• D Nast-Kolb, C Waydhas, S Ruchholtz, and G Täger.
• Klinik für Unfallchirurgie, Universitätsklinikum, Hufelandstrasse 55, 45147 Essen, Deutschland. Dieter.Nast-Kolb@uk-essen.de
• Chirurg. 2007 Oct 1;78(10):885-93.

AbstractOptimal outcome in the treatment of multiple trauma patients requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times with respect to personnel, technical equipment, and emergency room design. The aim is-based on standardized and prioritized clinical pathways and algorithms-to identify and treat not only life-threatening and debilitating but all other injuries in a timely fashion. Diagnostic and therapeutic measures to manage airway, breathing, and circulatory problems (including transfusion and surgery for bleeding control) have priority, even over the operative treatment of severe head injuries. With respect to severe intra-abdominal and retroperitoneal injuries, the concept of damage control surgery has reached world wide acceptance. However, many parenchymal lesions of intra-abdominal organs can be managed nonoperatively. Similarly, damage control orthopedics for the initial management of major fractures with initial temporary and minimally invasive fracture stabilization followed by definitive osteosynthesis as soon as the patient has stable organ functions is gaining more acceptance. Maintainance of and improvement in the quality of care requires standardized documentation, regular analysis, and feedback in an internal quality management process as well as participation in an external quality program such as the Trauma Registry of the German Society for Accident Surgery.

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