[Trauma room workload in German trauma centers : Reality of trauma care underrepresented in reform].

Introduction: The Federal Joint Committee (G-BA) published a regulation on a staged system for emergency structures in hospitals (according to Social Security Code V) in April 2018 and therefore established the foundations for emergency care in the inpatient sector. The structural requirements for the care of potentially severely injured patients is primarily defined by the specialist society and means a high provision of personnel with a simultaneous annual increase in the burden due to increasing numbers of patients. Critics fear that the reforms do not take sufficient account of trauma care both professionally and financially.

[Composition of trauma room teams : Reality experienced in 12 transregional trauma centers].

Background: The provision of specialized trauma teams for the care of severely injured patients is mandatory according to the requirements of the S3 guidelines polytrauma and the composition is determined by the White Book Medical Care of the Severely Injured (Weißbuch Schwerverletztenversorgung). In each level of care the basic resuscitation room team is composed of four disciplines: orthopedics and trauma surgery, anesthesia, radiology and emergency medicine in the emergency department.

Material And Methods: A prospective, multicenter observational study was conducted in 12 supraregional trauma centers in Germany and Switzerland, where a total of 3753 patients were treated in the emergency department following accidents.

Stop the bleed " - Prehospital bleeding control in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline - A systematic review and clinical practice guideline.

Purpose: Our aim was to develop new evidence-based and consensus-based recommendations for bleeding control in patients with multiple and/or severe injuries in the prehospital setting. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries.

Methods: MEDLINE and Embase were systematically searched until June 2021.

[Consideration and implementation of the elements of hospital mass casualty planning in the hospitals of the TraumaNetworks DGU® : An evaluation within the framework of the development process of the guidelines for clinical disaster medicine in Germany (LeiKliKatMeD) by the EKTC, NIS, AKUT, AUC].

Background: The protection and maintenance of hospital functionality and treatment capacity require preventative planning and preparation for a mass casualty incident with respect to the scenarios, disasters or catastrophes to be expected. The hospital alarm and operations (KAEP) or stockpiling plan should include and organize the procedures and measures in the respective clinics and hospitals. The aim of the present study was to evaluate the hospitals of the Trauma Networks of the German Society for Trauma Surgery® (TNW DGU®) with respect to the established organizational structures and contents of the KAEP.

[Possibilities of the utilization of trauma networks of the German Society for Trauma Surgery using digital solutions].

This paper describes the use of digital solutions to improve the care of trauma patients in Germany. The focus is on the trauma networks of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). The use of digital solutions includes quality assurance through the TraumaRegister, which enables comprehensive data analysis as well as preregistration and resource utilization through programs such as the interdisciplinary proof of treatment IVENA eHealth, Rescuetrack and Rescue-Net.

Functional and Radiological Results Following Revision Blade Plating and Cephalomedullary Nailing in Aseptic Trochanteric and Subtrochanteric Nonunion.

Trochanteric and subtrochanteric fractures result in nonunion in more than 20% of cases. The aim of this study was to assess the functional and radiological results following revision cephalomedullary nailing and 95-degree angled blade plating in aseptic trochanteric and subtrochanteric nonunion. In a retrospective multi-center study between January 2010 and December 2020, a total of 68 consecutive patients (21 women and 47 men) from two European level I trauma centers with the diagnosis of aseptic nonunion were recruited.

[Is the 95°blade plate still important in the treatment of proximal femoral pseudarthrosis?].

Due to demographic changes, fractures and subsequently delayed fracture healing as well as pseudarthrosis of the proximal femur are on the increase. In the acute fracture situation, a load-stable treatment with an intramedullary implant (cephalomedullary nail) is generally sought. To date, there is no uniform consensus on the optimal treatment for complicated cases.

Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation-Results from a Prospective Study in 12 Level one German Trauma Centers.

This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. : Each trauma center collected the data during a three-month period between December 2019 and February 2021.

Imposter or knight in shining armor? Pelvic circumferential compression devices (PCCD) for severe pelvic injuries in patients with multiple trauma: a trauma-registry analysis.

Background: Pelvic Circumferential Compression Devices (PCCD) are standard in hemorrhage-control of unstable pelvic ring fractures (UPF). Controversial data on their usefulness exists. Aim of the study was to investigate whether prehospital application of PCCD can reduce mortality and transfusion requirements in UPF.

The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures.

Purpose: The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management.

Methods: To identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AIS ≥ 3). Analysis including patient's charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed.

[Comparison of planimetric CT‑based volumetry with simplified models for determining the size of intrapelvic hematomas due to pelvic fractures in emergency room diagnostics].

Background: Bleeding in the pelvis can lead to a circulatory problem. The widely used whole-body computed tomography (WBCT) scan in the context of treatment in the trauma resuscitation unit (TRU) can give an idea of the source of bleeding (arterial vs. venous/osseous); however, the volume determination of an intrapelvic hematoma by volumetric planimetry cannot be used for a quick estimation of the blood loss.

[Trauma team activation-Who should be alerted for which patients?].

Introduction: It is estimated that in total almost 10 million people are injured in accidents in Germany every year, most of which are in the household milieu and leisure sector. It is estimated that of these more than 32,000 seriously injured patients are admitted to the emergency room every year. It is recommended that the decision of the prehospital treatment team or the first examiner in the hospital as to whether a potentially severely injured patient should be admitted via the emergency room of the hospital should be based on a catalogue of criteria.

Changes in injury patterns, injury severity and hospital mortality in motorized vehicle accidents: a retrospective, cross-sectional, multicenter study with 19,225 cases derived from the TraumaRegister DGU.

Purpose: In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15 years and investigate the development and changes of injury patterns, injury severity and hospital mortality.

Analysis of the primary utilization of videolaryngoscopy in prehospital emergency care in Germany.

Background: In 2019, the German prehospital airway management guidelines were published. One of the recommendations was the primary utilization of videolaryngoscopy (VL) for every prehospital endotracheal intubation (phETI). Guideline compliance is extremely important in emergency medicine as non-compliance in the worst-case scenario leads to death.

The Immo Traffic Light System as a Decision-Making Tool for Prehospital Spinal Immobilization—A Systematic Review.

Background: Spinal injuries are difficult injuries to assess yet can be associated with significant neurological damage. To avoid secondary damage, immobilization is considered state of the art trauma care. The indication for spinal immobilization must be assessed, however, for potential complications as well as its advantages and disadvantages.

The predictive value of serum lactate to forecast injury severity in trauma-patients increases taking age into account.

Background: Two-tier trauma team activation (TTA)-protocols often fail to safely identify severely injured patients. A possible amendment to existing triage scores could be the measurement of serum lactate. The aim of this study was to determine the ability of the combination of serum lactate and age to predict severe injuries (ISS > 15).

Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism.

Background: The identification of risk factors for severe injury is crucial in trauma triage and trauma team activation (TTA) depends on a sufficient triage. The aim of this study was to determine whether or not elevated serum lactate levels and age are risk factors for severe injury in TTA due to trauma mechanism.

Methods: We conducted a retrospective cohort study in a single level one trauma center between September 2019 and May 2021 and analysed every TTA due to trauma mechanism.

[Changes in number of emergency medical service deployments in an urban area during the first COVID-19 pandemic-related contact restriction phase].

Background: To contain the coronavirus disease (COVID-19) pandemic, public life was reduced through contact restriction measures (referred to as "lockdown" in the further course for reading simplicity), among other things to make health system resources available for the treatment of COVID-19 patients. In parallel, a decrease in emergency patients was observed in the public health system.

Methods: For two 10-week periods before and during the lockdown, ambulance service deployment rates were analysed in 6 ambulance service areas for 6 tracer diagnoses.

Evaluation of a standardized instrument for post hoc analysis of trauma-team-activation-criteria in 75,613 injured patients an analysis of the TraumaRegister DGU.

Introduction: To improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to the hospital and therefore can benefit from a specialized trauma team mostly.

Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey.

Background: Trauma team activation (TTA) requires significant human and financial resources. The implemented German guidelines reduced the mortality of severe injured patients significantly over the last decade. Up to now there is no two-tier trauma team activation protocol in Germany.

Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft.

Large bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise.

How effective are different models of pelvic binders: results of a study using a Pelvic Emergency Simulator.

Background: The application of pelvic binders in the preclinical and early clinical phase is advisable to avoid or treat C-problems in unstable and potential bleeding pelvic ring fractures, even if the clinical effectivity is not completely proved. The use for pathologies in the posterior pelvic ring is still debatable.

Questions/purposes: We determined if there is a difference in achievable compression in the dorsal pelvic ring depending on position and pelvic binder model.