Competence and time decide the fate of severely injured

The recommendations of the Whitebook Medical Care of the Severely Injured, which was first published in 2006, have been updated. The Whitebook now contains measures for improving the chances of survival as well as specifications for the optimisation of long-term and improved life quality of people after accidents. Germany has shown a clear improvement in its clinical infrastructure and the process quality of medical care for severely injured persons since the Whitebook was introduced and its recommendations have been implemented on a federal scale in the TraumaNetzwerk DGU® project.

The Whitebook Medical Care of the Severely Injured describes the standards for promoting quality, safety and satisfaction in the care for severely injured persons in Germany. A new focus of the second issue of the Whitebook is the early start of integrated rehabilitation therapy. The purpose of the measures recommended in the Whitebook is increasing survival chances as well as improving the clearly remaining deficits in the functional and mental rehabilitation of the injured person.

„We as trauma surgeons take responsibility for the whole treatment process – from the accident site up to the re-integration of the patient back to work, family and leisure activities. This is only possible for pain-free and satisfied patients. We will therefore regularly include suitable rehabilitation centres in the networked care structures of the trauma networks“, said trauma surgeon Siebert. A further novelty is a compulsory cooperation of each TraumaNetzwerk DGU® with a trauma centre that is also specialised in trauma in adolescents (pediatric trauma) to provide comprehensive help with high competence and quality to the 1 500 children per year who are severely injured.

Following the bottlenecks and quality differences in the care for severely injured persons which became known in 2006, the DGU started the Whitebook Medical Care of the Severely Injured and the TraumaNetzwerk DGU® project. What was then a globally unique quality initiative, has since been joined by over 800 clinics, i.e. almost all clinics involved in the care of severely injured persons. Within only six years, care quality in Germany was brought to a comparable or higher level by providing the clinics with 35% more equipment such as X-ray and CT scanner as well as a specially equipped shock room or a helicopter landing pad proximal to the shock room.*

Care processes were improved by 55 percent so that severely injured persons, for example after a multiple collision, could be treated within 30 minutes and brought into a suitable clinic for immediate further treatment after a minimum rescue time. The availability of all specialist disciplines, e.g. intensive medicine, neuro-, visceral- and vascular surgery for treatment of complex and irregular injury patterns was ensured around the clock on all 365 days per year.

Every year, more than 35 000 persons suffer severe, often life-threatening injuries in Germany. Their chance of survival decreases every quarter of an hour. The result of the treatment strongly depends on the type and severity of the injury, on time pre-hospital and clinical primary care in a competent trauma hospital and on trained rescue services as well as the availability of all medical disciplines required to care for severely injured persons. The DGU has initiated the TraumaNetzwerk DGU® project to provide each individual severely injured person at any place in Germany at all times with the same chances of survival. Germany currently has 53 TraumaNetzwerk DGU® units with 864 participating clinics, of which 31 TraumaNetzwerk DGU® units with 413 participating clinics have already been certified according to the specifications of the Whitebook.

* Data collected during project implementation.