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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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Humphreys P, Spratt B, Tariverdi M, Burdett RL, Cook D, Yarlagadda PKDV, Corry P. An Overview of Hospital Capacity Planning and Optimisation. Healthcare (Basel) 2022; 10:healthcare10050826. [PMID: 35627963 PMCID: PMC9140785 DOI: 10.3390/healthcare10050826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Health care is uncertain, dynamic, and fast growing. With digital technologies set to revolutionise the industry, hospital capacity optimisation and planning have never been more relevant. The purposes of this article are threefold. The first is to identify the current state of the art, to summarise/analyse the key achievements, and to identify gaps in the body of research. The second is to synthesise and evaluate that literature to create a holistic framework for understanding hospital capacity planning and optimisation, in terms of physical elements, process, and governance. Third, avenues for future research are sought to inform researchers and practitioners where they should best concentrate their efforts. In conclusion, we find that prior research has typically focussed on individual parts, but the hospital is one body that is made up of many interdependent parts. It is also evident that past attempts considering entire hospitals fail to incorporate all the detail that is necessary to provide solutions that can be implemented in the real world, across strategic, tactical and operational planning horizons. A holistic approach is needed that includes ancillary services, equipment medicines, utilities, instrument trays, supply chain and inventory considerations.
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Affiliation(s)
- Peter Humphreys
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
- Correspondence: ; Tel.: +61-07-448-963-844
| | - Belinda Spratt
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
| | | | - Robert L. Burdett
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
| | - David Cook
- Princess Alexandra Hospital, Brisbane, QLD 4000, Australia;
| | - Prasad K. D. V. Yarlagadda
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
| | - Paul Corry
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
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Hoffmann F, Landeg M, Rittberg W, Hinzmann D, Steinbrunner D, Hey F, Heinen F, Kanz KG, Bogner-Flatz V. [Childhood emergencies-worsening healthcare bottlenecks for children in a systematic long-term analysis of the EMS system in a German metropolis]. Med Klin Intensivmed Notfmed 2021; 117:358-366. [PMID: 34156483 DOI: 10.1007/s00063-021-00831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children have the right to the best possible medical care. The lack of treatment capacity is rising steadily and increasingly leads to forced centralized allocation of patients by the emergency medical services (EMS) to pediatric emergency departments that are, officially, temporarily "closed". AIM The aim of this study is to present trends in allocation of pediatric emergency patients in greater Munich. MATERIALS AND METHODS Retrospective analysis of hospital admissions of children < 18 years of age collected from 01 January 2015 to 31 December 2019 by means of the web-based IT system IVENA eHealth (manis IT, Frankfurt) used by the emergency medical services. The focus of the evaluation is on patients in category II, who are likely to require inpatient admission. RESULTS During the 5‑year observation period, a total of 44,549 pediatric patients < 18 years of age (90.6% of total admissions) were admitted to a children's hospital by the ambulance service as category II (SKII) in the Munich metropolitan area. These patients showed an increase in the relative frequency of forced allocations from 1.7% (2015) to 9.4% (2019). Parallel to this, there is an increasing frequency of time intervals over the years in which all children's hospitals were temporarily closed due to lack of treatment availability, especially in the winter half-year. CONCLUSION In the examined period from 2015 to 2019, there has been a relevant increase in the number of forced allocations to children's hospitals by the emergency medical services in the Munich area. This observed trend is likely to persist over the coming years, in view of current staff shortages and diminishing hospital capacities.
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Affiliation(s)
- F Hoffmann
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland.
| | - M Landeg
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - W Rittberg
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - D Hinzmann
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Rettungszweckverband München, München, Deutschland
| | | | - F Hey
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - F Heinen
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Regierung von Oberbayern, München, Deutschland
| | - V Bogner-Flatz
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.,Rettungszweckverband München, München, Deutschland
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Schweigkofler U, Sauter M, Wincheringer D, Barzen S, Hoffmann R. [Emergency room activation due to trauma mechanism]. Unfallchirurg 2020; 123:386-394. [PMID: 31667554 DOI: 10.1007/s00113-019-00733-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The quality of trauma care in Germany has been significantly increased due to the establishment of standards in the white paper on severe injury care and the S3 guidelines. A key issue of multiple trauma treatment is the trauma resuscitation unit (TRU)/emergency room management, which is associated with extensive material and human resources. From the very beginning of the introduction of structured care for the severely injured, the choice of the target hospital and the indications for TRU have been the focus of scientific research. Furthermore, a reduction of the TRU team for presumably less seriously injured patients is discussed. MATERIAL AND METHODS The emergency room assignments of a level I trauma center (n = 686) were analyzed in more detail. Of the patients 235 were assigned with the TRU indications according to the cause of the accident (GoR B criteria) and compared with the collective of TRU patients admitted according to the severity of injuries or life-threatening signs, the so-called GoR A criteria (n = 104) during the corresponding period. In addition to basic data (age, sex), the injured region and severity (injury severity score, ISS), the length of stay in the intensive care unit (ICU) and hospital as well as the necessity for surgery and transfusion were compared. RESULT Of the emergency room allocations at the trauma center 34% were due to the cause of the accident and the severity of the injuries in this patient group was almost half as high as that of the control group with an ISS of 11. Of the patients 74% were admitted to the IMC/ICU and stayed there for an average of almost 3 days. There were between 4% and 18% severe injuries (abbreviated injury scale, AIS 3) and 17.9% were characterized as polytrauma with an ISS ≥ 16 points. CONCLUSION A significant number of patients admitted to a TCU due to the cause of accident (the so-called B criteria of the white book), have severe and potentially life-threatening injuries, which necessitate a prioritized and immediate treatment by a TCU team. Whether a reduced TCU team is sufficient in this situation needs to be critically examined.
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Affiliation(s)
- U Schweigkofler
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland.
| | - M Sauter
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland
| | - D Wincheringer
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland
| | - S Barzen
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland
| | - R Hoffmann
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland
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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]
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Marzi I, Lustenberger T, Störmann P, Mörs K, Wagner N, Wutzler S. [Increasing overhead ressources of the trauma room]. Unfallchirurg 2019; 122:53-58. [PMID: 29556688 DOI: 10.1007/s00113-018-0484-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Every year up to 35,000 people in Germany are severely injured in accidents in traffic, during work or leisure activities. The 24-h availability of the trauma room as well as surgical and intensive care unit capacities are essential to provide optimal acute care. This study analyzed the frequency of utilization of the resource trauma room in a level I trauma center in the past. METHODS Data of a level I trauma center from 2005 to 2016 including trauma room alerts deployed by the rescue coordination center and the number of patients found to be severely injured (ISS ≥ 16) during trauma room diagnostics were analyzed retrospectively. Additionally, alerts due to trauma mechanism, accompanying by the emergency physician, ventilation and resuscitation were evaluated via a web-based interdisciplinary care capacity system (IVENA) from 2012 to 2016. Therefore, a comparison between the number of trauma room alerts and the number of severely injured patients was performed for the time after 2012. RESULTS For the time from 2012 to 2016, data obtained by IVENA showed a continuous increase in the number of trauma room alerts (n = 367 to n = 623). At the same time, the number of patients admitted under resuscitation (n = 15 to n = 45) as well as ventilated patients (n = 78 to n = 139) increased significantly; however, there was also an increase in the number of trauma alerts due to trauma mechanisms (n = 84 to n = 194) as well as the number of patients admitted to the trauma room not accompanied by an emergency physician (n = 38 to n = 132). The ratio between the number of trauma room alerts and severely injured patients (ISS ≥ 16) increased from 3.1 in 2012 to 5.4 in 2015 and 4.6 in 2016. CONCLUSION The data at hand showed a constant number of severely injured trauma patients admitted to a level I trauma center over the past few years. At the same time, there was a significant increase in utilization of the trauma room; however, in a considerable number of patients admitted to the trauma room the diagnostic process resulted in non-traumatic diagnostic findings. In the analyzed cohort, especially patients admitted to the trauma room due to trauma mechanism or without an accompanying emergency physician contributed to this development, necessitating an increased operational readiness of the trauma room team.
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Affiliation(s)
- I Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - T Lustenberger
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - P Störmann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - K Mörs
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland.
| | - N Wagner
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - S Wutzler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
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Eder PA, Dormann H, Krämer RM, Lödel SK, Shammas L, Rashid A. Telemedizinische Voranmeldung durch den Rettungsdienst bei Schwerverletzten. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0436-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gries A. [Pressure and gases: Current guidelines on diving accidents]. Anaesthesist 2015; 64:421-2. [PMID: 26040965 DOI: 10.1007/s00101-015-0045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland,
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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.
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Affiliation(s)
- U Schweigkofler
- Notfall- und Rettungszentrum, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Deutschland,
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Abstract
Zusammenfassung
Hintergrund
Die effiziente Bewältigung eines Massenanfalls von Verletzten und Erkrankten erfordert sowohl gut abgestimmte und geübte Vorgehensweisen der Einsatzkräfte als auch reibungslosen Informationsaustausch zwischen allen Beteiligten und durch alle Führungsebenen. Bestehende Systeme für die Patientensichtung, -registrierung und Rettungsmitteldisposition basieren auf händisch gepflegten Listen, die sprachlich per Funk und Telefon abgeglichen werden müssen. Elektronische Hilfsmittel können Informationsflüsse deutlich beschleunigen. Aus dem komplexen, nicht planbaren Einsatzgeschehen ergeben sich vielfältige Anforderungen an die Technik und an ein zukünftiges elektronisches Dokumentationssystem, die zu berücksichtigen sind und die sich aus der Arbeit von mehreren Forschungsprojekten in den letzten Jahren entwickelt haben.
Schlussfolgerung
Eine bundesweite Harmonisierung von Vorgehensweisen und Schnittstellen ist notwendig, sodass reibungslose überregionale Zusammenarbeit möglich ist.
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