Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

Abstract

BackgroundHospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations.MethodsThe data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission.ResultsFrom 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene.ConclusionsThe mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

The Berlin Acute Trauma Care Instrument Set (BATMIN) – A Selected Combination of Surgical Instruments for Damage Control and Hemostasis Surgery in Severe Acute Trauma

“…2,7 Additionally, fundamental surgical strategies (damage control vs. early total care) and how they are best applied in such scenarios to ensure the survival of as many patients as possible have been described. 5,[7][8][9][10] Furthermore, some working groups address the question of how to optimize patient distribution from the scene to a center with an appropriate level of care, and what opportunities these centers have to increase their capacities accordingly. 11 Detailed data on supply resources are rare.…”

Towards automated self-tagging in emergency health cases

“…[6] provides a Field Triage Decision Scheme (FTDS) that is takes into consideration the facilities and the services of available trauma centers. The researchers in [7] address the duration and predictors of life saving operations. According to their calculations, the mean operation time of 130 minutes calculated for emergency lifesaving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity.…”

“…There are several proposals to improve emergency response processes [4] [5] [6] [7]. However, all these efforts address manual tagging of patients and there are less efforts to automate the tagging process.…”