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Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products

BACKGROUND: Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial...

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Autores principales: Franke, Axel, Bieler, Dan, Friemert, Benedikt, Hoth, Patrick, Pape, Hans-Christoph, Achatz, Gerhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364295/
https://www.ncbi.nlm.nih.gov/pubmed/32676714
http://dx.doi.org/10.1007/s00068-020-01399-w
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author Franke, Axel
Bieler, Dan
Friemert, Benedikt
Hoth, Patrick
Pape, Hans-Christoph
Achatz, Gerhard
author_facet Franke, Axel
Bieler, Dan
Friemert, Benedikt
Hoth, Patrick
Pape, Hans-Christoph
Achatz, Gerhard
author_sort Franke, Axel
collection PubMed
description BACKGROUND: Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. METHODS: The Terror and Disaster Surgical Care (TDSC®) - Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. RESULTS: The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1—T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). CONCLUSION: The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. mass-casualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed.
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spelling pubmed-73642952020-07-16 Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products Franke, Axel Bieler, Dan Friemert, Benedikt Hoth, Patrick Pape, Hans-Christoph Achatz, Gerhard Eur J Trauma Emerg Surg Original Article BACKGROUND: Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. METHODS: The Terror and Disaster Surgical Care (TDSC®) - Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. RESULTS: The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1—T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). CONCLUSION: The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. mass-casualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed. Springer Berlin Heidelberg 2020-07-16 2020 /pmc/articles/PMC7364295/ /pubmed/32676714 http://dx.doi.org/10.1007/s00068-020-01399-w Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Franke, Axel
Bieler, Dan
Friemert, Benedikt
Hoth, Patrick
Pape, Hans-Christoph
Achatz, Gerhard
Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
title Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
title_full Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
title_fullStr Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
title_full_unstemmed Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
title_short Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
title_sort terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364295/
https://www.ncbi.nlm.nih.gov/pubmed/32676714
http://dx.doi.org/10.1007/s00068-020-01399-w
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