LNSLNS

PD Dr Hinkelbein rightly comments that the time from preclinical emergency treatment to shock-room treatment is longer than stipulated. He also mentions that interpreting the data can be problematic, and not all possibly limiting or influential factors can be discussed in detail. The time of the accident, for example, is often merely an estimate and therefore rather imprecise. Furthermore, the arrival of the emergency services is documented but not that of the first emergency treatment, so that no conclusion can be drawn about the adherence, or otherwise, to the stipulated response times. Behrendt showed in 2009 that 95% of all emergencies are reached in 16.3 minutes, and 93.2% within 15 minutes (1). The high proportion of air transports is also likely to have a role in the duration of preclinical emergency treatment since these would often be the result of a secondary callout. The duration of preclinical emergency treatment has remained stable, at about 70 minutes, since the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) was started (2). One possible explanation for this time period, which is rather long compared with non-trauma emergencies, is the fact that many accidents happen out of town and administering technical emergency treatment to persons involved in the accident often takes a long time.

Shock-room treatment is also subject to many variables that we were not able to discuss in detail. In 2010, Wutzler et al. investigated the time intervals during and after shock-room treatment on the basis of data from the TR-DGU (3). They found that the time to CT-scanning is usually about half an hour, and that especially the delay between the end of the diagnostic evaluation and a patient’s referral or hospital admission could be optimized.

In order to verify possible structural deficiencies, further analyses of these partial aspects are required, because it is not possible to explain all problem areas in the context of a review article, owing to the different influencing factors. Data from the TraumaNetwork DGU of the German Society for Trauma Surgery (TraumaNetzwerk DGU) will help to find answers to these types of questions in the future.

DOI: 10.3238/arztebl.2013.0504b

Dr. med. Carsten Mand

Klinik für Unfall-, Hand- und
Wiederherstellungschirurgie

Universitätsklinikum Giessen und Marburg GmbH,
Standort Marburg

mand@med.uni-marburg.de

Conflict of interest statement

Dr Mand has received reimbursement of travel costs from AUC
(responsible for the Trauma Registry).

1.
Behrendt H, Schmiedel R, Auerbach K: Überblick über die Leistungen des Rettungsdienstes in der Bundesrepublik Deutschland im Zeitraum 2004/2005. Notfall & Rettungsmedizin 2009; 12: 383–8.
2.
Deutsche Gesellschaft für Unfallchirurgie and Sektion NIS: TraumaRegister DGU – Jahresbericht 2012. www.traumaregister.de. Last accessed on 27 April 2012.
3.
Wutzler S, Westhoff J, Lefering R, Laurer HL, Wyen H, Marzi I: Zeitintervalle
während und nach Schockraumversorgung. Eine Analyse anhand des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU). Unfallchirurg 2010; 113: 36–43.
4.
Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10. VOLLTEXT
1. Behrendt H, Schmiedel R, Auerbach K: Überblick über die Leistungen des Rettungsdienstes in der Bundesrepublik Deutschland im Zeitraum 2004/2005. Notfall & Rettungsmedizin 2009; 12: 383–8.
2. Deutsche Gesellschaft für Unfallchirurgie and Sektion NIS: TraumaRegister DGU – Jahresbericht 2012. www.traumaregister.de. Last accessed on 27 April 2012.
3. Wutzler S, Westhoff J, Lefering R, Laurer HL, Wyen H, Marzi I: Zeitintervalle
während und nach Schockraumversorgung. Eine Analyse anhand des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU). Unfallchirurg 2010; 113: 36–43.
4.Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10. VOLLTEXT

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