„Lebensbedrohliche Einsatzlagen“ (LebEL), wie z. B. Terroranschläge und Amoklagen,
unterscheiden sich in wesentlichen Aspekten vom konventionellen „Massenanfall von
Verletzten“
(MANV) – somit erfordern sie teilweise auch andere Bewältigungsstrategien im Krankenhaus.
Dieser
Beitrag erläutert die rechtlichen Rahmenbedingungen und stellt Strukturen und Prozesse
im
Krankenhaus zur Bewältigung lebensbedrohlicher Einsatzlagen dar.
Abstract
Due to several peculiarities the clinical treatment after terror-related mass casualty
incidents (TerrorMASCAL) differs from handling a conventional MCI. For this reason,
TerrorMASCAL situations should get attention as an own entity in hospitals emergency
preparedness and response. Among other challenges hospitals surrounding the emergency
area
will have to deal with a large amount of non-triaged, non-treated and seriously harmed
patients, some of them with unfamiliar and disfiguring injuries. In addition, the
hospitals
themselves can be endangered as a target of further terrorist attacks. Therefore,
security
concepts depending on the individual circumstances must be elaborated in consultation
with the
local police authorities.
The incident’s clinical management should be put in hands of specially trained in-house
institutions. Operational and tactical tasks close to patients (“on site”) should
be separated
from strategic and administrative responsibilities (“in the background”). The function
of an
“Emergency Operational and Medical Coordinator” (EOMC = ZONK) is installed to manage
initial
diagnostics and therapy for seriously injured victims by prioritization and scheduling
available clinical resources.
In order to structure the process of emergency admission for numerous patients a triage-
and holding area as well as specific in-house treatment areas for different severities
of
injury should be set up. The clinical triage should follow a consistent algorithm
that is
based on the cABCDE approach. It is recommended that this algorithm should be defined
in
hospitals disaster and emergency planning.
Surgical strategies concerning the treatment of terror victims might be oriented according
to the principles of “tactical abbreviated surgical care” (TASC). This means that
in extreme
cases the initial measures have to be concerted to save as much lives as possible
while
accepting a reduced individual outcome.
Schlüsselwörter
klinische Sichtung - Terror-MANV - Terrorismus - Massenanfall von Verletzten - MANV
- Notfallvorsorge und -reaktion
Keywords
clinical trage - terror-MASCAL - terrorism - mass casualty incident - emergency preparedness
and response
