Der Unfallchirurg
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Clinical algorithms can divide sophisticated treatment concepts for blunt trauma care into logical, systematic and easy to follow sequences. The presented algorithm for prehospital management of major and suspected blunt trauma will assure appropriate trauma care within narrow time windows. ⋯ Due to the lack of evident data the algorithm was confirmed via consent expert opinion of trauma surgeons, incorporating the ABC priorities and also the concept of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.
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The rescue and treatment of trapped persons in car accidents requires a close cooperation and coordination between firefighters and medical personnel. Priorities of medical care as well as aspects of extrication should be considered equally. ⋯ The concept incorporates the ABC priorities for polytrauma management and also the structure of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.
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Patient safety is determined by the performance safety of the medical team. Errors in medicine are amongst the leading causes of death of hospitalized patients. These numbers call for action. Backgrounds, methods and new forms of training are introduced in this article. ⋯ As the need to reduce error rates in medicine is very high and the reasons, methods and training concepts are known, we are urged to implement these new training concepts widely and consequently. To err is human - not to counteract it is not.
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Case Reports
[Emergency treatment of penetrating, combined thoracic- and abdominal injury. Pre-hospital i.v. fluid therapy].
We report the rare case of a penetrating, combined thoracic- and abdominal injury as a consequence of a farm work accident. During the recent years, a "treat and run" approach has been increasingly advocated as a time-saving way of treating penetrating injuries, constituting a compromise between the existing strategies of "scoop and run" (used mainly in the USA) and "stay and treat" (preferred in Central Europe). A prolonged rescue response time makes the treat and run approach impossible here. ⋯ We examine the course of pre-hospital treatment of a trauma patient to illustrate the various approaches to i.v. fluid therapy in relation to rescue response time. However there are only a few studies with a real evidence. If "treat and run" is not possible, the outcome of patients with penetrating trauma can be influenced positively by moderate fluid therapy under continuous monitoring after having reached a constant, low mean arteria pressure (so called permissive hypotension).
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The growing number of mass casualty events during the early 1990s led, in January 1996, to the foundation of an honorary group of specially trained emergency physicians for dealing primarily with the management of large-scale emergency events and mass casualties. The incidence and quantity of these casualties was analysed in order to be better prepared for such events in the future. ⋯ All calls prospectively registered by the Augsburg Rescue Co-ordination Centre (ARCC) in the 5 years from July 1997 to June 2002 were analysed, distinguishing between the different types of damage, number of patients involved, and time of occurrence (time of day/season). The area served by the ARCC includes the city of Augsburg with its surrounding counties. An estimated 850,000 inhabitants live in this area of 4,100 square kilometers (1,600 square miles). Since 1998, more than 145,000 calls a year have been dealt with of which 28,000 were covered by emergency physicians. In the 5 year period discussed here, 75 large-scale-calls were registered, giving an average incidence of 1.25 calls/month. Most of the calls were fire alarms, followed by car accidents. In total, we were able to serve more than 800 patients. The lowest number per event was two people during an emergency landing of a sport aircraft; the largest number was about 150 patients during a large open-air event in the city. While there was no difference in the time of day at which the event happened, most occurred in November and December. Taking these results into account, the authors, supported by the members of the emergency physician team of the German Trauma Society, developed an algorithm describing the optimal procedure for mass casualty events. This is presented here. In mass casualty or large-scale emergency events, an experienced emergency physician is necessary to co-ordinate the rescue brigades on site.