[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].
The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.
Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Universität München. karl-georg.kanz@med.uni-muenchen.de
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Huber-Wagner
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Lefering
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Kay
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Qvick
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Biberthaler
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Mutschler
D003422:Critical Care / Q000706:statistics & numerical data*; D004189:Disaster Planning / Q000379:methods* / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D012042:Registries; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*