CONCLUSIONS Only minor differences in age and ISS were found between the groups. The time between the accident and arrival of the physician was longer in the HEMS group. The HEMS group also remained on the scene for longer, but had a higher rate of intervention. According to our analysis of the German Trauma Registry, patients with multiple injuries benefit from HEMS transportation.
Collapse
Affiliation(s)
- M Frink
- Unfallchirurgische Klinik, Medizinische Hochschule , Karl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Döhnert J, Auerbach B, Wyrwich W, Heyde CE. [The preclinical care of polytraumatized patients]. DER ORTHOPADE 2005; 34:837-51. [PMID: 16049722 DOI: 10.1007/s00132-005-0843-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In industrially developed countries, trauma is the major mortality factor for people younger than 40 years. The preclinical management of polytraumatized patients influences the prognosis of mortality and morbidity. In this period, a number of decisions have to be made under unfavourable conditions and with limited time. This situation represents a great challenge for the whole rescue team. Diagnostic overview, protection of the vital functions under the special situation of shock, immobilization of the spine and the treatment of the isolated injuries are part of the preclinical management efforts. Rescue of the polytraumatized patient, organization and announcement of transfer and the protection of the rescue team have to be taken into account.
Collapse
Affiliation(s)
- J Döhnert
- Neurochirurgische Praxisklinik Leipzig, Johannisplatz 1, 04103 Leipzig, Germany.
| | | | | | | |
Collapse
|