20110720_S3-LL Polytrauma DGU_final_eng_cleaned_mc_korrigiert

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S3 Guideline on Treatment of Patients with Severe and Multiple Injuries References 1. Field, M.J. and K.N. Lohr, eds. Clinical Practice Guidelines: Directions for a New Program. 1990, National Academy Press: Washington, D.C. 2. Council of Europe, Developing a Methodology for drawing up Guidelines on Best Medical Practices: Recommendation Rec(2001)13 adopted by the Committee of Ministers of the Council of Europe on 10 October 2001 and explanatory memorandum. 2001, Strasbourg Cedex: Council of Europe. 3. Kopp, I.B., [Perspectives in guideline development and implementation in Germany.]. Z Rheumatol, 2010. 4. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. 3-Stufen-Prozess der Leitlinien-Entwicklung: eine Klassifizierung. 2009; Available from: http://www.uniduesseldorf.de/AWMF/ll/ll_s1-s3.htm. 5. Robert Koch-Institut, ed.; Gesundheit in Deutschland. Gesundheitsberichterstattung des Bundes. 2006, Robert Koch-Institut: Berlin. 6. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin. Unfallstatistik: Unfalltote und Unfallverletzte 2007 in Deutschland. 2007; Available from: www.baua.de/cae/servlet/content blob/672542/publicationFile/49620/Unfallstatistik- 2007.pdf;jsessionid=CC8B45BA699EE9E4E11AC1E AD359CB34. 7. Bouillon, B., et al., Weißbuch Schwerverletzten- Versorgung. Empfehlungen zur Struktur, Organisation und Ausstattung stationärer Einrichtungen zur Schwerverletzten-Versorgung in der Bundesrepu-blik Deutschland., ed. D.G.f.U.e.V. (DGU). 2006, Berlin: Dt. Gesellschaft für Unfallchirurgie e.V. 8. Oxford Centre of Evidence-based Medicine (CEBM): Levels of Evidence (March 2009); Available from: www.cebm.net/index.aspx?o=1025. 9. Schmiegel, W., et al.: S3-Leitlinie “Kolorektales Karzinom: Available from: www.krebsgesellschaft.de/download/s3_ll_kolorektal es_karzinom_2008.pdf. - 13 -
S3 Guideline on Treatment of Patients with Severe and Multiple Injuries 1 Prehospital 1.1 Introduction Within the structured emergency services, the professional treatment of severely injured patients starts right at the accident scene. The subsequent course can be set at this stage. So, even for this initial treatment phase, it is expedient and necessary to develop the clearest priorities and strategies for dealing with the situation. Due to the difficult environmental conditions in the prehospital emergency situation, the evidence level is low yet the full diversity of experience and expert knowledge is considerable. Moreover, the benefit-risk evaluation is disputed in a number of interventions, not least in considering the point at which an essentially indicated intervention should be carried out, for example, in the prehospital phase or only once admitted to hospital. Finally, the polarization between “stay and treat” and “load and go” also plays a role here. In addition, a large amount of scientific knowledge has been gained from different emergency systems and its transferability to specific situations in Germany is often ambiguous. Those active on the spot want a highly specific recommendation with broad validity but this desire is in conflict with the unfortunately often weak data available and the resulting unreliable conclusions. This desire can only be met by achieving a consensus among the experts, on the understanding that scientific uncertainty continues to exist in such areas and that there are differences between different emergency systems and cultures. The structuring of the prehospital guideline section is based on several considerations. Basically, the management of a (potentially) severely injured patient involves a sequence of actions that follow certain priorities. Every detail and individual step of the sequence itself cannot be evidence-based with proof of general validity. Moreover, many individual circumstances relating to the actual patient have to be considered so that not all possible sequence models can be depicted. The contents of the guideline were therefore not oriented to a specific sequence algorithm but focused instead on individual aspects. These sections concentrate on anatomic regions (head, chest, abdomen, spine, extremities, and pelvis). In the prehospital phase, very few invasive interventional options are available; of these the most important (volume replacement, airway management, chest drain) are dealt with in terms of indications and implementation. The individual aspects, interventions, and guidelines must be embedded in a general pathway of action that sets priorities and prescribes action pathways and sequences. A framework of this kind can be provided by programs such as Prehospital Trauma Life Support (PHTLS), Advanced Trauma Life Support (ATLS), European Trauma Course (ETC), and others. As such programs already exist and the individual steps cannot be individually scientifically proven, as indicated above, the attempt was not made to develop such a program in this guideline package. The individual guidelines are not intended to replace these programs but to represent the aspects embedded in them. Besides directly treating the individual patient, general aspects also play a role in the prehospital phase. On the one hand, a decision must be made about the designated hospital. It must be able to treat all acute, life-threatening injuries immediately and independently. The initial-treating hospital must have clear, well-ordered transfer strategies for injuries which require a special structure or expertise. In addition to the increasing number of trauma networks being set up, the Prehospital - Introduction 14
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20110720_S3-LL Polytrauma DGU_final_eng_cleaned_mc_korrigiert

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