RESUMO
On June 3, 1998, at 10:59 a.m., a high-speed train (Intercity Express, ICE) traveling at 200 kilometers per hour collided with a bridge at Eschede, Germany, causing it to collapse. The force of the collision, combined with the speed of the train's rear engine, propelled the rear wagons into the structure. The accident caused 101 deaths and 103 injuries. Four minutes after the accident, the alarm was reported; sixteen minutes after the accident, the first doctor on emergency call was on the scene, arriving from Celle, approximately twenty kilometers away. In the first four hours after the crash, different rescue organizations brought a total of 1,844 people to the accident site, including 461 ambulance personnel and paramedics. Thirty-nine aircraft, including helicopters and army aircraft, were available at the scene. Ninety-five passengers passed away on site. Many of the surviving passengers had multiple injuries and were stuck in the train; although they had to be rescued from the severely damaged wagons, all patients, with one exception, were on the way to hospitals by 12:55 p.m. The casualties were distributed among twenty-two hospitals; two victims later had to be transferred to other hospitals for medical reasons. This paper details the factors that were responsible for the success of the rescue operations at Eschede.
Assuntos
Ferrovias , Trabalho de Resgate , Desastres , Serviços Médicos de Emergência , Alemanha , Humanos , Socorro em DesastresRESUMO
On 3 June 1998 a high-speed train (Inter City Express, ICE) collided with a bridge at a speed of 200 km/h. The bridge collapsed and the rear wagons of the train were pushed into it with the power of the rear engine. The accident caused 101 deaths and 103 injuries. Four minutes after the accident the alarm was raised, and 16 minutes after the accident the first doctor was on the scene, arriving from Cells, approx. 20 km away. In the first 4 hours after the crash 1844 people from different organisations were at the site of the accident; 461 of these were ambulance personnel and paramedics. 39 aircraft (incl. helicopters and army aircraft) were available at the scene. Many passengers with multiple injuries were stuck in the train and had to be rescued from the severely damaged wagons. Nevertheless all patients with one exception were on the way to hospitals or in the trauma centers 2 hours after accident. 95 passengers passed away on site. The casualties were distributed among 22 hospitals, 2 of them had to be transferred to other hospitals later on for medical reasons. This speaks for the correct selection of hospitals. There were many reasons for the quick rescue and the success of Eschede, namely good weather conditions, the time of the accident (normal working day) the availability of rescue by air, the great number of doctors, ambulance personnel, paramedics and search and rescue teams on site, as well as the excellent cooperation between the different organisations, mainly fire brigades, police, army, border patrol, technical assistance teams and search and rescue coordinators).
Assuntos
Acidentes de Trânsito/mortalidade , Desastres , Traumatismo Múltiplo/mortalidade , Ferrovias , Socorro em Desastres , Resgate Aéreo , Alemanha , Humanos , Centros de TraumatologiaRESUMO
Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were documented consecutively using a special set of evaluation sheets. The study closed with 1,722 patients. A 2-year follow-up was completed for 486 patients injured in 1991 and 1992 after type B and C injuries, complex pelvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special "out-come" criteria. Of the pelvic ring injuries without significant peripelvic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilization was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3% after C-type injuries. In isolated acetabular fractures ORIF was performed in 38.6%. The total lethality was 7.9% with a significant difference between "complex" pelvic trauma (21.3%) and patients without concomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was reported as the main cause of death. Pain at follow-up was observed in every classification group, the rate of completely "pain-free" patients being 55% after A-type, 41% after B-type and 27% after C-type fractures. Malfunction of micturia was reported by 7.6% of all patients, sexual malfunction by 11.6% of the males ("erectile dysfunction") and 2.2% of the female ("dysparneuria"). Scaled by the recently developed "outcome score", the radiological result showed anatomical healing after 90.8% of the B-type and 74.6% of the C-type injuries. On the other hand, the clinical result was rated as good or excellent in only 70% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.
