Abstract
Purpose
To describe the evidence-based insights and guidelines regarding the preparedness of health-care systems to deal with terror attacks.
Methods
Review of the existing literature on the subject with an emphasis on data from the Second Intifada of 2000–2005.
Results
The most critical components of dealing with terror attacks are not the clinical guidelines and protocols but organization, command, control, communication, and coordination (OCCCC). Creating universal protocols for dealing with terror attacks is problematic because they can differ greatly in injury characteristics, time to evacuation and treatment, and levels of hospital preparedness. Overall, terror casualties involve more severe injuries than other types of trauma and require more hospital resources. The most important clinical parameter of injuries from terrorist explosion attacks is a mix of different types of severe injury in the same patient. This complicates triage, and thus the dichotomic distinction of “urgent” and “not urgent” patients may be more helpful than the classic “color system.” The stream of severely injured patients into hospital frequently creates bottlenecks, especially in the emergency department, the intensive care unit, and imaging and operation rooms.
Conclusions
The most important guidelines for the preparedness of health-care systems for terror attacks are: establishment of a central authority for coordinating preparedness and response; existence of clear preparedness goals; definition of standard operating procedures for all organizational levels; enhancement of surge in hospital capacity; quick clearance of emergency departments to receive urgent casualties with non-urgent patients directed elsewhere; quick reinforcement of emergency departments by additional staff; distribution of severe casualties between adjacent hospitals with possible definition of the closest one as triage hospital; training and exercising of medical staff on all levels.
Zusammenfassung
Zielsetzung
Im vorliegenden Beitrag sollen die evidenzbasierten Erkenntnisse und Richtlinien zur Vorbereitung von Gesundheitssystemen auf Terroranschläge beschrieben werden.
Methoden
Die themarelevante Literatur wurde gesichtet und geprüft. Ein Schwerpunkt lag dabei auf Daten zur Zweiten Intifada von 2000 bis 2005.
Ergebnisse
Die entscheidenden Elemente im Umgang mit Terroranschlägen sind nicht etwa klinische Leitlinien und Protokolle, sondern Organisation, Führungsstrukturen, Kontrolle, Kommunikation und Koordination (engl. Abkürzung: OCCCC). Die Formulierung allgemeingültiger Handlungsanweisungen für den Fall eines Terroranschlags ist problematisch, da große Unterschiede in den Verletzungen, der Zeit bis zur Evakuierung und Behandlung sowie im Vorbereitungsstand der Kliniken bestehen können. Im Allgemeinen erleiden Terroropfer schwerere Verletzungen als die Opfer anderer Schadensereignisse, im Krankenhaus beanspruchen sie mehr Ressourcen. Der wichtigste klinische Parameter bei Traumata nach Sprengstoffanschlägen ist das Auftreten verschiedener Formen von schweren Verletzungen beim einzelnen Patienten. Dadurch wird die Triage erschwert, weshalb eine dichotome Unterscheidung zwischen „dringenden“ und „nichtdringenden“ Patienten sinnvoller sein kann als das klassische System der farblichen Codierung. Der Zustrom von Schwerverletzten sorgt im Krankenhaus häufig für Engpässe, insbesondere in der Notaufnahme, auf der Intensivstation, in der Bildgebung und in den Operationssälen.
Schlussfolgerungen
Die wichtigsten Richtlinien für die Vorbereitung von Gesundheitssystemen auf Terroranschläge sind die Etablierung einer zentralen Stelle für die Koordination der Vorbereitungen und des Einsatzes im Ernstfall; die Formulierung klarer Vorbereitungsziele; die Definition von Standard Operating Procedures auf allen Organisationsebenen; die Erhöhung von Reservekapazitäten; die schnelle Räumung von Notaufnahmen für „dringende“ Opfer bei gleichzeitiger Umleitung „nichtdringender“ Patienten; die schnelle Verstärkung der Notaufnahme durch zusätzliches Personal; die Verteilung schwer verletzter Opfer zwischen nahe gelegenen Kliniken mit eventueller Definition des nächstgelegenen Krankenhauses als Triageklinik; Schulungen und Übungen für das medizinische Personal auf allen Ebenen. Eine deutsche Version des Beitrags ist verfügbar auf SpringerLink unter dx.doi.org/10.1007/s10049-015-0029-5.
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K. Peleg and M. Rozenfeld state that there are no conflicts of interest.
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J. Hinkelbein, Köln
H. Moecke, Hamburg
A German version of this article is available at http://dx.doi.org/10.1007/s10049-015-0029-5.
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Peleg, K., Rozenfeld, M. Dealing with terror-related mass casualty events. Notfall Rettungsmed 18, 285–292 (2015). https://doi.org/10.1007/s10049-015-0028-6
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DOI: https://doi.org/10.1007/s10049-015-0028-6