Zusammenfassung Hintergrund und Ziel der Arbeit Das Eckpunktepapier aus dem Jahr 2007 hat wichtige Rahmenbedingungen und Ziele definiert, die als Grundlage für Strukturanforderungen und die notfallmedizinische Planung dienten. Die steigenden Anforderungen an die notfallmedizinische Versorgung der Bevölkerung machen es erforderlich, das Eckpunktepapier 2007 zu aktualisieren und zu erweitern. Das Ergebnis der Überarbeitung wird in diesem Artikel präsentiert. Material und Methoden Der Entwurf für das neue Eckpunktepapier wurde auf einem Symposium mit Vertretern der an der notfallmedizinischen Versorgung beteiligten Fachgesellschaften/Institutionen/Organisationen ausgearbeitet und in einer Plenumsitzung vorgestellt. Zur exakten Begriffsbestimmung wurde ein Glossar erstellt. In einem zweistufigen Konsensusverfahren wurden alle Dokumente in einem Umlaufverfahren überarbeitet und endgültig zur Abstimmung gebracht. Am Konsensus zum Eckpunktepapier beteiligten sich insgesamt 30 Fachgesellschaften/Institutionen/Organisationen. Die Zustimmungsrate entspricht mit 96,7 % einem starken Konsensus. Ergebnisse Das „Eckpunktepapier 2016“ enthält nun Empfehlungen zur notfallmedizinischen Strukturplanung und zum notfallmedizinischen Vorgehen gemäß den geltenden Leitlinien und Anforderungen an die geeignete Zielklinik. Zusätzlich zu den bisherigen Tracerdiagnosen Schädel-Hirn-Trauma, Schlaganfall, Schwerverletzte/Polytrauma und ST-Hebungsinfarkt wurden in die Überarbeitung Empfehlungen zum plötzlichen Kreislaufstillstand und zur Sepsis aufgenommen. Betrachtet wurden jeweils die Prozessqualität der Rettungsleitstelle, Anforderungen für Diagnostik und Therapie durch Notarzt und Rettungsdienst, Einsatztaktik und Zeitmanagement, die klinische Erstversorgung in einem geeigneten Krankenhaus sowie Instrumente des Qualitätsmanagements. Zusätzlich sind die Besonderheiten bei der Versorgung pädiatrischer Patienten aufgeführt. Außerdem enthält das Papier Kernempfehlungen zum ersten Glied der Rettungskette (Risikoaufklärung, Erste Hilfe und Notruf). Diskussion Das „Eckpunktpapier 2016“ berücksichtigt somit die gesamte notfallmedizinische Prozesskette vom Eintritt des Notfalls und dem Notrufeingang in der Rettungsleitstelle über die notärztliche/rettungsdienstliche Versorgung bis zur Weiterbehandlung im Krankenhaus und dient damit als Leitfaden für die integrierte Bedarfsplanung einer erreichbarkeitsorientierten Notfallversorgung.

Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002–2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt chest trauma.

Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF) as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG) or demineralized-bone-matrix (DBM).

Pre-hospital emergency medical services (EMS) are an integral part of emergency medical care. EMS planning can be achieved by analyzing patterns of use. However, long-term time trends of EMS use have rarely been studied. The objective of this retrospective study was to investigate utilization patterns over a ten year period, and to compare utilization trends between urban and rural municipalities and between events with and without prehospital emergency physician (PEP) dispatch. Routine data collected by 26 dispatch centers in the federal state of Bavaria, Germany, from 2007 to 2016 was analyzed. Emergency locations were classified into five levels of rurality. Negative binomial mixed effects regression models were fitted to predict emergency rates and to investigate differences in rates and utilization trends. Graphical representation methods were used to compare distribution of transport rates and distribution across daytime and weekday. Twelve million two hundred thousand one hundred fifty-five dispatches assigned to 7,725,636 single emergencies were included. The mean number of emergencies per year and 1000 population (emergency rate) was 42.8 (±16.0) in rural municipalities and 80.7 (±9.3) in large cities. Compared to rural municipalities, cities had higher emergency rates without (IRR = 3.0, CI 2.2–4.0) and with pre-hospital physicians (IRR = 1.5, CI 1.2–2.0). Between 2007 and 2016, the absolute number of emergencies increased by 49.1%. Estimated annual percent change of emergency rates without physician activation ranged from 5.7% (CI 4.3–7.1) in cities to 7.8% (CI 7.6–7.9) in rural areas. Changes in emergency rates with physician attendance were lower, with estimated increases between 1.3 and 2.4%. The average proportion of patients transported to a hospital was lower in cities and remained unchanged. There were no considerable differences or changes in the distribution across daytime and weekdays. Differences between cities and other areas suggest that the planning of EMS should be targeted to regional characteristics. A substantial increase in emergency rates was observed across all areas of Bavaria, but did not impact transport rates or temporal distributions. Further research is needed to better understand the urgency of emergency events and reasons behind increasing EMS utilization.