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May 22, 2017

German Trauma surgeons begin a new course format on medical care in the event of terrorism

The German Trauma Society (DGU) is launching a new course format today for treating gunshot wounds and explosion injuries following a potential terror attack. The new course on Terror and Disaster Surgical Care (TDSC®) is aimed at experienced trauma surgeons and surgeons at German hospitals who could face the medical challenge posed by terror incidents in the future.

“In the event of a disaster, trauma surgeons have to set other priorities than they would in normal care. The course exercises this change in thinking during terror situations. Even though we hope that it will prove unnecessary, we want to be prepared to provide optimal treatment for as many patients as possible in the event of an emergency,” explains DGU President, Prof Dr Ingo Marzi. DGU experts presented the course concept today during a press conference in Frankfurt am Main and offered insights into the first TDSC® course.

Mass-casualty incidents in the event of terrorism (terror MCIs) differ from standard MCIs, such as multiple collisions on the motorway. The particularly hazardous situation and heavily bleeding gunshot and explosion injuries call for special management at the scene of the incident and in hospital. The two-and-a-half-day TDSC® course includes instruction regarding deployment in dangerous areas, key aspects of wound ballistics, the particulars of treating certain typical injuries, important decision algorithms and damage control measures. The course curriculum was developed by the DGU Work Group for Deployment, Disaster and Tactical Surgery (AG EKTC), where a substantial contribution was provided by experts from the Medical Service of the German Armed Forces. Chief Staff Surgeon and AG-EKTC Director, Prof Dr Benedikt Friemert, adds: “Thanks to our close collaboration with the Armed Forces, we are able to provide highly specialised expertise from field surgery to civilian medical practitioners.”

Participants discuss the special scenarios associated with terror incidents: the high number of critically injured people, sometimes at several different terror sites at the same time, the unknown duration of an incident and the inestimable hazard situations demand different tactical approaches to emergency rescue, as well as in the treatment of terror victims in the specialist trauma centres of the network initiative TraumaNetzwerk DGU®. Here, experts provide important criteria to help teach the participants how they can save the lives of as many people as possible while taking their own safety into consideration and how they can still treat victims individually despite the exceptional circumstances.

The course focuses on a simulation exercise in the form of a game. Participants undergo various terror simulations where they face a mass-casualty incident as a result of a terror attack (terror MCI). In as realistic conditions as possible, the participants train their decision-making skills in the event of a terror situation: which patient should receive which operation with which medical equipment and in which order? Friemert continues: “Severe gunshot wounds and explosion injuries as well as the handling of limited resources previously played almost no role at all for us in our daily care. It is therefore important that we have developed this course in order for us to learn from the experiences of Paris, Brussels and Berlin and be prepared for emergency situations.”

As part of the course, the instructors also consider organisational issues, such as hospital emergency plans in the event of a terror incident. Time and again, the DGU calls for the regular review, update and adjustment of hospital emergency and deployment plans. DGU experts recommend adding aspects relating to extreme danger situations, such as terror incidents, to existing hospital emergency plans for mass-casualty incidents. The DGU General Secretary, Prof Dr Reinhard Hoffmann, notes: “Here it is also important to ensure that we work closely with the competent authorities. The provision of an emergency contingency of operation material and regular emergency drills have to be taken into consideration and safeguarded financially. To achieve this, we need more support from the political sphere.”

The course went through a pilot phase for half a year and will be conducted in cooperation with experts from other medical disciplines in future. The German Society for Anaesthesia and Intensive Care (DGAI) and the German Society for General and Abdominal Surgery (DGAV) play a significant role in the course. Since injuries arising from terror incidents are often particularly threatening due to heavy bleeding, medical practitioners from the German Society for Vascular Surgery and Vascular Medicine (DGG) are likewise involved. Moreover, representatives from the Medical Service of the German Armed Forces provide their expertise with respect to atomic, biological and chemical weapons (ABC weapons).

The threat of global terrorism currently poses a significant challenge as the likelihood of terrorist incidents is rising in Germany. The civilian population is typically the target of terror attacks in Europe. Inestimable hazard situations at the scene of the incident and severe typical injuries, such as complex gunshot and explosion injuries, as well as the high number of critically injured people often at multiple places at various times create organisational, medical and tactical challenges for emergency services, paramedics and hospitals in the TraumaNetzwerk DGU® network.

With its TraumaNetzwerk DGU® network initiative and over 600 participating trauma centres, the German Trauma Society (DGU) has already been ensuring that critically injured people have the best possible chances of survival throughout all of Germany on 365 days of the year and around the clock, since 2006. In addition, the Medical Service of the German Armed Forces has medical expertise in special hazard situations, such as rescue under gunfire and the treatment of gunshot and explosion injuries. The DGU and the Medical Service of the German Armed Forces have a common goal: to continue to sustainably develop tactical/strategic and medical competence for treating terror victims throughout all of Germany on the basis of scientific findings.

The DGU is the first medical society in Germany to be committed to purposefully gathering and harnessing the necessary knowledge for the medical care of terror victims. In close collaboration with the Medical Service of the German Armed Forces, it thus presented a 5-Point Plan at the first emergency conference of the DGU in September 2016. The TDSC course represents a major milestone in the 5-Point Plan.

Schedule information:
28 September 2017: 2nd Emergency Conference of the DGU in Frankfurt am Main


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