[Admission and organization of emergency care for multiple injured patients. The experience of the Strasbourg Center of traumatology and orthopedics].

The admission of patients with severe multiple trauma and the organization of treatment must follow a few basic principles: 1) continuous, uninterrupted management by the various links of the medical chain, 2) single location: the various persons ensuring the treatment must go to the patient's side, and not the opposite, 3) pluridisciplinary, polyvalent care, and lastly, 4) single command: for us, the orthopedist-traumatologist must direct and coordinate care to the severely injured persons, and the so-called general surgeons is in charge of the others. Three structures of admission currently coexist in France: the department of admission, the emergency department and, rarely, the center of traumatology. Carefully planned routes, adapted facilities, plenty of material and staff are essential. The initial management of patients with multiple trauma in both diagnostic and therapeutic at the same time: first aid in case of vital emergency, resuscitation, clinical, radiological and biological assessment, aimed at drawing a complete census of the lesions and establishing their hierarchy. Considering this hierarchy, the treatment must urgently, completely and definitively deal with: In the first place, and in extreme emergency, vital lesions: visceral rupture, internal and external hemorrhages as well as orthopedic priorities: neuromedullary compression, fracture with vascular lesion, open fracture. All the lesions must be treated definitively if this is possible. However, not all fractures must be operated immediately. Only the severe lesions that are a factor of shock (eg. fracture of both femurs) must be reduced and fixed in emergency. The temporary treatment of the other lesions with plaster casts or continuous extension must not be neglected.(ABSTRACT TRUNCATED AT 250 WORDS)