title: [Pretreatment mass casualty incident workflow analysis : Comparison of two level 1 trauma centers].
abstract: BACKGROUND
  Mass casualty incidents (MCI) have particularly high demands on patient care processes but occur rather rarely in daily hospital routine. Therefore, it is common to use simulations to train staff and to optimize institutional processes.
  
  
  OBJECTIVE
  Aim of study was to compare the pre-therapeutic in-house workflow of two differently structured level 1 trauma sites in the case of a simulated mass casualty incident (MCI).
  
  
  METHODS
  A MCI of 70 patients was simulated by actors in a manner that was as realistic as possible. The on-site triage assigned 7 cases to trauma site A with relatively long in-house distances and 4 patients to an independent trauma site B in which these distances were relatively short. During in-house treatment, time intervals for reaching milestones were measured and compared using the Mann-Whitney U test.
  
  
  RESULTS
  As no simultaneous patient arrival occurred, the Patient Distribution Matrix proved to be effective. Site A needed more time (minutes) from admission to endpoints (A: 31.85 ± 7.99; B: 21.62 ± 4.76; p = 0.059). In detail, the time intervals were particularly longer for both patient stay in trauma room (A: 8.46 ± 3.02; B: 2.73 ± 0.78, p < 0.01) and transfer time to the CT room (A: 1.81 ± 0.62; B: 0.06 ± 0.03, p < 0.01). A shorter stay in the CT room did not compensate these effects (A: 8.86 ± 1.84; B: 10.40 ± 2.89, p = 0.571). For both sites, image calculation and distribution were relatively time consuming (17.36 ± 3.05).
  
  
  CONCLUSIONS
  Although short in-house distances accelerated pretherapeutic treatment processes significantly, both sites remained clearly within the "golden hour". The strongest potential bottleneck was the time interval until images were available at the endpoints.
authors.affiliation: Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland. fabian.mueck@med.uni-muenchen.de.
authors.forename: F
authors.initials: F
authors.lastname: Mück
authors.affiliation: Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Wirth
authors.affiliation: Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Muggenthaler
authors.affiliation: Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
authors.forename: K G
authors.initials: KG
authors.lastname: Kanz
authors.affiliation: Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Kreimeier
authors.affiliation: Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Maxien
authors.affiliation: Institut für Interventionelle und Diagnostische Radiologie, HELIOS Klinikum München West, Steinerweg 5, 81241, München, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Linsenmeier
authors.affiliation: Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Mutschler
authors.affiliation: Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Wirth
mesh_terms: D019091:Critical Pathways / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D016544:Patient Simulation; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data*; D057188:Workflow; D016526:Workload / Q000706:statistics & numerical data
keywords: Mass casualty incidents; Multidetector computed tomography; Multiple trauma; Trauma room; Workflow