ZusammenfassungWährend einer Pandemielage sind Patienten mit Verdacht auf COVID-19 auch im Rahmen von Rettungsdienstalarmierungen zu versorgen. Um ein adäquates Vorgehen zu etablieren, ist die Entscheidungshilfe zur Patientenzuweisung bei Verdacht auf COVID-19 für die Rettungsdienstmitarbeiter sowie für die Notärzte im bayerischen Rettungsdienst erstellt worden. Die Entscheidungshilfe schließt die aktuellen Leitlinien und Empfehlungen zum Thema COVID-19 ein. Für die Darstellung der Entscheidungshilfe wurde ein Flussdiagramm in DIN-A4-Format gewählt, welches nach dem im Rettungsdienst etablierten ABCDE-Schema (A-Airway, B-Breathing, C-Circulation, D-Disability, E-Environment/Exposure)aufgebaut ist. Das Flussdiagramm ermöglicht eine Kategorisierung der Patienten in drei Stufen, welche anhand von (Vital‑)Parametern und Kriterien wie Risikofaktoren und spezifischen Rahmenbedingungen erfolgt. Ziel ist es, Notärzten und Rettungsdienstmitarbeitern eine Orientierungshilfe für die Beurteilung der Patienten sowie daraus entstehende Transportentscheidung mit gegebenenfalls geeigneter Zielklinik an die Hand zu geben.

In this work the optical feedback generated by a tapered amplifier (TPA) emitting at 1120 nm is characterized at different operational conditions. The TPA is operated in a master oscillator power amplifier (MOPA) configuration, while the influence of pump current or seed power on the emitted feedback is investigated. Measurements are also performed with the TPA exposed to defined external optical feedback. For an estimation of the feedback from the TPA a simple formula is derived and the calculations are compared to the measurement results. With the experimental and theoretical results the required feedback resistance of the master oscillator seed source can be defined and the MOPA system optimized for certain applications with unwanted optical feedback.

Context The LMU University Hospital is among the largest healthcare facilities in Germany. The measures implemented prior to and during the first pandemic wave of COVID-19, were evaluated in preparation of a second pandemic wave. This paper presents the pandemic management concept, evaluation and adaptation of LMU University Hospital. Methods Between July and September 2020 the disaster management team of LMU University Hospital conducted a mixed-method evaluation of the hospital’s pandemic management. A workshop series based on the After Action Review working group format was organized to examine the management structure, decision-making processes, documentation, and crisis preparedness response for a second COVID-19 wave. Further, the satisfaction of employees with the hospital’s COVID-19 management was examined through an anonymous survey. Results The workshop series highlighted a need for structural and operational adaptation of the COVID-19 management at LMU University Hospital. The results of the employee survey ( N = 2182) provided positive feedback for the measures taken during the first pandemic wave. Specific actions were derived concerning the availability of personal protective equipment and emergency childcare services. A key outcome of both evaluation activities was the identified need for further improvement in communication between stakeholders. All changes were adopted prior to the second pandemic wave.

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Background In a terror attack mass casualty incident (TerrorMASCAL), compared to a “normal” MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL. Methods To answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta. Results In the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers. Conclusion The results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers.