Trauma surgeons extend emergency network across Germany

Map of the emergency network (Source: Academy for Trauma Surgery, AUC)

Each year, 35,000 people in Germany suffer severe injuries in accidents on the road, at work or during leisure activities. Saving and treating such patients is a race against time in which every move counts. In 2006, trauma surgeons codified the optimal approach to treating severely injured in the Whitebook Medical Care of the Severely Injured, and founded the TraumaNetwork DGU® initiative. These measures should enable the differing treatment plans, as well as staff equipment, machines and medical supplies to be standardised in Germany’s Departments for Trauma Surgery. The goal is to give anyone who suffers a severely injured the best possible chance of survival everywhere and at all times, which includes guaranteeing optimal treatment in less populated areas. The department’ participation in the initiative led to changes in their staffing and organisational structures. For instance, shock room guidelines were established, work schedules changed to ensure round-the-clock availability of a skilled rescue team, and doctors trained in shock room management. In many departments the equipment was also optimised: for example, X-ray machines and ultrasound scanners for the emergency treatment room were upgraded, teleradiological systems were introduced, and the necessary equipment for emergency operations and blood transfusions was made available.

As part of a quality assessment in the form of onsite inspections by an independent certifying body, departments were categorised into one of three care levels according to their resources and staff competence. Supraregional trauma centres are able to treat especially severe, complex or rare injuries such as injuries to the aorta, severed limbs, or severe facial injuries. The regional trauma centres provide comprehensive emergency care and a wide range of services, including, for instance, the treatment of severe injuries to the skull and brain. The local trauma centres, meanwhile, provide pre-hospital and primary clinical care for trauma patients. In order to ensure the best possible care on a regional level, trauma centres of differing care levels collaborate within a TraumaNetwork. Each TraumaNetwork consists of an average of 14 departments, with eight local, four regional, and two supraregional trauma centres. This emergency network ensures that the rescue services can reach a trauma centre’s emergency room in less than 30 minutes – in sparsely populated areas as well as in urban centres. This is especially important for patients with potentially fatal injuries, since their chances of survival diminish with every passing minute. As soon as the department-doctors have stabilised the patient and he or she is out of immediate danger, the patient can then be transferred as necessary to a department ideally equipped to handle the injury in question. The criteria for admission and transfer within a TraumaNetwork are clearly defined in cooperation agreements, which do away with the need for time-consuming consultations in situations when every moment counts. These criteria are also regularly reviewed in TraumaNetwork quality circles. The rescue services, which play an important role in the selection of an appropriate department, also participate in these discussions. 

In order to review their treatment procedures, the trauma centres collect anonymised patient data in the Trauma Register DGU® – regarded as the most extensive database of severely injured worldwide, and documenting nearly 200,000 cases since its establishment back in 1993. Departments also receive feedback on their performance in the Trauma Register’s annual report. As well as ensuring common quality standards, the Trauma Register answers medical queries about how to avoid mistakes, increase patient safety, and improve treatment outcomes. 

The TraumaNetwork DGU® enjoys wide recognition in Germany and abroad. In Austria and Switzerland, trauma surgeons have already begun to construct a network based on the German model, and in 2014 the Salzburg TraumaNetwork, with eight departments, received certification as Austria’s first network to comply with the DGU criteria. The initiative is also factored into the hospital funding and supply budgets of several German states. 

Map of the emergency network (Source: Academy for Trauma Surgery, AUC)

Map showing locations of the TraumaNetworks and trauma centres in Germany
Red: Supraregional trauma centres
Blue: Regional trauma centres
Green: Local trauma centres