Statistics show that each year one in ten German citizens suffers a serious accident necessitating hospital admission for in-patient care. Staff in trauma centers are faced with seriously and severely injured patients following accidents. Even though medicine has developed rapidly in recent years, even today roughly 20% of those affected die from their serious injuries.

Overview

Trauma Center - Further information

What are trauma centers?

Trauma centers have invested heavily in the infrastructure needed for emergency medicine and provide the highest level of care for the treatment of the seriously and severely injured. Thanks to an excellent emergency system and a high level of specialization, the seriously injured have maximum prospects of surviving. Specialist clinics are certified by the German Society for Accident Surgery. These are staffed by medical practitioners working in a network made up of the fields of accident surgery, anesthesia, neurosurgery, plastic surgery and other specialist fields such as pneumonology. The commonest reasons for admission are workplace and road traffic accidents.

The chief feature of trauma centers

Trauma centers have pledged to guarantee the best possible care for the seriously and severely injured. Depending on their equipment, they carry out clinical and radiological diagnoses there and then on the examination table in the trauma room (provided a computed tomograph is available). Thanks to them and the regime of interdisciplinary collaboration, patients can have an operation within a few minutes. On the day of admission, the centers care for life-threatening injuries, they stabilize fractures and then transfer patients to the intensive care ward. Only when the circulation has been stabilized will the remaining injuries be operated on surgically.

Certification by the German Society for Accident Surgery

Trauma centers are special clinics for accident and reconstructive surgery. Authority to bear this name comes from certification by the 'German Society for Accident Surgery (DGU). Such clinics must meet numerous standards designed to assure and promote trauma care. These are recorded in the White Paper governing the care of the seriously injured. The guidelines stipulate a standard level of care for the seriously injured in terms of staffing and organization. The treatment processes are also formulated in this as standards. For example. trauma centers must have trauma room equipment. Also, there are criteria governing how the seriously injured can be transferred in the early stage. The doctors here are specially qualified and undertake to attend additional training programs such as ATLS or DSCT courses.

What are ATLS and DSTC courses?

The ATLS concept is a further training concept established around the world which sets standards for trauma room management. Doctors train here in virtual simulations to prepare themselves for real situations. The DSTC concept is a method using video training for surgeons with practical experience. It focuses on interventions which are seldom used, such as emergency thoracotomy or abdominal hemostasis (bleeding control). Emergency thoracotomy is a subject of controversy and discussion. It entails making an opening in the thorax after a cardiac arrest (necessitated by trauma). Abdominal hemostasis uses new anti-coagulant medication to simplify treatment.

Which injuries are treated in a trauma center?

Typical emergencies are injuries to the internal organs and pulmonary contusions, spinal cord fractures, open bone fractures, spinal cord compressions, skull fractures, and brain hemorrhages. Polytrauma, which occurs frequently after a road traffic accident, is characterized by injuries to multiple body parts. At least one of them is life-threatening. Burns as traumatic emergencies are rather rare. Even so, the severity of an injury and the action taken in the first hour determine the prognosis of the injured person. Emergency action must now be taken in a very targeted manner. While still at the site of an accident, the emergency doctor makes decisions on further treatment.

Primary care comes before the trauma center.

Primary care at the accident site consists of stopping bleeding and care for any injuries to the thorax. Also in the event of severe traumatic brain injury, stabilization of the vital functions is the first concern, followed by prevention of any secondary injuries. Also, steps are taken to ensure breathing and blood circulation. A damaged brain cell in the face of lack of oxygen is significantly more sensitive than a healthy one. This is why rapid trauma treatment must be a first priority.

The following points are particularly important in primary care:

  • keeping the airways unobstructed
  • provision of sufficient oxygen
  • stabilizing the circulation
  • equalizing the acid-alkaline balance
  • administering high-dose corticoids

Trauma center: Every minute counts

Rapid action and high-quality medical care are the prime objective in emergency medicine. They determine the chances of survival of the accident victim. After primary care at the scene of the accident, next is surgical treatment in a trauma center, because the specialists here are able to treat all conceivable injuries properly and rapidly. This is why trauma clinics have access to helicopter landing pads, which emergency teams can fly to all around the clock.