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Versorgungsstrategien beim MANV/TerrorMANV in der Unfall- und Gefäßchirurgie

Darstellung eines Versorgungskonzeptes

Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery

Presentation of a treatment concept

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Zusammenfassung

Der Massenanfall von Verletzten (MANV) stellt das Rettungssystem und die Kliniken vor große Herausforderungen. Aufgrund der zunehmenden Terroraktivitäten ist es erforderlich, sich mit dieser neuen Form der Bedrohung der Zivilgesellschaft im Hinblick auf die medizinische Versorgung der Terroropfer zu beschäftigen. Zwischen einem „normalen“ MANV und einem TerrorMANV bestehen erhebliche Unterschiede im Hinblick auf die auftretenden Verletzungsmuster (stumpfes Trauma vs. penetrierendes/perforierendes Trauma), die Art und Weise des Geschehens (MANV = statische Lage vs. TerrorMANV = dynamische Lage) und die unterschiedlichen Sicherheitslagen (Rettungsdienstlage vs. Polizeilage). Dieser Artikel beschäftigt sich mit der Frage, welche Veränderungen diese neuen Anforderungen bei der chirurgischen Versorgung von Patienten erforderlich machen. Ärztliche Kollegen müssen sich mit den veränderten Verletzungsmustern vertraut machen, wobei hier die Schuss- und Explosionsverletzungen im Vordergrund stehen. Weiterhin sind geänderte taktisch-strategische Vorgehensweisen („damage controle surgery“ vs. „tactical abbreviated surgical care“) erforderlich, um möglichst vielen Patienten in einer Terrorlage das Überleben zu sichern und dabei gleichzeitig ein möglichst gutes funktionelles Ergebnis zu erreichen. Nur mit einer Änderung des „mindset“ bei der Behandlung eines TerrorMANV gegenüber eines MANV wird es möglich sein, dieser neuen Herausforderung erfolgreich zu begegnen. Wesentliche Komponente dieses „mindset“ ist, sich ein Maximum an Flexibilität anzueignen. Dazu möchte dieser Artikel beitragen.

Abstract

The treatment of patients in the context of mass casualty incidents (MCI) represents a great challenge for the participating rescue workers and clinics. Due to the increase in terrorist activities it is necessary to become familiar with this new kind of threat to civilization with respect to the medical treatment of victims of terrorist attacks. There are substantial differences between a “normal” MCI and a terrorist MCI with respect to injury patterns (blunt trauma vs. penetrating/perforating trauma), the type and form of the incident (MCI=static situation vs. terrorist attack MCI= dynamic situation) and the different security positions (rescue services vs. police services). This article is concerned with question of which changes in the surgical treatment of patients are made necessary by these new challenges. In this case it is necessary that physicians are familiar with the different injury patterns, whereby priority must be given to gunshot and explosion (blast) injuries. Furthermore, altered strategic and tactical approaches (damage control surgery vs. tactical abbreviated surgical care) are necessary to ensure survival for as many victims of terrorist attacks as possible and also to achieve the best possible functional results. It is only possible to successfully counter these new challenges by changing the mindset in the treatment of terrorist MCI compared to MCI incidents. An essential component of this mindset is the acquisition of a maximum of flexibility. This article would like to make a contribution to this problem.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eseleberg 40, 89081, Ulm, Deutschland

    B. Friemert & A. Achatz

  2. Klinik für Unfallchirugie und Orthopädie, Wiederherstellungs, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstr. 170, 56072, Koblenz, Deutschland

    A. Franke & D. Bieler

  3. Klinik für Allgemein‑, Visceralchirurgie- und Thoraxchirurgie, Bundeswehrkrankenhaus Hamburg, Lesserstr. 180, 22049, Hamburg, Deutschland

    D. Hinck

  4. Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    M. Engelhardt

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  1. B. Friemert
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  2. A. Franke
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  3. D. Bieler
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  4. A. Achatz
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  5. D. Hinck
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  6. M. Engelhardt
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Correspondence to B. Friemert.

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Interessenkonflikt

B. Friemert, A. Franke, D. Bieler, A. Achatz, D. Hinck und M. Engelhardt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Friemert, B., Franke, A., Bieler, D. et al. Versorgungsstrategien beim MANV/TerrorMANV in der Unfall- und Gefäßchirurgie. Chirurg 88, 856–862 (2017). https://doi.org/10.1007/s00104-017-0490-4

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  • DOI: https://doi.org/10.1007/s00104-017-0490-4

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