[Emergency medical service response to major incidents. A study of 21 cases].
Major incidents are high-profile events where many lives are at stake. The response of the health-care-related agencies has to be well-planned and co-ordinated, thus retaining the public's confidence in the emergency services whilst efficiently responding to those in need. The communication between supervising officers such as medical incident officer (MIO) and ambulance incident officer (AIO) with the ambulance personnel is vital for the proper employment of doctors and ambulance teams at the incident scene. In Germany the experience gained at such events has not yet been collected into a single coherent and comprehensive analysis. This study investigates the delivery of ambulance vehicles and personnel at major incidents. Was appropriate emergency treatment and transport for each seriously injured patient possible? Were the communication structures between the supervising officers and the ambulance teams sufficient to provide effective co-ordination and utilisation of the teams at the scene?


METHODS
A major incident was defined as any incident with more than ten casualties. All central ambulance controls (CAC) in the five federal states Rhineland-Palatinate, Bavaria, Saarland, Hessen, and Baden-Württemberg were asked by telephone and mail if a major incident had occurred in their area from September 1992 to September 1994. In cases of major incidents in other federal states of West Germany during that period, the appropriate CAC was contacted to collect data. A standardised questionnaire was send to the CACs. The data were split into chronological periods of responses to major incidents.


RESULTS
Twenty-one major incidents were included in the study, 11 of them road accidents. The mean time to arrival of physician-staffed ambulances at the scene was calculated as 20 min after alerting of the CAC. In 90% of all cases enough physicians were available to treat each seriously injured patient (NACA score 3-6). In 9 cases a MIO and an AIO were sent out. Their mean time to arrival at the scene was 25 min after alerting of the CAC. In 19 cases (90%) enough ambulance vehicles were provided to rapidly distribute all casualties. With one exception, this was also true for the use of helicopters. Onsite communication of the ambulance staff was always by direct personal contact. In 38% of all incidents the arriving ambulance staff had difficulties in contacting senior officers, and thus, nobody defined their roles and responsibilities.


CONCLUSIONS
Quality assurance in emergency medicine can only be achieved by research and documentation. Analysis of the data for this study revealed a severe documentation gap. Only in Bavaria did a one-page documentation form for major incidents exist. For a comprehensive analysis of the health-care-related response to major incidents, a standardised and detailed documentation form should be introduced. According to the data from this study, ambulance staff and vehicles can be quickly and sufficiently provided for the vast majority of major incidents in Germany. For the optimal use of these resources, however, communication skills and knowledge and understanding of on-side supervision structures such as the MIO and AIO need to be promoted.
Mentges
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D
Klinik für Anaesthesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen am Rhein.
Kirschenlohr
R
R
Adamek
H
H
Boldt
J
J
Riemann
J F
JF
D000063:Accidents, Traffic; D017732:Air Ambulances; D000552:Ambulances; D004282:Documentation; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D005858:Germany; D006801:Humans; D011785:Quality Assurance, Health Care