Guideline on Treatment of Patients with Severe and Multiple ... - AWMF

S3 <strong>Guideline</strong> on Treatment of Patients with Severe and Multiple Injuries
recommendations in the White Paper of the German Trauma Society [1] may be of great benefit
here [2]. The resulting local and regional regulations can provide the emergency physician with
additional support when selecting a suitable designated hospital. Besides the hospital structure,
however, organizational and logistical circumstances, weather and road conditions or the time of
day can also be significant in addition to purely medical considerations. Inextricably linked to
this is the question of whether the patient is in fact severely injured. Criteria for this purpose are
defined which are aligned to actual detected or suspected injuries, impairment of vital functions
or mechanisms of injury. Finally, a balance must be found between the desire to underestimate as
few patients as possible and the consequence of classifying too many patients unnecessarily as
severely injured (overtriage). Conversely, although undertriage reduces the number of
unnecessary emergency room alerts, it is at the cost of having underestimated more genuinely
severely injured patients. The latter is viewed by many as the more critical model. Every trauma
center should come to an agreement about this within its network or with the emergency services
in its area.
The mass casualty incident represents a rare yet particularly challenging situation. Until the
arrival of the on-duty lead emergency physician, the emergency physician who arrives on the
scene first must take over this function. The switch from individual medical care to triage
represents a special challenge and the algorithm should provide support here.
Many important, central domains are dealt with in the present edition of the prehospital
polytrauma guideline. But some major topics, for example, pain therapy or prehospital
management of traumatic brain injury, are not included. These are to be drawn up in future
stages of guideline development, as well as other topics that are requested by the users.
Overall, the rapid, smoothly running medical care of (severely) injured patients is the focus of all
action. In this context, the emergency services must work hand-in-hand with the hospitals. To
this end, the 2008 Key Points Paper [3] on emergency medical management of patients in
hospital and prehospital demands that definitive clinical treatment shall be achieved within 90
minutes for major emergency medical clinical pictures such as a severely injured patient. To
make this possible, a time of 60 minutes from emergency call to hospital admission must be
achieved. The scope of emergency physician care must be aimed at these targets.
Prehospital - Introduction 15