title: [Preclinical management of accident trauma patients in the large city].
abstract: Congested urban areas make specific demands on emergency medical systems (EMS); Berlin as an example, structural and logistic necessities of EMS are demonstrated. Short response times, a narrow hospital net and short transport times suggest the possibility to minimize prehospital care for the traumatised patient. Pathophysiology of severe trauma and accepted basic principles of primary care, the pattern of multiple injuries and a low rate of necessary emergency operations, as well as frequently unavoidable secondary transports to appropriate hospitals contradict such consequences. With modern preclinical emergency care enough time is gained to primarily reach an even more distant but competent trauma centre. A high number of secondary transports from low level hospitals of more distant rural regions shows the importance of concentrated high level medicine in urban areas and proves the necessity of qualified inter-hospital transport systems.
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Unfallkrankenhaus Berlin.
authors.forename: J
authors.initials: J
authors.lastname: Beneker
authors.forename: P
authors.initials: P
authors.lastname: Heidt
mesh_terms: D001604:Berlin; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000600:supply & distribution*; D006801:Humans; D015994:Incidence; D009104:Multiple Trauma / Q000453:epidemiology*; D010360:Patient Transfer / Q000706:statistics & numerical data; D014187:Transportation of Patients; D014193:Trauma Centers / Q000600:supply & distribution; D014504:Urban Health / Q000706:statistics & numerical data*