Mentges D, Kirschenlohr R, Adamek H, Boldt J, Riemann J F
Klinik für Anaesthesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen am Rhein.
Anaesthesist. 1997 Feb;46(2):114-20. doi: 10.1007/s001010050380.
Major incidents are high-profile events where many lives are at stake. The response of the health-care-related agencies has to be well-planned and co-ordinated, thus retaining the public's confidence in the emergency services whilst efficiently responding to those in need. The communication between supervising officers such as medical incident officer (MIO) and ambulance incident officer (AIO) with the ambulance personnel is vital for the proper employment of doctors and ambulance teams at the incident scene. In Germany the experience gained at such events has not yet been collected into a single coherent and comprehensive analysis. This study investigates the delivery of ambulance vehicles and personnel at major incidents. Was appropriate emergency treatment and transport for each seriously injured patient possible? Were the communication structures between the supervising officers and the ambulance teams sufficient to provide effective co-ordination and utilisation of the teams at the scene?
A major incident was defined as any incident with more than ten casualties. All central ambulance controls (CAC) in the five federal states Rhineland-Palatinate, Bavaria, Saarland, Hessen, and Baden-Württemberg were asked by telephone and mail if a major incident had occurred in their area from September 1992 to September 1994. In cases of major incidents in other federal states of West Germany during that period, the appropriate CAC was contacted to collect data. A standardised questionnaire was send to the CACs. The data were split into chronological periods of responses to major incidents.
Twenty-one major incidents were included in the study, 11 of them road accidents. The mean time to arrival of physician-staffed ambulances at the scene was calculated as 20 min after alerting of the CAC. In 90% of all cases enough physicians were available to treat each seriously injured patient (NACA score 3-6). In 9 cases a MIO and an AIO were sent out. Their mean time to arrival at the scene was 25 min after alerting of the CAC. In 19 cases (90%) enough ambulance vehicles were provided to rapidly distribute all casualties. With one exception, this was also true for the use of helicopters. Onsite communication of the ambulance staff was always by direct personal contact. In 38% of all incidents the arriving ambulance staff had difficulties in contacting senior officers, and thus, nobody defined their roles and responsibilities.
Quality assurance in emergency medicine can only be achieved by research and documentation. Analysis of the data for this study revealed a severe documentation gap. Only in Bavaria did a one-page documentation form for major incidents exist. For a comprehensive analysis of the health-care-related response to major incidents, a standardised and detailed documentation form should be introduced. According to the data from this study, ambulance staff and vehicles can be quickly and sufficiently provided for the vast majority of major incidents in Germany. For the optimal use of these resources, however, communication skills and knowledge and understanding of on-side supervision structures such as the MIO and AIO need to be promoted.
重大事件是备受瞩目的事件，许多人的生命危在旦夕。医疗相关机构的应对措施必须精心规划和协调，从而在有效应对有需要的人员的同时，保持公众对紧急服务的信心。诸如医疗事件官员（MIO）和救护车事件官员（AIO）等监督官员与救护人员之间的沟通对于在事件现场合理调配医生和救护团队至关重要。在德国，此类事件所积累的经验尚未被整合为一份连贯且全面的分析报告。本研究调查了重大事件中救护车车辆和人员的调配情况。是否有可能为每一位重伤患者提供适当的紧急治疗和转运？监督官员与救护团队之间的沟通结构是否足以在现场有效协调和利用这些团队？
将重大事件定义为伤亡人数超过十人的任何事件。通过电话和邮件询问莱茵兰 - 普法尔茨、巴伐利亚、萨尔州、黑森和巴登 - 符腾堡这五个联邦州的所有中央救护车控制中心（CAC），1992年9月至1994年9月期间其所在地区是否发生过重大事件。对于在此期间西德其他联邦州发生的重大事件，联系相应的CAC以收集数据。向CAC发送标准化问卷。数据按对重大事件的响应时间顺序进行划分。
本研究纳入了21起重大事件，其中11起为道路交通事故。配备医生的救护车抵达现场的平均时间经计算为中央救护车控制中心发出警报后20分钟。在所有案例中，90%的情况下有足够的医生可用于治疗每一位重伤患者（北美分类法评分3 - 6分）。有9起事件派出了一名医疗事件官员和一名救护车事件官员。他们抵达现场的平均时间为中央救护车控制中心发出警报后25分钟。在19起事件（90%）中，提供了足够的救护车车辆以迅速疏散所有伤员。除了一起例外情况，直升机的使用也是如此。救护人员的现场沟通始终通过直接的个人接触进行。在所有事件的38%中，抵达的救护人员在联系高级官员时遇到困难，因此，无人明确他们的角色和职责。
急诊医学中的质量保证只能通过研究和记录来实现。对本研究数据的分析揭示了严重的记录空白。只有巴伐利亚州有一份针对重大事件的单页记录表格。为了对医疗相关机构对重大事件的应对进行全面分析，应引入标准化且详细的记录表格。根据本研究的数据，在德国，绝大多数重大事件能够迅速且充分地提供救护人员和车辆。然而，为了最佳利用这些资源，需要提升沟通技巧以及对诸如医疗事件官员和救护车事件官员等现场监督结构的了解。
