Franke A, Bieler D, Paffrath T, Wurmb Th, Wagner F, Friemert B, Achatz G
Klinik für Unfallchirurgie und Orthopädie, Wiederherstellung- und Handchirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Klinikum Köln-Merheim, Köln-Merheim, Deutschland.
Unfallchirurg. 2020 Jun;123(6):453-463. doi: 10.1007/s00113-019-00735-z.
Terrorist-related mass casualty incidents represent a medical and organizational challenge for all hospitals. The main reasons are the special patterns of injuries, the onset and development of the scenario, the lack of information at the beginning, the overall number of casualties and the number of uninjured but involved patients presenting at the hospital.Due to these circumstances and the high percentage of penetrating injuries with a permanent risk of uncontrollable bleeding and other life-threatening complications, a strategic and tactical initial surgical care is necessary.For these special terrorist-related mass casualty (MasCal) situations, the Terror and Disaster Surgical Care (TDSC®) course was developed and imparts special medical and surgical knowledge as well as a scenario-based training in surgical decision-making. The TDSC® course focusses on the scenario-related provision of surgical care and distribution of the limited resources to enable survival for as many patients as possible.To improve individualized trauma care course formats, such as the Advanced Trauma Life Support (ATLS®) were established and are nowadays widespread in Germany. It could be shown that standardized approaches and algorithm-based treatment could improve the outcome of trauma victims. Faced with the present day permanent risk of a possible terrorist-related MasCal situation, the question arises how and to what extent elements and principles of both course formats (TDSC® and ATLS®) could be used to improve and organize the initial care in a terrorist-linked MasCal incident.For the first time it is shown that the key elements of both courses (primary survey of the ATLS® and the TDSC® principles: categorization, prioritization, disposition and realization) could be established and integratively used to structure the initial intrahospital medical and surgical care.
与恐怖主义相关的大规模伤亡事件对所有医院来说都是一项医疗和组织方面的挑战。主要原因包括损伤的特殊模式、事件的发生和发展、初期信息的匮乏、伤亡总人数以及前来医院就诊的未受伤但受影响患者的数量。由于这些情况以及穿透性损伤比例高且存在无法控制出血和其他危及生命并发症的永久风险，进行战略性和战术性的初期手术治疗是必要的。针对这些与恐怖主义相关的特殊大规模伤亡（MasCal）情况，开发了恐怖与灾难外科护理（TDSC®）课程，该课程传授特殊的医学和外科知识以及基于情景的手术决策培训。TDSC®课程专注于与情景相关的外科护理提供和有限资源的分配，以使尽可能多的患者存活。为改进个性化创伤护理课程形式，诸如高级创伤生命支持（ATLS®）等课程得以确立，如今在德国广泛开展。结果表明，标准化方法和基于算法的治疗可改善创伤受害者的预后。面对当前可能发生与恐怖主义相关的MasCal情况的永久风险，问题在于这两种课程形式（TDSC®和ATLS®）的要素和原则如何以及在何种程度上可用于改进和组织与恐怖主义相关的MasCal事件中的初期护理。首次表明，这两种课程的关键要素（ATLS®的初级评估以及TDSC®原则：分类、优先级排序、处置和实施）可以确立并综合用于构建医院内初期的医疗和外科护理结构。
