[Consideration and implementation of the elements of hospital mass casualty planning in the hospitals of the TraumaNetworks DGU® : An evaluation within the framework of the development process of the guidelines for clinical disaster medicine in Germany (LeiKliKatMeD) by the EKTC, NIS, AKUT, AUC].

Abstract

Background: The protection and maintenance of hospital functionality and treatment capacity require preventative planning and preparation for a mass casualty incident with respect to the scenarios, disasters or catastrophes to be expected. The hospital alarm and operations (KAEP) or stockpiling plan should include and organize the procedures and measures in the respective clinics and hospitals. The aim of the present study was to evaluate the hospitals of the Trauma Networks of the German Society for Trauma Surgery® (TNW DGU®) with respect to the established organizational structures and contents of the KAEP.

Material and method: In this study 622 hospitals from the TNW DGU® were surveyed to determine current treatment capacities depending on the principles and standards of care. This was done via the DGU Academy of Trauma Surgery (AUC) and an online-based survey with voluntary participation via a web-based platform (SurveyMonkey Europe UC, Dublin, Ireland). The data presented here represent an excerpt of the overall data focused on the topic of this paper. Of the 622 certified clinics 252 (40%) took part in the survey in December 2022 and 250 data sets could be evaluated.

Results: Level I, II, III trauma centers (LTZ, RTZ, ÜRTZ) took part in equal numbers. Of the participating clinics 90% have a KAEP that has been updated in the last 3 years. The manual of the Federal Office of Civil Protection and Disaster Assistance (BBK) was known in two thirds of the clinics surveyed. Only 30% of the clinics adapted their own KAEP after it was published and only 40% exercised it in the last 3 years. Elements for the care of those affected and injured (psychosocial network, end-of-life care, care of relatives) were included in 25-44% of hospitals. Regardless of the certification, it became obvious that around 80% of the hospitals rely exclusively on one alarm procedure and only 20% use a redundant system with 2 or more notification procedures. The survey showed that more than 75% of the hospitals already have the option of selective or partial alerting. Depending on the triage category, the LTZs were able to initially admit an average of 2 SK I and 4 SK II patients. These capacities were almost doubled by the RTZ and tripled by the ÜTZ.

Conclusion: The DGU Trauma Networks represent an essential part for the care in disaster and major disaster situations. The KAEP has been implemented in the majority of hospitals. Updating the KAEPs to current content, practicing and digital, selective and redundant systems for alerting represent a challenge. In addition, the harmonization of terms and organizational elements but also the establishment of care for relatives and the care and psychosocial emergency treatment (PSNV) have not yet been fully implemented. Ultimately, a KAEP must be implemented to make hospitals and the healthcare system more resilient to disasters and major disasters. It is important to support the hospitals and ensure that costs for exercises and training course formats are covered.