Pfenninger E, Königsdorfer M
Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland.
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Ulm, Deutschland.
Anaesthesist. 2019 Oct;68(10):702-710. doi: 10.1007/s00101-019-00670-z.
Following a terrorist attack a second hit is to be feared. The adequate reaction of the emergency services on site is to clear the scene. Since in such cases no treatment areas are set up at the scene of the incident, the injured are quickly admitted to the nearest hospital, either by themselves or by the emergency services and are largely untreated. Therefore, the hospital has to be ready to take in a significantly larger number of injured people in a very short period of time than after a conventional mass casualty incident. Due to the conceivably large number of wounded persons the emergency department can ensure primary medical care but nowhere near all casualties admitted to the hospital can be definitively treated.
In order to provide injured patients with individual medical care after initial treatment according to the criteria of damage control resuscitation, a concept should be developed that enables a well-organized secondary transfer to receiving hospitals with appropriate equipment.
Within a radius of 100 km from Ulm, all hospitals certified by the German Society for Trauma Surgery were contacted and asked to indicate how many emergency patients of the triage categories T1 (red), T2 (yellow) and T3 (green) could be admitted and treated around the clock (24/7). Special features such as a helicopter landing pad, neurosurgical care and pediatric traumatology care were considered.
Of the 32 hospitals within a 100 km radius of Ulm 29 (91%) provided information on the admission capacity. In these hospitals 45 T1, 121 T2 and 333 T3 patients could be admitted around the clock (24/7). A helicopter landing pad is available at 26 of the 29 hospitals (90%), 11 hospitals (38%) can treat patients for emergency neurosurgery and 18 hospitals (62%) have the possibility of pediatric traumatological emergency care. Based on this information the structured exit wave plan was developed, which enables a secondary transfer of at least 100 patients to qualified trauma centers.
The University Hospital of Ulm has made preparations to admit at least 100 injured patients for initial medical treatment following a terrorist attack. This corresponds to 10% of the hospital beds as required in the literature. Together with the neighboring Military Hospital and the University and Rehabilitation Hospital Ulm up to 300 injured patients can be treated; however, the number of available intensive care unit (ICU) beds and capacities in normal wards for definitive care is much lower, therefore, patients treated according to the principles of damage control resuscitation have to be relocated. By documenting the capacity of the hospitals within a 100 km radius around Ulm and taking their specific features into account, an exit wave plan could be created that enables patient distribution for definitive care without time-consuming procedures.
恐怖袭击之后，人们担心会出现二次伤害。现场应急服务的适当反应是清理现场。由于在这类事件中，事发地点不会设立治疗区域，伤者会自行或由应急服务部门迅速送往最近的医院，且大多未得到治疗。因此，医院必须准备好在极短时间内接收比常规大规模伤亡事件后数量多得多的伤者。鉴于可能有大量伤员，急诊科可提供初步医疗护理，但远非所有入院伤员都能得到最终治疗。
为了根据损伤控制复苏标准在初始治疗后为受伤患者提供个性化医疗护理，应制定一个概念，以便有组织地将患者二次转运至配备适当设备的接收医院。
联系了乌尔姆方圆100公里内所有获得德国创伤外科学会认证的医院，询问它们能够全天候（一周7天，一天24小时）收治和治疗多少例分诊类别为T1（红色）、T2（黄色）和T3（绿色）的急诊患者。考虑了诸如直升机停机坪、神经外科护理和儿科创伤护理等特殊情况。
在乌尔姆方圆100公里内的32家医院中，29家（91%）提供了收治能力信息。在这些医院中，全天候可收治45例T1患者、121例T2患者和333例T3患者。29家医院中有26家（90%）设有直升机停机坪，11家医院（38%）可进行急诊神经外科治疗，18家医院（62%）具备儿科创伤急诊护理能力。基于这些信息制定了结构化的出院流程计划，该计划能够将至少100名患者二次转运至合格的创伤中心。
乌尔姆大学医院已做好准备，在恐怖袭击后收治至少100名受伤患者进行初始医疗治疗。这相当于文献中要求的医院床位的10%。连同邻近的军事医院以及乌尔姆大学和康复医院，最多可治疗300名受伤患者；然而，可用的重症监护病房床位数量以及普通病房用于最终治疗的能力要低得多，因此，根据损伤控制复苏原则治疗的患者必须转移。通过记录乌尔姆方圆100公里内医院的收治能力并考虑其特殊情况，可制定出院流程计划，实现患者的合理分配以进行最终治疗，而无需耗时的程序。
