Der Unfallchirurg
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Due to revised conditions of medical care in Germany, in particular the introduction of the newly designated specialist for orthopaedics and trauma surgery, the working conditions in trauma surgical clinics in Germany has changed. In May 2008 the professional committee of the German Trauma Society conducted a survey at the 729 trauma surgical clinics and departments in order to establish the true level of care at these particular sites. The results of the 90,000 variables presented in the following article, reflect the changes in trauma care as well as in the medical care structures and emphasize the increased work load. In particular the lack of qualified candidates underlines the main explanation for vacant posts and is also evaluated in this article.
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Relevant changes have occurred in disaster management in Germany due to legal alterations and the introduction of the diagnosis-related groups (DRG) system. This has resulted in a reduction in bed capacities and an increase in bed utilization. In addition to the preclinical deployment strategy the provisional aspects of disaster medicine with the problem of the emergency service/hospital interface will be described. A suggestion for a solution for optimization of patient allocation in mass disasters or catastrophes will be demonstrated with the catastrophe network of the German Society for Trauma Surgery (DGU).
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Life-threatening situations after multiple trauma which then require interruption of the diagnostic algorithm and immediate surgical treatment after admission are a challenge for the multidisciplinary trauma team. Emergency surgery after trauma may be necessary for the abdomen, the pelvis, the chest as well as the head. Therefore, several disciplines may be involved. ⋯ However, surgical interventions in the shock room rarely occur in the German health system. Therefore, indications and decision-making processes of these challenging situations have to be practiced with standardized algorithms. The "Definitive Surgical Trauma Care" (DSTC)- courses may contribute to a straightforward performance in an emergency operation.