Pfenninger Ernst G, Naser J, Träger K, Dennler U, Jungwirth B, Schindler S, Henn-Beilharz A, Geldner G, Bürkle H
Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland.
Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, RKH-Klinikum Ludwigsburg, Ludwigsburg, Deutschland.
Anaesthesist. 2021 Nov;70(11):951-961. doi: 10.1007/s00101-021-00961-4. Epub 2021 Apr 28.
A sharp rise in COVID-19 infections threatened to lead to a local overload of intensive care units in autumn 2020. To prevent this scenario a nationwide relocation concept was developed.
For the development of the concept publicly available infection rates of the leading infection authority in Germany were used. Within this concept six medical care regions (clusters) were designed around a center of maximum intensive care (ECMO option) based on the number of intensive care beds per 100,000 inhabitants. The concept describes the management structure including a structural chart, the individual tasks, the organization and the cluster assignment of the clinics. The transfers of intensive care patients within and between the clusters were recorded from 11 December 2020 to 31 January 2021.
In Germany and Baden-Württemberg, 1.5% of patients newly infected with SARS-CoV‑2 required intensive care treatment in mid-December 2020. With a 7-day incidence of 192 new infections in Germany, the hospitalization rate was 10% and 28-35% of the intensive care beds were occupied by COVID-19 patients. Only 16.8% of the intensive care beds were still available, in contrast to 35% in June 2020. The developed relocation concept has been in use in Baden-Württemberg starting from 10 December 2020. From then until 7 February 2021, a median of 24 ± 5/54 intensive care patients were transferred within the individual clusters, in total 154 intensive care patients. Between the clusters, a minimum of 1 and a maximum of 15 (median 12.5) patients were transferred, 21 intensive care patients were transferred to other federal states and 21 intensive care patients were admitted from these states. The total number of intensive care patients transferred was 261.
If the number of infections with SARS-CoV‑2 increases, a nationwide relocation concept for COVID-19 intensive care patients and non-COVID-19 intensive care patients should be installed at an early stage in order not to overwhelm the capacities of hospitals. Supply regions around a leading clinic with maximum intensive care options are to be defined with a central management that organizes the necessary relocations in cooperation with regional and superregional rescue service control centers. With this concept and the intensive care transports carried out, it was possible to effectively prevent the overload of individual clinics with COVID-19 patients in Baden-Württemberg. Due to that an almost unchanged number of patients requiring regular intensive care could be treated.
2020年秋季，新型冠状病毒肺炎（COVID-19）感染人数急剧上升，有可能导致当地重症监护病房不堪重负。为防止这种情况发生，制定了一项全国性的转运方案。
在制定该方案时，使用了德国主要感染防控机构公开的感染率。在此方案中，根据每10万居民的重症监护病床数量，围绕一个具备最高重症监护能力（体外膜肺氧合[ECMO]选项）的中心，划分了六个医疗护理区域（集群）。该方案描述了管理结构，包括组织结构图、各项任务、组织架构以及各诊所的集群分配。记录了2020年12月11日至2021年1月31日期间重症监护患者在集群内部以及集群之间的转运情况。
在德国和巴登-符腾堡州，2020年12月中旬，1.5%的新冠病毒（SARS-CoV-2）新感染患者需要重症监护治疗。德国7天新增感染发病率为192例时，住院率为10%，COVID-19患者占用了28%-35%的重症监护病床。仅有16.8%的重症监护病床可用，而2020年6月这一比例为35%。制定的转运方案自2020年12月10日起在巴登-符腾堡州启用。从那时起到2021年2月7日，各集群内部平均有24±5/54名重症监护患者被转运，总计154名重症监护患者。在集群之间，最少转运1名、最多转运15名（中位数为12.5）患者，21名重症监护患者被转运至其他联邦州，同时有21名重症监护患者从这些州转入。重症监护患者的总转运人数为261名。
如果SARS-CoV-2感染人数增加，应尽早制定针对COVID-19重症监护患者和非COVID-19重症监护患者的全国性转运方案，以免医院不堪重负。应确定一个具备最高重症监护能力的主要诊所周边的供应区域，并通过中央管理机构进行组织，该机构与地区及跨地区急救服务控制中心合作安排必要的转运工作。通过这一方案以及实施的重症监护转运，巴登-符腾堡州有效地防止了个别诊所因COVID-19患者而不堪重负。因此，需要常规重症监护的患者数量基本保持不变，仍可得到治疗。
