TY - JOUR A1 - Kippnich, Maximilian A1 - Duempert, Maximilian A1 - Schorscher, Nora A1 - Jordan, Martin C. A1 - Kunz, Andreas S. A1 - Meybohm, Patrick A1 - Wurmb, Thomas T1 - Simultaneous treatment of trauma patients in a dual room trauma suite with integrated movable sliding gantry CT system: an observational study JF - Scientific Reports N2 - The trauma center of the University Hospital Wuerzburg has developed an advanced trauma pathway based on a dual-room trauma suite with an integrated movable sliding gantry CT-system. This enables simultaneous CT-diagnostics and treatment of two trauma patients. The focus of this study was to investigate the quality of the concept based on defined outcome criteria in this specific setting (time from arrival to initiation of CT scan: tCT; time from arrival to initiation of emergency surgery: tES). We analyzed all trauma patients admitted to the hospital’s trauma suite from 1st May 2019 through 29th April 2020. Two subgroups were defined: trauma patients, who were treated without a second trauma patient present (group 1) and patients, who were treated simultaneously with another trauma patient (group 2). Simultaneous treatment was defined as parallel arrival within a period of 20 min. Of 423 included trauma patients, 46 patients (10.9%) were treated simultaneously. Car accidents were the predominant trauma mechanism in this group (19.6% vs. 47.8%, p < 0.05). Prehospital life-saving procedures were performed with comparable frequency in both groups (intubation 43.5% vs. 39%, p = 0.572); pleural drainage 3.2% vs. 2.2%, p = 0.708; cardiopulmonary resuscitation 5% vs. 2.2%, p = 0.387). At hospital admission, patients in group 2 suffered significantly more pain (E-problem according to Advanced Trauma Life Support principles©; 29.2% vs. 45.7%, p < 0.05). There were no significant differences in the clinical treatment (emergency procedures, vasopressor and coagulant therapy, and transfusion of red blood cells). tCT was 6 (4–10) minutes (median and IQR) in group 1 and 8 (5–15.5) minutes in group 2 (p = 0.280). tES was 90 (78–106) minutes in group 1 and 99 (97–108) minutes in group 2 (p = 0.081). The simultaneous treatment of two trauma patients in a dual-room trauma suite with an integrated movable sliding gantry CT-system requires a medical, organizational, and technical concept adapted to this special setting. Despite the oftentimes serious and life-threatening injuries, optimal diagnostic and therapeutic procedures can be guaranteed for two simultaneous trauma patients at an individual medical level in consistent quality. KW - dual-room trauma suite KW - movable sliding gantry KW - CT Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299695 VL - 12 IS - 1 ER - TY - JOUR A1 - Kippnich, Maximilian A1 - Schorscher, Nora A1 - Kredel, Markus A1 - Markus, Christian A1 - Eden, Lars A1 - Gassenmaier, Tobias A1 - Lock, Johann A1 - Wurmb, Thomas T1 - Dual‑room twin‑CT scanner in multiple trauma care: first results after implementation in a level one trauma centre JF - European Journal of Trauma and Emergency Surgery N2 - Purpose The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator. Methods All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained. Results 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9–34) (median and interquartile range, IQR). tCT was 15 (11–19) minutes (median and IQR) and tOR was 96.5 (75–119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1–6) (median and IQR) and one (0–1) (median and IQR) ventilator day. Conclusion The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously KW - trauma centre KW - trauma management KW - resuscitation time KW - dual-room whole-body CT Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232390 SN - 1863-9933 ER - TY - THES A1 - Schorscher, Nora T1 - Systematic literature review on lessons learnt from terrorist attacks with a focus on pre-hospital and in-hospital management T1 - Systematische Literatur Recherche über Terrorangriffe mit dem Fokus auf präklinischer und klinischer Versorgung von Verletzten N2 - Purpose: The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001. Methods: PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018. Results: 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied. Conclusions: The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation. N2 - Zweck: Die Bedrohung durch den nationalen und internationalen Terrorismus ist nach wie vor hoch. Vorbereitung ist die zentrale Voraussetzung für die Resilienz von Krankenhäusern und außerklinischen Rettungskräften. Die wissenschaftliche Evidenz für die Definition medizinischer und taktischer Strategien speist sich oft aus der Analyse realer Vorfälle und der daraus gezogenen Lehren. Diese systematische Literaturübersicht zielt darauf ab, Lehren aus Terroranschlägen seit 2001 zu ziehen und systematisch aufzuarbeiten. Methodik: Als Datenbank wurde PubMed verwendet. Dabei wurden bestimmte Suchstrategien und Auswahlkriterien genutzt. Alle Länder, die Teil der Organisation für wirtschaftliche Zusammenarbeit und Entwicklung (OECD) sind, wurden aufgenommen. Der Zeitrahmen wurde zwischen 2001 und 2018 festgelegt. Ergebnisse: 68 Artikel wurden in die Literaturrecherche inkludiert. Daraus wurden 616 gewonnene Erkenntnisse extrahiert und in 15 Kategorien zusammengefasst. Die Daten zeigen, dass trotz des Unterschieds bei den Angriffen, Ländern und Opfern, viele der gewonnenen Erkenntnisse ähnlich sind. Wir fanden auch heraus, dass sich das Muster der gelernten Lektionen während des untersuchten Zeitraums immer wieder wiederholte. Schlussfolgerungen: Die Lehren aus Terroranschlägen seit 2001 folgen einem gewissen Muster und blieben im Laufe der Zeit konstant. Um so viele Opfer wie möglich zu retten, die Rettungskräfte vor Schaden zu bewahren und Krankenhäuser auf dem bestmöglichen Niveau vorzubereiten, ist es wichtig, die identifizierten Lektionen in der Ausbildung und auch in der Einsatzvorbereitung umzusetzen. KW - Terror KW - Medical Managment KW - Lessons Learnt Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282133 ER - TY - JOUR A1 - Schorscher, Nora A1 - Kippnich, Maximilian A1 - Meybohm, Patrick A1 - Wurmb, Thomas T1 - Lessons learned from terror attacks: thematic priorities and development since 2001 - results from a systematic review JF - European Journal of Trauma and Emergency Surgery N2 - PURPOSE The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001. METHODS PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018. RESULTS Finally 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied. CONCLUSIONS The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation. KW - terror attacks KW - evaluation KW - lessons learned KW - emergency preparedness KW - public health preparedness KW - mass casualties Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-264862 SN - 1863-9941 VL - 48 ER - TY - JOUR A1 - Wurmb, Thomas A1 - Franke, Axel A1 - Schorscher, Nora A1 - Kowalzik, Barbara A1 - Helm, Matthias A1 - Bohnen, Renate A1 - Helmerichs, Jutta A1 - Grueneisen, Ulrich A1 - Cwojdzinski, Detlef A1 - Jung, Georg A1 - Lücking, Gesa A1 - Weber, Martin T1 - Emergency response to terrorist attacks: results of the federal-conducted evaluation process in Germany JF - European Journal of Trauma and Emergency Surgery N2 - Purpose Rescue missions during terrorist attacks are extremely challenging for all rescue forces (police as well as non-police forces) involved. To improve the quality and safety of the rescue missions during an active killing event, it is obligatory to adapt common rescue mission goals and strategies. Methods After the recent attacks in Europe, the Federal Office of Civil Protection and Disaster Assistance started an evaluation process on behalf of the Federal Ministry of the Interior and the Federal Ministry of Health. This was done to identify weaknesses, lessons learned and to formulate new adapted guidelines. Results The presented bullet point recommendations summarise the basic and most important results of the ongoing evaluation process for the Federal Republic of Germany. The safety of all the rescue forces and survival of the greatest possible number of casualties are the priority goals. Furthermore, the preservation and re-establishment of the socio-political integrity are the overarching goals of the management of active killing events. Strategic incident priorities are to stop the killing and to save as much lives as possible. The early identification and prioritised transportation of casualties with life-threatening non-controllable bleeding are major tasks and the shortest possible on-scene time is an important requirement with respect to safety issues. Conclusion With respect to hazard prevention tactics within Germany, we attributed the highest priority impact to the bullet points. The focus of the process has now shifted to intense work about possible solutions for the identified deficits and implementation strategies of such solutions during mass killing incidents. KW - terror attack KW - mission strategies KW - lessons learned KW - first responders KW - safety Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231777 SN - 1863-9933 VL - 46 ER - TY - JOUR A1 - Wurmb, Thomas A1 - Scholtes, Katja A1 - Kolibay, Felix A1 - Schorscher, Nora A1 - Ertl, Georg A1 - Ernestus, Ralf-Ingo A1 - Vogel, Ulrich A1 - Franke, Axel A1 - Kowalzik, Barbara T1 - Hospital preparedness for mass critical care during SARS-CoV-2 pandemic JF - Critical Care N2 - Mass critical care caused by the severe acute respiratory syndrome corona virus 2 pandemic poses an extreme challenge to hospitals. The primary goal of hospital disaster preparedness and response is to maintain conventional or contingency care for as long as possible. Crisis care must be delayed as long as possible by appropriate measures. Increasing the intensive care unit (ICU) capacities is essential. In order to adjust surge capacity, the reduction of planned, elective patient care is an adequate response. However, this involves numerous problems that must be solved with a sense of proportion. This paper summarises preparedness and response measures recommended to acute care hospitals. KW - Mass critical care KW - Disaster response KW - SARS-CoV-2 KW - Hospital emergency plan Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230201 VL - 24 ER -