Zusammenfassung
Im Rahmen der vorliegenden Publikation sollen die personellen und strukturellen Voraussetzungen beschrieben werden, die für eine adäquate und qualitätsorientierte Diagnostik und Akutbehandlung schwerverletzter Patienten als Grundlage zu sehen sind. Es werden Angaben zur Zusammensetzung und Qualifikation des Schockraumteams, Aktivierungskriterien, Versorgungsqualität sowie zu baulichen und apparativen/medizintechnischen Voraussetzungen gegeben.
Klinische Studien wurden über systematische Literatursuchen (Medline, Cochrane und Handsuchen) und Klassifikation nach Evidenzgüte (Level 1–5 nach Oxford-Schema) zusammengetragen.
Das Basisschockraumteam sollte mit Vertretern der (unfall)chirurgischen, anästhesiologischen und radiologischen Disziplinen sowie 1–2 Pflegekräften der jeweiligen Abteilungen besetzt werden. Der unfallchirurgische Oberarzt sollte innerhalb von ca. 20 min im Schockraum anwesend sein. Definierte Verletzungskriterien (Hochrasanztrauma, penetrierende Verletzungen des Körperstamms, GCS≤14, Intubation u.a.) sollten zur Aktivierung des Schockraumteams führen. Der Schockraum selbst sollte zentral in der Notaufnahme integriert sein und alle medizintechnischen Voraussetzungen für eine optimale Diagnostik und Akutbehandlung schwer- und schwerstverletzter Patienten ständig vorhalten. Die Möglichkeit zur Computertomographie (CT) sollte sich in unmittelbarer Nähe befinden.
Eine adäquate Versorgung Schwerverletzter setzt optimale Strukturen voraus. Um diese zu gewährleisten, ist ein hoher apparativer und personeller Aufwand unabdingbar, der trotz hoher Kosten durch die verbesserte Versorgungsqualität gerechtfertigt wird.
Abstract
The aim of the study was the description of personal and structural preconditions essential for adequate diagnostic requirements and treatment in severely injured patients. Herein we give detailed information regarding both the composition and qualification of the trauma team and the activation criteria as well as instructions for the design of the emergency room and technical requirements.
Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).
The trauma team should consist of (trauma) surgeons, anesthesiologists, radiologists, and one to two nursing staff members of each department. The attending physician should be present within 20 min. Trauma team activation criteria are among others: high energy/velocity trauma, penetrating injuries, GCS ≤14, and intubation. The emergency room should be integrated in the emergency department with all technical equipment being permanently available for optimal diagnostic and therapeutic management. A CT scanner should be positioned nearby.
Adequate management of severely injured patients requires optimal personal and structural conditions. High costs and additional personnel are justified by improved quality of treatment.
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Danksagung
Wir danken Herrn Prof. Dr. med. A. W. Rettenmeier (Direktor: Institut für Hygiene und Arbeitsmedizin, Universitätsklinikum Essen) sowie Frau Dr. med. K. Stang (Institut für Hygiene und Arbeitsmedizin, Universitätsklinikum Essen) für die Hilfe und Unterstützung bei der Bearbeitung der arbeitsmedizinischen Fragen.
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Kühne, C.A., Ruchholtz, S., Sauerland, S. et al. Personelle und strukturelle Voraussetzungen der Schockraumbehandlung Polytraumatisierter. Unfallchirurg 107, 851–861 (2004). https://doi.org/10.1007/s00113-004-0813-z
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DOI: https://doi.org/10.1007/s00113-004-0813-z