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Erschienen in:
01.06.2012 | Editorial
Physician involvement in the care of multiply injured patients: the role of guidelines and subspecialties
Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 3/2012
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Recently, evidence-based guidelines for the management of multiply injured patients were released [1]. These guidelines were initiated by the German Trauma Society and developed in cooperation with all other subspecialties involved in trauma care (Table 1). The fact that 11 different societies were involved in the development of these guidelines demonstrates the high degree of specialization required for modern trauma care [2]. Distinct criteria were developed in order to define the responsibilities during initial management (Table 2).
Table 1
Recommendations for trauma teams (from [1])
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The care of multiply injured patients should be undertaken by fixed teams (emergency room teams) who work according to pre-structured plans and/or have undergone special training (grade of recommendation: A)
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The basic emergency room team should consist of at least three doctors (two surgeons, one anaesthetist); at least one anaesthetist and one surgeon should be at the consultant level (grade of recommendation: A)
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Trauma centres should maintain extended emergency room teams (grade of recommendation: A)
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Other senior doctors needed for continued treatment of the patient should arrive within 20–30 min of being called (grade of recommendation: A)
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The emergency room should be 25–50 m2 in size (per patient to be treated) (grade of recommendation: B)
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The emergency room, ambulance entrance, radiology department, and surgical department should be in the same building. The helicopter landing pad should be within the hospital grounds (grade of recommendation: B)
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Table 2
Activation of internal alarm mechanisms to activate the trauma room team (from [1])
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Grade of recommendation: A
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Systolic blood pressure <90 mmHg after trauma
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Penetrating injuries to the neck and torso
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Gunshot wounds to the neck and torso
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Glasgow Coma Scale (GCS) <9 after trauma
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Respiratory impairment/requirement for intubation after trauma
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Fracture of more than two proximal bones
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Unstable chest/pelvic fractures
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Amputation injury proximal to hands/feet
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Spinal cord injury
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Open head wound/burns 20 % and grade ≥2b
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Additional criteria (the trauma/emergency room team should be activated for the following additional criteria; grade of recommendation: B)
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Fall from a height (>3 m)
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Road traffic accident (RTA) with frontal impact and intrusion of more than 50–75 cm
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A change in speed of delta >30 km/h
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Collision involving a pedestrian or two-wheeler, death of a driver or passenger, and/or
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Ejection of a driver or passenger
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