with a focus on trauma - meshhp · 1 the german rescue system with a focus on trauma c. waydhas...

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The German Rescue Systemwith a

Focus on Trauma

C. Waydhas

University Hospital Essen

Titel

Trauma Surgery, University Hospital Essen

Geographical Facts

Mongolia Germany

Area 1.564.116 km2 357.021 km2

Population 2.95 million 81,1 million

Urban population 40 % 89%

Population density 1,9 / km2 227 / km2

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Urgency and Emergency

• Doctors on-call („Ärztlicher Notdienst“) Tel. 116117

Diseases or conditions that require urgent treatment

(within hours) but are not life-threatening, provided mostly

by general practitioners and internists

• Emergency Medical Service („Rettungsdienst“) Tel. 112

Diseases or conditions that are life-threatening and

require emergent treatment (within minutes or less than an

hour). New: eCall (starting by 2018)

paramedics

(prehospital) emergency physicians

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Dispatch Center

Decision which type of rescue vehicle (emergency

physician required or not)

Decision which specific vehicle

Rescue time < 8 to 15 minutes (>95% of cases)

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Qualification of Emergency Physicians

• 24 months of training (patient-centered, in-hospital, acute care)

• 6 months of training in intensive care, anaesthesiology or

emergency department

• 80 hours course in emergeny care

• 50 accompanied missions in ground or air ambulance

(with physician)

Specific skills and knowledge

• Endotracheal intubation (≥25)

• Manual/mechanical ventilation

• cardio-pulmonary reanimation

• Intravenous access (≥50)

• Chest tube insertion ( ≥2)

• ..........

Titel


A definite treatment of major emergency conditions such as

STEMI (ST-elevation myocardial infarction): PCI

Stroke: decision for lysis

Severe traumatic brain injury: start of surgery

Polytrauma: start of surgery

should be achieved/started within 90 min

To attain this goal it has to be aimed at an intervall between

the emergency call and admission to the (appropriate)

hospital of less than 60 minutes

Corner Pointsfor the emergency care of the German population

German Medical Association 2007and 16 Medical Societies

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Titel


Consequences:

• Appropriate structure and organisation

of the prehospital rescue system

• Appropriate medical priorities of the

amublance team

• Appropriate structure and organisation

of the emergency room in the hospital

Corner Pointsfor the emergency care of the German population

German Medical Association 2007and 16 Medical Societies

Titel


Air Rescue

Helicopter Service

• Primary Rescue

• Secondary transfer,

critically ill patients

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State Traffic accidents

(died/survived(%))

Area (km2) per

Hospital

Area (km2) per

helicopter

Mecklenburg 2.7 4634 7724

Brandenburg 2.4 5895 9825

Thüringen 2.3 1470 5390

Sachsen-Anh. 2.2 1858 20445

Niedersachsen 1.6 2506 9523

Sachsen 1.6 1673 6137

Bayern 1.6 1720 8818

Rheinland-Pf.. 1.5 1653 6615

Baden-Wür. 1.4 1430 7150

Schleswig-Hol. 1.2 2251 7881

Hessen 1.2 1319 7038

Saarland 1.2 856 2568

NRW 1.1 541 4869

Berlin 0.5 89 891

Bremen 0.5 101 404

Hamburg 0.4 151 387

Availability of Hospitals

Road traffic statistics 2002

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State Traffic accidents

(died/survived(%))

Area (km2) per

Hospital

Area (km2) per

helicopter



Thüringen 2.3 1470 5390

Sachsen-Anh. 2.2 1858 20445


Sachsen 1.6 1673 6137

Bayern 1.6 1720 8818

Rheinland-Pf.. 1.5 1653 6615

Baden-Wür. 1.4 1430 7150


Hessen 1.2 1319 7038

Saarland 1.2 856 2568

NRW 1.1 541 4869

Berlin 0.5 89 891

Bremen 0.5 101 404

Hamburg 0.4 151 387


Verkehrsunfallstatistik 2002Road traffic statistics 2002

2,7

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State Road traffic accidents

mortality (%)

Area (km2) per

Hospital

Area (km2) per

helicopter



Thüringen 2.3 1470 5390

Sachsen-Anh. 2.2 1858 20445


Sachsen 1.6 1673 6137

Bayern 1.6 1720 8818

Rheinland-Pf.. 1.5 1653 6615

Baden-Wür. 1.4 1430 7150


Hessen 1.2 1319 7038

Saarland 1.2 856 2568

NRW 1.1 541 4869

Berlin 0.5 89 891

Bremen 0.5 101 404

Hamburg 0.4 151 387


Verkehrsunfallstatistik 2002Road traffic statistics 2002

2,7

1,1

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Causes of Mortality in Germany

Diseases of the heart and

the vascular system

myocardial infarction

Cancer

Diseases of the

respiratory system

Diseases of the GI-tract

Injuries

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Causes of Mortality in Mongolia

78/100.000

Cardiovascular: 380/100.000

Cancer: 206/100.000

Injury: 78/100.000

Leading cause of death

in age group 25-44yrs

WHO/OECD Report Asia 2012

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Lost Years in Work (*1000)

0 200 400 600 800 1000

Verletzungen

Psych. Erkrank.

Neoplasie

Muskulo-skelet.

Herz-Kreislauf

Atemorgane

Verdauungstrakt

Neurol. Erkrank.

Federal Statistical Office 2008; www.destatis.de

neurological d.

GI-tract

respiratory syst.

heart/circulation

musculo/skelet.

malignacies

psychiatric d.

injuries

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Causes of Trauma Mortality

Soreide et al., World J Surg 2007

TBI: 67%

Bleeding: 25%

MOF: 8%

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Medical Errors in Trauma Care„Lessons Learned From 2594 Deaths“

Gruen et al, Ann Surg 2006

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Titel


Trauma-Center Approach

• Local

Trauma Center

• Regional

Trauma Center

• Supraregional

Trauma Center

Titel


50 Trauma-

Networks

with 557

Trauma Centers

(certified)

Re-Audit

every 3 years

Trauma-Center Approach

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Defines:

• Structural

requirements

• Personnel

requirements

• Organisational

requirements

• Networking between

trauma centers

• Quality Management

White Book of Trauma Care

Titel


Prehospital:

• Airway Management

• Volume Therapy

• Analgesia

• Chest Trauma

• Head Injury

• Spinal Trauma

• Extremity Trauma

• Mass Casualty

Polytrauma Guideline Update 2015

• Prehospital Phase

• Emergency / Shock

Room Phase

• First Operation

Phase

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American College of Surgeons

Advanced Trauma

Life Support

for Doctors

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Traumaregister

• Input (online-registry) of data (prehospital, emergency

room, operation, intensive care unit, outcome)

• Output of your performance compared with the

average

www.traumaregister.de

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Traumaregister


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Traumaregister


Injury severity vs. Length of stay

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Traumaregister


Observed vs. expected outcome

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Conclusions

• Physician-based ambulance concept

• Specific training requirements for

emergency physicians

• System of geographical coverage for

rescue vehicles and hospitals

• Predefined structural and organisational

requirements for trauma care

with a focus on trauma - meshhp · 1 the german rescue system with a focus on trauma c. waydhas...

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