Trauma centers have invested heavily in emergency medical infrastructure and have the highest level of care for the treatment of seriously and critically injured patients.
Thanks to a standardized emergency system and a high level of specialization, seriously injured patients have the best chances of survival here. The specialist clinics are certified by the German Society for Trauma Surgery. Specialists from at least the fields of orthopaedics/trauma surgery, anaesthesia, visceral surgery or general surgery work in a trauma center; in the larger (supra-regional) centers, other specialist competencies are added, such as neurosurgery and vascular surgery.
Trauma centers guarantee optimal care for seriously and severely injured patients. They have at least one shock room, also known as a resuscitation room , in which initial treatment takes place. The shock room enables at least these treatments:
- Maintain or restore vital functions (resuscitation)
- Ventilate the patient (if necessary)
- Circulatory stabilization as part of shock management
- Carrying out initial imaging examinations(CT, X-ray, ultrasound)
- Performing immediate life-saving interventions
As the work processes are standardized when a patient is admitted and the expertise of the interdisciplinary shock room team is highly professional, the initial diagnosis and treatment are carried out within a very short time. This means that no valuable time is lost before patients can undergo any vital operations.
Local, regional and national trauma centers are linked together in the TraumaNetwork of the German Society for Trauma Surgery (DGU). They differ in the
- the number of trauma room treatment places
- the equipment available,
- the available specialist expertise and
- experience in the treatment of complex injury patterns
Trauma centers are categorized as follows:
- Local trauma centers are responsible for the area-wide treatment of the most common individual injuries. Outside of metropolitan areas, they also provide initial treatment for the most severely injured if required.
- Regional trauma centers specialize in the emergency and definitive care of severely injured patients and have sufficient intensive care and surgical capacities. Experts from a wide range of specialist fields are involved in the treatment and the equipment is of the highest standard.
- Supra-regional trauma centers are located at maximum care hospitals and also specialize in the emergency and definitive treatment of severely injured patients. In contrast to regional trauma centers, they have several shock room treatment areas and unlimited specialist expertise in the treatment of exceptionally complex and rare injuries.
A trauma center can take over the care of seriously injured patients @ Adobe Contributor /AdobeStock
In order to guarantee that the centers meet the spatial, personnel, technical and equipment requirements for securing and promoting trauma care, the centers are certified by the DGU. The criteria for this quality assurance are documented in the "DGU White Paper on the Care of Severely Injured Trauma Patients".
The guidelines require uniform personnel and organizational care for severely injured patients. The treatment procedures are also formulated as standards. Trauma centers, for example, require shock room equipment. There are also criteria for the transfer of seriously injured patients in the early phase. The doctors are specially qualified and are obliged to take part in additional training programs such as ATLS or DSCT courses.
The ATLS concept (ATLS = Advanced Trauma Life Support) is a globally established training concept that enables doctors to learn the standardized initial treatment of trauma patients in the trauma room. To this end, they train for emergencies in realistic simulations. The aim is to enable doctors to quickly and accurately assess the patient's condition, treat the most threatening injuries and disorders and assess the resources for further treatment.
The DSTC concept (DSTS = Definitive Surgical Trauma Care) describes the diagnostic and therapeutic measures following shock room care. In special training courses, doctors learn emergency surgical techniques such as abdominal hemostasis, emergency thoracotomy and retroperitoneal packing under realistic conditions, usually using body donors or models. Such exercises ensure that vital measures can be carried out safely, in a standardized and routine manner, even in less common procedures.
Trauma centers treat injuries
- after all types of traffic accidents (car, motorcycle, bicycle, pedestrian),
- after falls from a height,
- after suicide attempts and
- after a violent crime (e.g. stab and firearm injuries).
Motorcycle accidents usually end with serious injuries @ AS Photo Family /AdobeStock
These blunt and penetrating accident mechanisms sometimes result in life-threatening damage to limbs, internal organs, the head, chest (thorax) and abdomen. Typical injury patterns include
- pulmonary contusions
- Spinal fractures and spinal cord contusions
- Open bone fractures
- Craniocerebral trauma (skull fractures and cerebral haemorrhages)
- Internal bleeding
The polytrauma that frequently occurs after a traffic accident is characterized by injuries to several parts of the body. At least one of these is life-threatening. Burns are also not uncommon as traumatological emergencies.
Craniocerebral trauma often occurs after traffic accidents @ bilderzwerg /AdobeStock
The severity of an injury and the measures taken in the first hour determine the injured person's prognosis. Emergency measures must be applied in a very targeted manner. The emergency doctor decides on further treatment at the scene of the accident.
Primary care at the scene of the accident includes hemostasis and treatment of injuries to the thorax. Even in the case of severe traumatic brain injury, the focus is on stabilizing vital functions, as the aim is to prevent secondary damage. Breathing and circulation are also secured. A damaged brain cell is much more sensitive to a lack of oxygen than a healthy one. This is why rapid shock control is the top priority.
The following points are particularly important in primary care:
- Keep the airways clear
- Adequate oxygen supply
- Stabilization of the circulation
- Balancing the acid-base balance
- Stabilization of bone fractures with splints
- Immobilization of the spine to protect against further damage
Speed and high-quality medical care are the top priorities in emergency medicine. They determine the accident victim's chances of survival. After primary care at the scene of the accident, further treatment, usually surgical, takes place in a trauma center, as the specialists here are able to treat all conceivable injuries quickly and professionally.
Trauma clinics therefore have helipads that emergency teams can fly to around the clock.