Massenanfall von Verletzten

Any emergency physician can be confronted at any time with major emergency incidents and mass casualties. The first emergency physician to arrive on the scene is called the emergency physician in charge and takes over these duties until arrival of the senior emergency physician. The emergency physician in charge has to deal with unusual organizational and medical challenges such as rapid situation assessment and arranging of the deployment area as well as triage, emergency treatment and coordinated transport of the patients. All actions must be forced in accordance with “work and go”: immediate and adequate clinical treatment is the main goal even in major emergency incidents with mass casualties.     

Massenanfall von Verletzten durch Terror

Notfall + Rettungsmedizin -     

Katastrophenschutzübung zum Massenanfall von Verletzten

The alert and deployment plan of the individual hospitals in Hamburg has been checked repeatedly in training exercises for catastrophe-based events, particularly the partial alert plan for managing mass casualty incidents. As part of the preparations for the Soccer World Cup 2006, various scenarios will be played out as simulations to adapt the chain of care provided by emergency medical services to suit the special requirements and conditions of this mass event. The medical and organizational management of an external incident with mass casualties will be run through in the central hospital emergency wards during an emergency drill. This article describes the preparation, organization, and documentation of these exercises. Carrying out these disaster control exercises under realistic conditions allows the hospitals to test the functionality of the workflows designated in their alert and deployment plans. These plans are reviewed and if necessary altered with the goal of further optimizing the structures, use of resources, and workflows to be best prepared for dealing with mass casualty incidents.     

Vorbereitungen im Krankenhaus für einen Massenanfall von Verletzten (Katastrophen-Dispositiv)

If a huge number of injured persons require immediate treatment at the same time, each hospital will become hopelessly overworked, unless it is prepared for a disaster. If a proper organisation is done, especially if a socalled dispositive for catastrophes and a plan for an alert are outlined, the treatment capacity of any hospital can be increased considerably. As a model the catastrophe dispositive and the alerting scheme of the Accident-Hospital of the ?Berufsgenossenschaft“ (Professional association) in Frankfurt/Main are described.     

Algorithmus für den Massenanfall von Verletzten an der Unfallstelle

Zusammenfassung In einem systematischen Review wurden alle Arbeiten, welche sich mit Großschadensereignissen befassen, gesichtet und gemäß ihrem Evidenzlevel klassifiziert. Aus diesen Ergebnissen sowie den zusätzlichen Anregungen der Autorengruppe aus der Arbeitsgemeinschaft Notfallmedizin der DGU wurde ein Algorithmus zur Abarbeitung von Großschadensereignissen erstellt und im Rahmen einer Delphi-Konferenz verabschiedet. Dieser Algorithmus zum Massenanfall von Verletzten schließt auch einen Triagealgorithmus mit ein, der primär nicht unbedingt die Anwesenheit eines Notarztes erforderlich macht. Beide Algorithmen werden in dieser Arbeit vorgestellt.AG Notfallmedizin der DGU: Dr. Hermann-Josef Bail; Dr. Mark Bardenheuer, Mannheim; Dr. Michael Bayeff-Filloff, Rosenheim; PD Dr. Alexander Beck, Ulm; Dr. Achim Biewener, Dresden; Prof. Dr. Bertil Bouillon, Köln; Dr. Marc Fischbacher, Essen; Dr. Sebastian Hentsch, Berlin; Dr. Ewald Hüls, Celle; Dr. Karl-Georg Kanz, München; Prof. Dr. Christian K. Lackner, München; Dr. Lutz Mahlke, Hannover; Dr. Ivan Marintschev, Halle; Dr. Gerrit Matthes, Berlin; Dr. Hubert Mayer, Augsburg; Prof. Dr. Udo Obertacke, Mannheim; Dr. M. Raum, Köln; Dr. Stefan Sauerland, Köln; Dr. Ulrich Schächinger, Regensburg; Dr. Thomas Schildhauer, Bochum; Prof. Dr. Andreas Seekamp, Kiel; Dr. Erwin Stolpe, München; Prof. Dr. Johannes Sturm, Detmold; Dr. F. Walcher, Frankfurt; Prof. Dr. Christian Waydhas, Essen; Dr. Michael Weinlich, Filderstadt; Dr. Christoph Wölfl, Ludwigshafen; Dr. Gerald Zimmermann, Ludwigshafen     

Der Massenanfall an Verletzten nach Explosion

Zusammenfassung Die israelisch-palästinensische Auseinandersetzung hat durch die Intifada einen Zustand erreicht, der durch Gewalt an Zivilpersonen auf beiden Seiten gekennzeichnet ist. Seit Beginn der 1990er Jahre hat dieser Konflikt eine besondere Qualität dadurch erreicht, dass gezielt Selbstmordattentäter eingesetzt werden, deren Ziel die Tötung von Zivilisten ist, die nicht unmittelbar an der Auseinandersetzung beteiligt sind. Für städtische und kommunale Krankenhäuser bedeutet das, dass sie regelmäßig mit einem begrenzten Massenanfall an Verletzten konfrontiert werden können. Daher wurde die Neustrukturierung von Notfalleinsatzplänen an der Einsatzstelle und im Krankenhaus notwendig. Bereits an der Unfallstelle erfolgt die Klassifikation des Ereignisses nach Anzahl und Verletzungsschwere der Opfer. Häufung und Schwere der Ereignisse erforderte in Israel ein Umdenken im Triagesystem, das sich in wesentlichen Zügen von dem mitteleuropäischen System unterscheidet. Neben der Umstellung der präklinischen und klinischen Versorgungsalgorithmen müssen sich Unfallchirurgen auf eine neue Qualität von Verletzungen einstellen. Barotraumen der Lunge und multiple, scheinbar oberflächliche Verletzungen stellen sich häufig erst sekundär als lebensbedrohlich heraus und führen zur Lähmung intensivmedizinischer und chirurgischer Kapazitäten.     

Organisatorische Grundlagen für einen sinnvollen ärztlichen Einsatz beim Massenanfall von Verletzten

First aid is the most important matter especially at the time of disaster. Every layman should be able to give first aid to any person without delay. Therefore it is necessary to teach the whole population accordingly, starting in schools and colleges. Whoever is interested in this field should receive further training at home or during the military service in order to render expert assistance, if first aid is required. Doctors need a special education for medical treatment in war and catastrophes. All measures to counteract mass fatalitities have to be prepared well in advance. Only the organized help of trained people and doctors may lessen the tragedy of a disaster, if such an unfavourable event occurs. We strongly advise to keep plans for hospitals and affiliated organisations ready, to help in the fight against catastrophes.     

mSTaRT-Algorithmus für Sichtung, Behandlung und Transport bei einem Massenanfall von Verletzten

The operational response for a mass casualty incident is characterized by the number and treatment of victims with critical injuries. It is possible to reduce mortality by means of rapid and targeted utilization of resources, even if they are limited so that normal individual care is not possible. The scene triage of patients during a mass casualty incident cannot be carried out by the chief medical incident officer in a medically efficient time frame as critically injured must be quickly identified and separated from the mostly moderate to minor injured and enter a targeted treatment process. By delegating EMTs to carry out triage, using the mSTaRT algorithm and defining treatment goals and procedures, the medical incident command is capable of coordinating an efficient response and delivering victims to appropriate clinics.     

Zur Frage der Operationspflicht von Verletzten

Ohne Zusammenfassung     

Die präklinische Versorgung von Verletzten

Ohne Zusammenfassung Prof. Dr. W. Mutschler, Chirurgische Klinik und Poliklinik, Klinikum der LMU München, Nu?baumstr. 20, 80336 München     

Verteilungsplanung von Verletzten beim MANV oder Katastrophenfall

Relevant changes have occurred in disaster management in Germany due to legal alterations and the introduction of the diagnosis-related groups (DRG) system. This has resulted in a reduction in bed capacities and an increase in bed utilization. In addition to the preclinical deployment strategy the provisional aspects of disaster medicine with the problem of the emergency service/hospital interface will be described. A suggestion for a solution for optimization of patient allocation in mass disasters or catastrophes will be demonstrated with the catastrophe network of the German Society for Trauma Surgery (DGU).     

Festlegung der Altersgrenze von verletzten Kindern beim Massenanfall verletzter Personen

Notfall + Rettungsmedizin - Bei einem Massenanfall verletzter Personen (MANV) werden die Patienten im Rettungsdienstbereich München gemäß der sog. Patientenverteilmatrix den...     

Massenanfall Verletzter

Background

Each weekend soccer arenas attract hundreds of thousands of spectators with the German Bundesliga being one of the most attractive sport series worldwide. In 2006 when the FIFA soccer World Cup? took place in Germany, the precautions in the participating arenas against mass casualty incidents (MCI) reached a level formerly unknown in Germany. However, it is unknown how soccer arenas are prepared to deal with such incidents in everyday life.

Methods

In 2011 all German major soccer league clubs were questioned about medical precautions in case of MCIs occurring in the stadium. The questionnaire included the following items: stadium capacity, the number of paramedic personnel, emergency physicians and ambulance vehicles, the command and communication structures, the availability of MCI plans, recent MCI drills and the frequency of MCI.

Results

Out of 39, 15 (38.4?%) participated, 50?% from the first league and 20.8?% from the second league. The mean stadium capacity was 41,800 spectators (minimum 10,600, maximum 80,700). Depending on the number of spectators and the individual risk score of the match the following resources were available within the stadiums (average, minimum, maximum,): emergency medical technicians 61–67 (15, 120), emergency physicians 2.3–2.5 (1, 5) and transport capacity 5.3–5.8 patients (1, 15). In 14 arenas (93.3?%) the medical personnel were trained in mass casualty care and had prepared MCI operation schedules. All stadiums had mission control centers equipped with a variety of wired and wireless communication tools, although only eight (52.3?%) arenas used a joint command structure and five (33.3?%) arenas reported MCIs (defined as a scenario involving more than 10 patients) within the past 10 years. In 40?% of the participants the last MCI-related exercise was conducted more than 36 months ago.

Conclusions

Most of the participating arenas were adequately staffed to manage the first phase of MCIs but in contrast command structures and transport capacities often focused on individual emergencies. Although most of the participants stated that they planned the resources provision according to well established algorithms, the resources actually available at the arenas varied considerably. The frequency of MCIs in soccer arenas was surprisingly high in contrast to the frequency of MCI-related drills.     

Patientenregistrierung im Massenanfall

Background

Efficient handling of mass casualty incidents (MCI) requires well-trained rescue teams and a well prepared course of action. Furthermore, smooth information interchange between all decision makers is mandatory. Existing systems for triage, registration, and management of transport means are based on various lists on paper which have to be synchronized by means of voice and radio systems. Electronic tools can significantly accelerate data flow. Various requirements for a future digital documentation system arise from the unpredictable conditions in the field. Several projects have researched this topic in recent years.

Conclusion

Nationwide harmonization of procedures and interfaces is necessary for smooth interregional cooperation.     

Management des Massenanfalls von Verletzten/Erkrankten durch den Leitenden Notarzt

The capacity of the chief emergency physician (CEP) has meanwhile become established all over Germany. Based on specialized training, the CEP is qualified to direct the emergency medical services (EMS) during large-scale casualty incidents. Until such time when the CEP has arrived at the emergency site, the emergency physician first on the scene assumes his responsibilities. The CEP first forms an opinion of the situation by sorting the patients to allocate further medical care or to requisition additional rescue personnel or technical support. He coordinates the planning of primary medical care, in particular by assigning treatment priority. The priority and type of transfer as well as designation of appropriate hospitals are determined by the CEP. The Organizing Supervisor of the EMS can effectively ease the CEP’s task in coping with logistics. After the end of the mission, follow-up assessment of each mass incident is important to be able to recognize or eliminate mistakes.     

49. Richtlinien bei der Behandlung von Frakturen und Luxationen beim Massenanfall

Zusammenfassung Beim Massenanfall ist in über 50% mit Extremitätenverletzungen zu rechnen. Bei mehr als der Hälfte der Frakturen sind offene Frakturen zu erwarten. Die Behandlung geschieht in verschiedenen Phasen. Zielsetzung der Behandlung mu sein: 1. Erhaltung des Lebens, 2. Erhaltung der Extremität, 3. Verhütung von Infektionen, 4. Erzielung der Knochenbruchheilung, 5. Erreichung der vollen Funktion der Extremität. In der Phase der ersten ärztlichen Versorgung stehen Schockbehandlung, Schmerzbekämpfung, Beseitigung von groben Dislokationen und Schienung im Vordergrund. Der Phase der ersten chirurgischen Behandlung ist das Wunddébridement, die sofortige Stabilisierung offener Frakturen sowie Reposition und Gipsfixation geschlossener Frakturen und Luxationen vorbehalten.     

Neuere medizinische Versorgungskonzepte (zur WM 2006) bei 1000 und mehr Verletzten

No existing concept for medical treatment in a major disaster with hundreds of injured people, is known to work properly. There are always the same problems at the scene of the accident, with a continuation of hospitals congestion. A new concept should be able to change this.     

Grundsätze für die ärztliche Versorgung von Verletzten unter Katastrophenbedingungen

In disaster, our daily practiced individual type medicine turns into one of masses. Its basics are explicitly discussed from the surgeon’s point of view under the three terms of “Triage, tactics and technique”. Only surgeons, who are capable of sufficiently adapting their medical thinking and actions to the new conditions, will be able to subsist in any eventual civilian or military disaster.