Trauma Care in Germany: An Inclusive System

Sturm, J. A.; Pape, Hans-Christian; Dienstknecht, Thomas

doi:10.1007/s11999-013-2967-x

Cited by 22 publications

(15 citation statements)

References 60 publications

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“…5 In-hospital care is provided by specialized trauma providers in approximately 900 trauma centers that are part of some 55 trauma networks. 6 Independent auditing and certification of trauma centers occur in an effort to maintain quality of care in accordance with standards set forth by the German Trauma Society. 6 Such high-quality and reliable trauma care is universally available to the entire German population but comes at significant cost to the health care system.…”

Section: The Bismarck Modelmentioning

confidence: 99%

“…6 Independent auditing and certification of trauma centers occur in an effort to maintain quality of care in accordance with standards set forth by the German Trauma Society. 6 Such high-quality and reliable trauma care is universally available to the entire German population but comes at significant cost to the health care system. 5 This has prompted intense scrutiny of total hospital spending.…”

Section: The Bismarck Modelmentioning

confidence: 99%

“…5 This has prompted intense scrutiny of total hospital spending. 6 With publicly funded trauma centers comprising approximately one half of all available beds in Germany and the remainder provided by both non-profit and for-profit private centers, 3 German trauma surgeons-much like their American counterpartsare faced with the task of advocating for financial support on both the administrative and political stage.…”

Section: The Bismarck Modelmentioning

confidence: 99%

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Global Systems of Health Care and Trauma

Lee

Mir

2014

Journal of Orthopaedic Trauma

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Health care policy continues to occupy the center of national debate in the United States. Exploration of international health care and trauma systems allows for better comprehension of our own policies. Four basic models of health care exist across the globe: Bismarck, Beveridge, National Health Insurance, and Out-of-Pocket. Expectantly, disparities in trauma care necessarily follow inequities in overall health care and infrastructure. In this article, we aim to review several countries' health care models and their respective trauma systems. Critical analysis of international solutions to deficiencies in overall health and trauma care may serve as a guide for issues in the United States.

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Section: The Bismarck Modelmentioning

confidence: 99%

Section: The Bismarck Modelmentioning

confidence: 99%

Section: The Bismarck Modelmentioning

confidence: 99%

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Global Systems of Health Care and Trauma

Lee

Mir

2014

Journal of Orthopaedic Trauma

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“…[3][4][5][6][7] As a consequence, many countries across the developed world are now at various stages of developing trauma networks. [12][13][14] Common features of inclusive trauma networks include designation of specialist trauma centres, pre-hospital triage of severely injured patients 15 , agreed transfer protocols between network hospitals, and quality assurance programmes.…”

Section: Introductionmentioning

confidence: 99%

Regionalisation of trauma care in England

Metcalfe

Perry

Bouamra

et al. 2016

The Bone & Joint Journal

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This study aimed to determine whether there is early evidence of improved outcomes in Major Trauma Centres following the regionalisation of trauma care in England. An observational study was undertaken using the Trauma & Audit Research Network (TARN), Hospital Episode Statistics (HES), and national death registrations. The outcome measures were trauma care quality indicators (e.g. treatment by a senior doctor) and clinical outcomes (e.g. in-hospital mortality).There were 20,181 major trauma cases reported to TARN during the study period. Following regionalisation of trauma services, all measured care quality indicators improved, fewer patients required secondary transfer between hospitals, and a greater proportion were discharged with a Glasgow Outcome Score of good recovery In this early post-implementation analysis, there were no differences in either crude or adjusted mortality. The overall number of traumatic deaths in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggest that further benefits may become apparent after a period of trauma system maturation.

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“…3 Many Emergency Medical Services (EMS) systems in European and Latin American countries promote involvement of emergency physician care at the scene. 4 In the United States, the "scoop and run" model is predominant and favored. The focus of this latter system is the rapid ground or air transport of trauma patients to specialized trauma centers for advanced trauma care.…”

Section: Introductionmentioning

confidence: 99%

The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient

Zakrison¹,

Namias²,

Grossman³

et al. 2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Objectives Entrapment of trauma patients in motor vehicle and other accidents is common. Frequently, Emergency Medical Services (EMS) personnel and firefighters are able to free the patient and initiate rapid transport to trauma centers. In rare circumstances, severe torso and extremity injuries combined with major entrapment may require complex rescue operations. These trauma patients spend the “Golden Hour” at the scene under difficult conditions. The objective of this review is to evaluate the role of the trauma surgeon leading the care at the scene of critically injured and entrapped trauma patients with possible need for surgical interventions. Materials and methods A 10-year review of all trauma surgeon to scene activations between 2005 and 2014 at the Ryder Trauma Center, an urban ACS Level 1 trauma center, was performed. An analysis of the trauma registry, individual cases, and surgical interventions was conducted. Results The University of Miami/Jackson Memorial Hospital (UM/JMH) Ryder Trauma Center and Miami Dade Fire Rescue have an established program in place for trauma surgeon to scene activations. During the study period, the on-call trauma surgeon was activated six times and traveled to the scene by air rescue helicopter four times, by ground in 1 case and in 1 case the patient expired before takeoff. One patient required on-scene amputation of an entrapped non-salvageable upper extremity. Two patients required on-scene amputation of bilateral lower mangled, entrapped extremities. One patient required a localized limb preserving surgical procedure to free him from entrapment. The incidence was 0.016% of 36,872 trauma alert activated patients evaluated at Ryder Trauma Center during the study period. Hemorrhagic shock, associated injuries, and long scene times were present in all patients. The survival of treated patients was 80%. Conclusion The need for on-scene amputations of nonsalvable extremities in entrapped trauma patients is rare. Experienced trauma surgeons should evaluate these patients and decide which interventions are necessary. All efforts should be made to salvage the limb. However, if the entrapped extremity appears nonsalvageable and the patient is in profound life-threatening shock requiring rapid transport, field amputation may be required. Policies, safety training and gear, supply kits, and partnerships with EMS are needed. How to cite this article Pust GD, Grossman MM, Shatz DV, Habib F, Pizano L, Zakrison TL, Marttos A, Ruiz G, Ginzburg E, Namias N. The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient. Panam J Trauma Crit Care Emerg Surg 2016;5(2):93-100.

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Trauma Care in Germany: An Inclusive System

Cited by 22 publications

References 60 publications

Global Systems of Health Care and Trauma

Global Systems of Health Care and Trauma

Regionalisation of trauma care in England

The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient

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