• Maximilian Kippnich, Yvonne Jelting, Martin Kraus, Thorsten Artmann, Thomas Wurmb, and Peter Kranke.
• Anasthesiol Intensivmed Notfallmed Schmerzther. 2018 Jul 1; 53 (7-08): 551-558.

BackgroundDue to the increasing threat by terrorism and the resulting range of operations for the emergency medical service, the equipment as well as the rescue strategies are being adapted and expanded. An example is the "Recommended Action for Emergency Medical Services in Special Operations" (REBEL, Handlungsempfehlung für Rettungsdienst bei besonderen Einsatzlagen) of the highest Bavarian rescue service authority. In the following article, three cases are presented using new tools such as hemostyptics, thoracic patches and tourniquet from the REBEL kit in everyday operations.CasesThe first case deals with a seriously injured driver involved in a truck accident suffering from a scalping violation of the facial skeleton with consecutive critical bleeding (use of hemostyptics-coated dressings). The second case describes an accident with a reinforcing steel perforating a builder's chest. After removal of the perforating steel by first aiders, the two open thoracic wounds are supplied with thoracic closure patches. The third case deals with an amputation injury of the lower leg after a traffic accident (use of tourniquet).DiscussionThe most common causes of death besides bleeding that can be prevented in patients with severe injuries and multiple trauma are tension pneumothorax and airway obstruction. These diagnoses can be identified and treated properly using the ABCDE algorithm. In these cases, the new tools such as tourniquet, hemostyptics, chest decompression needles and thoracic closure patches can be used, which are increasingly held as an additional equipment in the ambulance vehicle. The application of these adjuvants requires a critical indication, competent knowledge and training of medical and non-medical emergency service personnel in theory and practice.Georg Thieme Verlag KG Stuttgart · New York.

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