THE MANAGEMENT OF POLYTRAUMATIZED PATIENTS IN GERMANY

Polytrauma care in Germany is well organized and follows clear-cut dem ands: (1) to reduce the therapy-free interval, (2) to ensure qualified and sufficient preclinical treatment, (3) to minimize transportation time, and (4) to immediately transport the patient to an adequate leve l trauma center. These concepts include wide use of rescue helicopters that are based in 51 stations and cover the entire country. In additi on, there is a countrywide system of emergency physician ambulances, A ll rescue forces are coordinated by special rescue coordination center s to ensure maximum efficacy. Specially trained emergency physicians a re taken to the scenes of accidents in the helicopters or emergency ph ysician ambulances and provide aggressive and advanced shock and traum a treatment at the scene. The patients then are carried to high level trauma centers by air transport. In the trauma centers, standardized d iagnostic and treatment protocols are applied by trauma surgery teams who care for the entire trauma, including orthopaedic trauma. In addit ion to stopping mass bleeding, basic concepts include aggressive infus ion shock therapy, early machine oxygenation, and instant stabilizatio n of all open, all major pelvic, and all lower limb long bone fracture s. These management concepts have decreased the lethality numbers in p olytrauma from 40% in 1972 to 18% in 1991. Most polytrauma survivors c an be rehabilitated socially to an excellent to acceptable degree.