In their article, Franke et al. give an important overview of treatments and treatment procedures for major casualty incidents (MCI) (1). In addition to the fastest possible identification and treatment of severely injured patients at the site of the incident, a further recommendation of the authors is that hospitals are prepared for a major incident. With regard to the latter point, we would like to broaden the discussion by adding the following important aspects.
In the hospital, the early phase of transitioning from routine activities to MCI procedures is essential for obtaining the most structured response possible. For this purpose, protocols for standard operating procedures that contain clearly defined roles with their responsibilities, chain of command, and clear guidelines for logistical structures must be compiled and available at all times. This includes for example the establishment of a triage sieve, and the definition of the sub-areas of the individual MCI triage categories by the emergency room team.
In addition, each individual patient must be clearly identifiable at all times during care. A paper-based form of documentation and/or the use of a hospital information system (HIS) with so-called MCI dummies (e.g., pre-defined cases prepared in advance) could be used for this.
From an interdisciplinary emergency and clinical laboratory perspective, developing a protocol in advance is necessary to be able to successfully allocate the required laboratory supplies (blood values and blood groups; blood units and products) to the patient during a MCI. The same applies to imaging diagnostics and the transmission of information to interface areas.
In addition to the repetitive training measures in the individual sub-areas (for example, central emergency reception area, laboratory, operative unit, intensive care unit), each concept has to be evaluated for its functionality and regularly tested for all clinics. For this, joint exercises of the rescue services have been established to carry out mock drills using persons who simulate injuries.
Dr. med. Ramona Dolscheid-Pommerich
Prof. Dr. med. Birgit Stoffel-Wagner
Institut für Klinische Chemie und Klinische Pharmakologie
Dr. med. Ingo Gräff
Universitätsklinikum Bonn, Germany
|1.||Franke A, Bieler D, Friemert B, Schwab R, Kollig E, Güsgen C: The first aid and hospital treatment of gunshot and blast injuries. Dtsch Arztebl Int 2017; 114: 237–43 VOLLTEXT|