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Background: In order to continue to efficiently provide both personnel-intensive and resource-intensive care to severely injured patients, some hospitals have introduced individually differentiated systems for resuscitation room treatment. The aim of this study was to evaluate the concept of the A and B classifications in terms of practicability, indications, and potential complications at a national trauma center in Bavaria., Methods: In a retrospective study, data from resuscitation room trauma patients in the year 2020 were collected. The assignment to A and B was made by the prehospital emergency physician. Parameters such as the injury severity score (ISS), Glasgow outcome scale (GOS), upgrade rate, and the indication criteria according to the S3 guidelines were recorded. Statistical data comparisons were made using t‑tests, χ 2 -tests, or Mann-Whitney U‑tests., Results: A total of 879 resuscitation room treatments (A 473, B 406) met the inclusion criteria. It was found that 94.5% of resuscitation room A cases had physician accompaniment, compared to 48% in resuscitation room B assignments. In addition to significantly lower ISS scores (4.1 vs. 13.9), 29.8% of B patients did not meet the treatment criteria defined in the S3 guidelines. With a low upgrade rate of 4.9%, 98% of B patients had a GOS score of 4 or 5., Conclusion: The presented categorization is an effective and safe way to manage the increasing number of resuscitation room alerts in a resource-optimized manner., (© 2023. The Author(s).)

Arterial catheterization is considered to be standard procedure for patients undergoing general anesthesia. The most common puncture site is the radial artery (RA), which carries a risk of RA occlusion. Several pieces of literature still recommend the performance of the Allen test (AT) to assess the circulation of the palmar arch. However, the result of the AT differs largely depending on the examiner and the test is not able to predict ischemic events correctly. Thus it appears that the performance of an AT is not mandatory before arterial cannulation., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme. All rights reserved.)

Background: The number of patients depending on home mechanical ventilation (HMV) has increased substantially in Germany in recent years. These patients receive long-term care in different nursing facilities (nursing home, shared living community, private home). However, there are limited data available on the quality of care of HMV patients. The aim of the OVER-BEAS project was to identify quality indicators (QIs) of HMV care using an evidence-based approach., Methods: A multidisciplinary board consisting of professionals and experts of HMV provision compiled a set of QIs between March and September 2019. In a structured, transparent process a set of QIs covering structures, processes and outcome of HMV patient's care were proposed and evaluated based on the best available evidence. QIs were defined as relevant, reliable and valid measurements of the quality of HMV care and furthermore to be comprehensive and applicable in practice., Results: The experts proposed 40 QIs and consented a final set of 26 QIs. Based on the final set, questionnaires to document the QIs were developed: (1) to assess the quality and describe the structure of the nursing facility; and (2) to gather information on patient-related processes and outcomes. The feasibility of the questionnaires was tested in 5 nursing facilities treating HMV patients. The remarks from the nursing specialists were categorised in three groups: (1) term missing accuracy, (2) problem of understanding, and (3) not documented or documented elsewhere. Mean documentation time by the nursing specialists for one patient was 15 min. Based on this feedback, the questionnaires were finalised., Conclusions: We proposed a set of QIs relating to long-term HMV care and developed two questionnaires to collect this information. In a pilot study, we found the set of questionnaires to be feasible in assessing the quality of HMV care according to current evidence. The development of standardised evidence-based QIs to evaluate HMV care is a step towards implementing a standardised quality assurance program to document the quality of care of HMV patients., (© 2024. The Author(s).)

Objective: Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management., Methods: The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants., Results: The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F)., Conclusion: The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

Background and Objectives: Weaning from ventilators is not always finished in the primary intensive care unit (ICU) setting. Transfer to other treatment facilities is a sensitive stage in the treatment and rehabilitation of the weaning patient. The aim of the present study was to investigate transition management and interhospital transfer of weaning patients, with special emphasis on documentation quality., Methods: A retrospective data analysis of one year (2018) in two ICUs of a university hospital was performed. All ventilated patients with the following tracer diagnoses were included: chronic obstructive pulmonary disease (COPD), asthma, patients with multiple injuries, pneumonia, sepsis, acute respiratory distress syndrome (ARDS), and cardiac arrest (ventilation > 24 h)., Results: A total of 750 patients were included in the study (median age 64 [IQR 52.8-76]; 32% female). In all, 48 (6.4%) patients were not weaned at the time of transfer (especially sepsis and ARDS). Routine documentation was sufficient for the sections "spontaneous breathing trial", "assessment of readiness to wean" and "presumed weanability" to adequately assess the parameters of the German S2k guideline "prolonged weaning". Predominantly, these patients were transferred with tracheostoma (76%) to rehabilitation units (44%) by specialized physician-assisted patient transport ambulances (75%)., Discussion: The transfer of ventilated patients after initial ICU stay is a relevant issue for interhospital transfer. Routine documentation of a structured weaning process is sufficient in core elements to describe the weaning process. This is of great importance for continuity in the further treatment of these patients., (© 2022. The Author(s).)

Complexity of outpatient intensive care for ventilated people: Cross-mapping into the standardised NNN-taxonomy Abstract. Background: In Germany, free text is the preferred method for recording the nursing process in outpatient intensive care, although classification systems could enable a more precise description. Research question: How is nursing care for people with outpatient ventilation represented by the NNN-taxonomy and what are the recommendations for nursing practice? Methods: A qualitative "multiple case" design was applied. Using deductive content analysis (data sources: nursing documentation and secondary analysis of interviews with affected persons), several cases, both individually and across all cases were linked to the NNN-taxonomy (cross-mapping). Results: In total, the nursing documentation of 16 invasively ventilated persons with a mean age of 58.4 years ( SD = 16.3) was analysed. Seven persons additionally contributed interview data. Documentation was mainly based on the "Strukturmodell" (14/16) with a moderate to high accuracy (D-Catch Score: 16.6; SD = 4.1). Cross-mapping resulted in 4016 codes: 618 nursing diagnoses, 1956 interventions and 1442 outcomes. Documentation was strongly measure-oriented, not very person-centred and with a lack of differentiation between diagnosis and intervention. Conclusions: To improve nursing practice, a person-centred attitude and the ability to differentiate between nursing diagnoses, interventions and outcomes should be promoted.

Objectives: In July 2021, the Medical Task Force 47 was deployed to the flood disaster in western Germany as part of the cross-regional disaster relief system. With the aim of deriving possible improvements in disaster management, it was scientifically evaluated. The focus of this study was the strategy to build up and to maintain a responsive and efficient rescue system., Materials and Methods: After defining an evaluation process, an interdisciplinary panel of experts reviewed operational documents and relevant concepts of the Bavarian Red Cross. Based on these, strategies and tactics were developed to achieve predefined goals., Results: The performance of the emergency units could be increased by modern vehicles and equipment (eBikes, drones, all-terrain vehicles). To improve the response capability, new rapid response groups could be required that can take over the function of an advance command and can process mission assignments in impassable terrain autonomously. These could be integrated and synchronized into regional and cross-regional disaster relief., Conclusion: In future, it could be difficult for Germany's largely volunteer-organised disaster management to safely deploy the multitude of possible state-of-the-art resources in the highly complex environment of a disaster. Partial professionalization by full-time command and control staff could be one solution for this problem., (© The Author(s) 2022.)

Hospitals play a crucial role in the management of large-scale emergencies or disasters. This has been clearly demonstrated by the recent terrorist attacks in Europe, by the SARS-CoV-2 pandemic, and currently by the Ukraine war. In order to cope with extraordinary situations and large-scale emergencies, such as mass casualty incidents, hospitals need to be prepared in detail - by preparing and implementing a hospital contingency plan. The article presented here describes in hospital preparation for a mass casualty incident., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Thomas Wurmb ist im Vorstand der Deutschen Arbeitsgemeinschaft Krankenhaus Einsatzplanung (DAKEP) sowie Mitglied in der Arbeitsgemeinschaft der in Bayern tätigen Notärzte (agbn) und der Bundesvereinigung der Arbeitsgemeinschaften der Notärzte Deutschlands e.V. (BAND)., (Thieme. All rights reserved.)

The trauma center of the University Hospital Wuerzburg has developed an advanced trauma pathway based on a dual-room trauma suite with an integrated movable sliding gantry CT-system. This enables simultaneous CT-diagnostics and treatment of two trauma patients. The focus of this study was to investigate the quality of the concept based on defined outcome criteria in this specific setting (time from arrival to initiation of CT scan: tCT; time from arrival to initiation of emergency surgery: tES). We analyzed all trauma patients admitted to the hospital's trauma suite from 1st May 2019 through 29th April 2020. Two subgroups were defined: trauma patients, who were treated without a second trauma patient present (group 1) and patients, who were treated simultaneously with another trauma patient (group 2). Simultaneous treatment was defined as parallel arrival within a period of 20 min. Of 423 included trauma patients, 46 patients (10.9%) were treated simultaneously. Car accidents were the predominant trauma mechanism in this group (19.6% vs. 47.8%, p < 0.05). Prehospital life-saving procedures were performed with comparable frequency in both groups (intubation 43.5% vs. 39%, p = 0.572); pleural drainage 3.2% vs. 2.2%, p = 0.708; cardiopulmonary resuscitation 5% vs. 2.2%, p = 0.387). At hospital admission, patients in group 2 suffered significantly more pain (E-problem according to Advanced Trauma Life Support principles © ; 29.2% vs. 45.7%, p < 0.05). There were no significant differences in the clinical treatment (emergency procedures, vasopressor and coagulant therapy, and transfusion of red blood cells). tCT was 6 (4-10) minutes (median and IQR) in group 1 and 8 (5-15.5) minutes in group 2 (p = 0.280). tES was 90 (78-106) minutes in group 1 and 99 (97-108) minutes in group 2 (p = 0.081). The simultaneous treatment of two trauma patients in a dual-room trauma suite with an integrated movable sliding gantry CT-system requires a medical, organizational, and technical concept adapted to this special setting. Despite the oftentimes serious and life-threatening injuries, optimal diagnostic and therapeutic procedures can be guaranteed for two simultaneous trauma patients at an individual medical level in consistent quality., (© 2022. The Author(s).)

Background: People on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC?, Methods: This study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care., Results: The quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs (n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL (n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers (n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18)., Conclusion: This study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting., (© 2022. The Author(s).)

Purpose: The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001., Methods: PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018., Results: Finally 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied., Conclusions: The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation., (© 2022. The Author(s).)

Purpose: The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator., Methods: All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained., Results: 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9-34) (median and interquartile range, IQR). tCT was 15 (11-19) minutes (median and IQR) and tOR was 96.5 (75-119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1-6) (median and IQR) and one (0-1) (median and IQR) ventilator day., Conclusion: The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously., (© 2020. The Author(s).)

Background: The rapid increase in the use of home mechanical ventilation (HMV) for people with chronic respiratory failure poses extreme challenges for the healthcare system. People on HMV have complex care needs and require support from an interprofessional team. In Germany, HMV is criticised for inadequate quality standards, particularly in outpatient intensive care practice. The objective of this study was to describe the quality of care for people on outpatient HMV in Germany, Bavaria and provide recommendations for improvement from the perspective of healthcare professionals (HCPs)., Methods: Semi-structured qualitative telephone interviews with HCPs (i.e., nurses, equipment providers, therapists, and physicians) were analysed using the framework method. The quality framework of Health Improvement Scotland (HIS), which aims to improve the quality of person-centred care, was used to build a deductive analysis matrix. The framework includes the three key areas: (1) Outcomes and impact, (2) Service delivery, and (3) Vision and leadership. The domains (meta-codes) and quality indicators (sub-codes) of the quality framework were used for deductive coding., Results: Overall, 87 HCPs (51 female, mean age of 44.3 years, mean professional experience in HMV of 9.4 years) were interviewed (mean duration of 31 min). There was a complex interaction between the existing health care system (Outcomes and impact, 955 meaning units), the delivery of outpatient intensive care (Service delivery, 939 meaning units), and improvement-focused leadership (Vision and leadership, 70 meaning units) that influenced the quality of care for people on HMV. The main barriers were an acceleration in transition management, a neglect of weaning potential, a shortage of qualified professionals and missing quality criteria. The central recommendations for promoting person-centred care were training and supervision of staff and an inspiring leadership. An integrated care structure supporting medical home visits and outpatient rehabilitation should be developed., Conclusion: This study describes a heterogeneous and partly deficient care situation for people on HMV, but demonstrates that high quality care is possible if person-centred care is successfully implemented in all areas of service provision. The recommendations of this study could inform the development of a person-centred integrated care structure for people on HMV., (© 2021. The Author(s).)

Background:  The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation., Material and Methods:  In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital., Results:  In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community)., Conclusion:  Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable., Competing Interests: T. Skazel: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .M. Kippnich: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .H. Klingshirn: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .L. Gerken: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .P. Heuschmann: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008), weitere Forschungsförderung außerhalb der Studie: Bundesministerium für Forschung und Bildung; Deutsche Forschungsgemeinschaft; Europäische Union; Charité – Universitätsmedizin Berlin; Ärztekammer Berlin; Deutsche Parkinson-Gesellschaft; Universitätsklinikum Würzburg – Robert-Koch-Institut; Deutsche Herzstiftung; Gemeinsamer Bundesausschuss (G-BA) im Rahmen des Innovationsfonds; Universitätsklinikum Heidelberg (im Rahmen von RASUNOA-prime; gefördert durch eine uneingeschränkte Forschungsförderung an das Universitätsklinikum Heidelberg von Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo); Charité – Universitätsmedizin Berlin (im Rahmen Mondafis; gefördert durch eine uneingeschränkte Forschungsförderung an die Charité von Bayer); Universität Göttingen (im Rahmen FIND-AFrandomised; gefördert durch eine uneingeschränkte Forschungsförderung an die Universität Göttingen von Boehringer-Ingelheim) .K. Haas: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .M. Schutzmeier: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .L. Brandstetter: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .J. Ahnert: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008).J. Koch: Keine Interessenkonflikte.B. Seese: Keine Interessenkonflikte.P. Meybohm: bekam für Forschungsvorhaben und für die Durchführung von klinischen Studien Gelder von Bundesministerium für Bildung und Forschung (BMBF; 01KG1815), B. Braun Melsungen AG, CSL Behring GmbH, Deutsche Forschungsgemeinschaft (DFG; ME 3559/1-1, ME 3559/3-1), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), European Society of Anaesthesiology (ESA), Fresenius Kabi GmbH, International Anesthesia Research Society (IARS), Pfizer Pharma GmbH, ViforPharma GmbH. P. M. erhielt Förderungen oder Reisekostenunterstützung für Beratungen und Vorträge der folgenden Firmen: Abbott GmbH & Co KG, AesculapAkademie GmbH, AstellasPharma GmbH, B. Braun Melsungen AG, Baxter Deutschland GmbH, Biosyn GmbH, Biotest AG, CSL Behring GmbH, Dr. F. KöhlerChemie GmbH, Dräger Medical GmbH, Fresenius Kabi GmbH, HCCM Consulting GmbH, Heinen + Löwenstein GmbH, MSD Sharp&Dohme GmbH, Pulsion Medical Systems S. E., Siemens Healthcare, ViforPharma GmbH.B. Reuschenbach: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008).T. Wurmb: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008)., (Thieme. All rights reserved.)

Disaster medicine faces complex challenges and will play an increasing role in the future. Disaster medicine is dominated by a phased imbalance of available and required resources. Various factors, such as a possible hazard for the rescue forces, inaccessible terrain or even destroyed infrastructure increase the complexity enormously. For casualties, this can mean a concentration of medical care on life-threatening conditions. The primary goal of emergency planning is to ensure standard or contingency care and to avoid crisis care.Hospitals and the preclinical emergency organizations must prepare for possible major emergencies or disasters. Easy-to-understand and just as easy to apply emergency plans are an important prerequisite for successful emergency management. These plans can only be guiding structures; the adaptation to the actual circumstances of the incident and the situation-adapted interpretation of the plans is the responsibility of the operational commanders. A clear leadership structure is essential for both preclinical and clinical operations. In this article, we describe important basic principles of disaster medicine mission planning and management., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management., Methods: The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants., Results: The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F)., Conclusion: The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

Background: Outpatient intensive care for people with long-term mechanical ventilation is a rapidly growing area with a wide range of care demands. The aim of this Scoping Review is to present the current state of research on the quality of care for people with home mechanical ventilation in Germany and to identify research gaps., Methods: Based on predefined inclusion criteria, 4 databases were searched for publications dealing with the care of people with home ventilation in Germany. The method of "data driven thematic analysis" led the data extraction and analysis. Distinction was made between research and expert opinion., Results: The search resulted in 493 matches of which 68 publications were included in the this study: two guidelines (3%), 45 (66%) research papers and 21 (31%) expert opinions. The following topics were identified: Organization and control of ventilation (n=43; 63%), nursing (n=23; 34%), medical (n=39; 57%), therapeutic (n=7; 10%) and assistive technologies care (n=24; 35%), as well as the perspective of people with home mechanical ventilation and their relatives (n=33; 49%) and other topics (n=13; 19%)., Conclusion: Although the debate on the quality of care for people living with home mechanical ventilation is conducted broadly, studies focusing on individual care demands, autonomy and participation depending on the living situation or on the role of specific health professionals within the interprofessional team are missing., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenskonflikt besteht. Peter Heuschmann berichtet neben den Zuwendungen des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (welcher im Artikel als offizieller Förderer der Studie genannt ist) über weitere Zuwendungen außerhalb der Studie: – Bundesministerium für Forschung und Bildung– Deutsche Forschungsgemeinschaft– Europäische Union– Charité – Universitätsmedizin Berlin – Ärztekammer Berlin– Deutsche Parkinson-Gesellschaft– Universitätsklinikum Würzburg– Robert-Koch-Institut– Deutsche Herzstiftung– Gemeinsamer Bundesausschuss (G-BA) im Rahmen des Innovationsfonds– Universitätsklinikum Heidelberg (im Rahmen von RASUNOA-prime; gefördert durch ein unbefristetes Forschungsstipendium an das Universitätsklinikum Heidelberg von Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo)– Charité – Universitätsmedizin Berlin (innerhalb Mondafis; gefördert durch ein unbefristetes Forschungsstipendium an die Charité von Bayer)– Universität Göttingen (innerhalb FIND-AF randomisiert; gefördert durch ein unbefristetes Forschungsstipendium an die Universität Göttingen von Boehringer-Ingelheim), (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The complete blackout of information technology (IT) in a hospital represents a major incident with acute loss of functionality. The immediate consequence is a rapidly progressive loss of treatment capacity. The major priority for the acute management of such an event is to keep patients safe and prevent life-threatening situations. A possibility to channel the uncontrolled loss of treatment capacity in order to achieve the aforementioned protective target is the immediate organization of an analog system for baseline emergency medical care. The switch over from a fully operational routinely functioning system to a reduced emergency state occurs daily in hospitals (night shift, weekends, public holidays) and reflects the controlled reduction of the treatment capacity. This process and the procedures associated with it are universally known, the functions are clearly defined and planned in advance by duty rotas and the interplay of clinics in the organizational schedule is regulated in detail. In order to accomplish this strategy analog instruments are necessary. These must all be conceived, established, practiced and evaluated in advance with the clinics and departments. Ultimately, all isolated IT blackout concepts must be amalgamated into a compatible and functioning total framework. This structure must be maintained for as long as a partially or totally functioning IT has been reinstated.

Background: An important instrument for handling mass casualty incidents in preclinical settings is the use of an advanced medical post. In certain circumstances, however, the establishment of such an advanced medical post on or close to the incident site is impossible. Terrorist attacks are a prime example for this. The highest priority for hospitals during mass casualty incidents is to adjust the treatment capacity to the acute rise in demand and to sustain its functionality throughout the duration of the incident. By establishing an advanced medical post within hospitals during certain types of mass casualty incidents these aims could potentially be accomplished., Aims: The aims of this pilot study were to test the practicability of the establishment of an advanced medical post within a university hospital and to identify potential problems. The results provide the foundation of a generalized concept, which will then be integrated into the hospital emergency plans., Methods: After the formation of a multiprofessional expert committee, different areas within the hospital were evaluated based on spatial and tactical considerations. Predefined questions were assessed and harmonized with respect to organization, vehicle management, communication, leadership and patient transport through the means of a practice run., Results: The establishment and operation of an advanced medical post within the hospital were easily possible. The consequent deployment of section leaders enabled the smooth coordination of transport and an unobstructed simulated patient flow. The management of the treatment area by a senior emergency physician and a senior emergency medical service officer in close cooperation with the operational hospital lead proved to be a useful concept. Technical problems with communication within the hospital were resolved by using wireless phones and the installation of a digital radio repeater., Discussion: During acute scenarios with only short prior notice, the authors prefer concepts that supplement the normal hospital operation through additional staff and material. In circumstances with prior notice of more than 60 min an advanced intrahospital advanced medical post, staffed by civil protection units, could be a concept that enables the absorption of the first patient arrivals within the first hour of a mass casualty incident without disturbing the functionality of hospitals to any great extent. Further practice runs are, however, necessary to further develop and adjust this concept to real-life circumstances.

Background: In the case of a mass casualty incident an advanced medical post (AMP) plays a central role in the medical care by ambulance service and civil protection units. Besides the traditional organization with one triage category per medical services tent, it can also be structured in a mixed form (i.e. a defined number of patients with different triage categories are assigned to each medical services tent). To date it remains unclear which organization format is better in order to rapidly evacuate those patients with the highest priority., Methods: The Medical Task Force of Lower Franconia treated 50 identical and standardized training patients including 18 triage category red/emergency (36%), 12 triage category yellow/urgent (24%), 18 triage category green/non-urgent (36%) and 2 triage category black/dead (4%) in the course of a scheduled field exercise within two consecutive training sessions (first session: classical structure, second session: mixed structure). The training patients were represented by a dynamic patient simulation, whereby simulation cards showed injury patterns and the external appearance of the patients at a defined point which required certain interventions. The patients' conditions changed when these measures were accomplished or neglected. The length of stay of the patients with the triage category red/emergency at the AMP (start of triage to start evacuation) as well as the overall number of evacuated patients were collated and compared., Results: Out of 18 patients with the triage category red/emergency, 13 patients in each session were evacuated in one pass. During the first session the mean evacuation time at the AMP was 25 min and during the second session the mean evacuation time was 18 min. After the end of the 90 min of exercise time in the first session 14 non-critical patients (triage categories yellow/urgent and green/non-urgent, n = 30) were still left at the AMP (16 evacuated) and in the second session 12 (18 evacuated)., Conclusion: Depending on the mission requirements the mixed form of AMP organization can provide several advantages. In addition to rapid operational readiness and high flexibility the patient distribution by triage category could be processed better and the evacuation time of critical patients could be shortened.

Background: Due to the increasing threat by terrorism and the resulting range of operations for the emergency medical service, the equipment as well as the rescue strategies are being adapted and expanded. An example is the "Recommended Action for Emergency Medical Services in Special Operations" (REBEL, Handlungsempfehlung für Rettungsdienst bei besonderen Einsatzlagen) of the highest Bavarian rescue service authority. In the following article, three cases are presented using new tools such as hemostyptics, thoracic patches and tourniquet from the REBEL kit in everyday operations., Cases: The first case deals with a seriously injured driver involved in a truck accident suffering from a scalping violation of the facial skeleton with consecutive critical bleeding (use of hemostyptics-coated dressings). The second case describes an accident with a reinforcing steel perforating a builder's chest. After removal of the perforating steel by first aiders, the two open thoracic wounds are supplied with thoracic closure patches. The third case deals with an amputation injury of the lower leg after a traffic accident (use of tourniquet)., Discussion: The most common causes of death besides bleeding that can be prevented in patients with severe injuries and multiple trauma are tension pneumothorax and airway obstruction. These diagnoses can be identified and treated properly using the ABCDE algorithm. In these cases, the new tools such as tourniquet, hemostyptics, chest decompression needles and thoracic closure patches can be used, which are increasingly held as an additional equipment in the ambulance vehicle. The application of these adjuvants requires a critical indication, competent knowledge and training of medical and non-medical emergency service personnel in theory and practice., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt vorliegt., (Georg Thieme Verlag KG Stuttgart · New York.)

The train crash of Bad Aibling/Germany in February 2016 and the terrorist attacks of the recent years in Europe have demonstrated the urgent need to be prepared for such disastrous events. Disaster preparedness and disaster control are very important governmental duties, as are civil protection and civil defense. In Germany the responsibility for those tasks are divided between the 16 "Länder" and the Federation. While the Federation takes care of the civil protection and disaster assistance, the Länder are responsible for disaster control. The presented article focuses on these issues and gives valuable insights into the German system of disaster control and civil protection with a focus on health protection., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia., Case Report: After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits., Discussion: Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.