[Distribution planning of injured persons in mass disasters or catastrophes. Structuring of hospital capacities exemplified by the catastrophe network of the German Society for Trauma Surgery (DGU)]. / Verteilungsplanung von Verletzten beim MANV oder Katastrophenfall. Strukturierung der Krankenhauskapazitäten am Beispiel des Katastrophennetzwerks der DGU.

Relevant changes have occurred in disaster management in Germany due to legal alterations and the introduction of the diagnosis-related groups (DRG) system. This has resulted in a reduction in bed capacities and an increase in bed utilization. In addition to the preclinical deployment strategy the provisional aspects of disaster medicine with the problem of the emergency service/hospital interface will be described. A suggestion for a solution for optimization of patient allocation in mass disasters or catastrophes will be demonstrated with the catastrophe network of the German Society for Trauma Surgery (DGU).

[Terrorists' target World Cup 2006: disaster medicine on the sidelines?! Aspects of hospital disaster planning]. / Terrorziel WM 2006: Katastrophenmedizin im Abseits?! Aspekte zur Krankenhauskatastrophenplanung.

Focussing on possible mass casualty situations during events such as the soccer world championship in 2006, the Professional Board of Surgeons in Germany and the German Society for Surgery canvassed surgeons-in-chief in the last quarter of 2003 concerning disaster plans for hospitals. The rate of returned questionnaires amounted to 26% covering the following areas of interest: plans-ready to use, known by the employees as well as by the rescue coordination center, performance of exercises, and concepts on decontamination and detoxification. Based on past numbers of casualties during soccer disasters, an excursus into details also includes a description of an approach to reduce the danger of bottleneck effects at doors. A preliminary concept based on the upcoming system for funding hospitals in Germany and including new partnerships is outlined, succeeded by some hopefully helpful hints for a web-based hospital disaster plan.

[The German Quality Management System for Outpatient Care (Q-M-A) Checklist--an instrument for assessing quality management systems in outpatient care]. / Die Checkliste Q-M-A--ein Instrument zur Bewertung von Qualitätsmanagementsystemen in der ambulanten Versorgung.

Quality management systems had originally been designed for industrial purposes and were hardly applicable for small enterprises, there have been adjustments to the two main applications EFQM and ISO enabling utilisation also in ambulatory care. There are also different approaches like the Dutch Visitatiae concept which reflects the needs of GP's and is based on peer exchange. The presented paper gives an overview of existing quality management and certification systems and presents an instrument for evaluation. This checklist was developed by an interdisciplinary expert panel of the Agency for Quality in Medicine and serves as an aid for users and graders of quality management systems with regard to the feasibility of these systems.

[A model project on certification of continuous education by the Bavarian Chamber of Physicians]. / Modellprojekt Fortbildungszertifikat der Bayerischen Landesärztekammer.

Beginning with April 1st 1998 Bavarian physicians are invited to join a project on certification of continuing medical education on a voluntary basis. After a one year period, 1238 of practicing medical doctors (2.8%) received an official certificate on continuing medical education by the Bavarian Chamber of Physicians. In order to get the idea to certify postgraduate continuing medical education spread over the state of Bavaria, the Bavarian Chamber of Physicians takes every effort to support congress organizers to issue credit points. Customer oriented processes are applied as well as modern technologies such as bar-codes. The systematic approach to take part in continuing medical education as an important aspect of quality assurance in physician's profession reveals the chance to keep autonomy within the medical chambers.

[The status of postgraduate education in the area of surgery--results of a survey of the North-Rhine Physicians Group and the Bavarian Regional Physicians Group in cooperation with the German Society of Surgery]. / Die Weiterbildungssituation im Gebiet Chirurgie--Ergebnisse einer Umfrage der Arztekammer Nordrhein und der Bayerischen Landesärztekammer in Zusammenarbeit mit der Deutschen Gesellschaft für Chirurgie.

Although in Germany most of the medical procedures have to be documented, there are almost no data available focusing on postgraduate training, especially in surgery. A retrospective analysis from 1 Jan to 31 Dec 1995 by the Chamber of Physicians in Nordrhein (AeK No) and the Bavarian (BLAEK) Chamber of Physicians revealed their surgical department's share of postgraduate trainees to be 59.2% and 63.6%, respectively. Operations per surgeon numbered approximately 220 p.a. (AeK No) and approximately 200 p.a. (BLAEK); mean hospital stay of patient equalled 10.3 d (AeK No) and 9.9 d (BLAEK). Especially in AeK No, there was an interesting follow-up when comparing 1985 with 1995; there was a decrease in the number of beds in the hospitals, a decrease of the length of patients' hospital stay, and an increase in the number of operations performed; there was an increasing number of surgeons per department, with a moderate increase of surgeons with postgraduate training completed.

[Recommendations for emergency strategies in crush trauma]. / Vorschläge zur notärztlichen Strategie bei Einklemmungstrauma.

In a retrospective study conducted from 1.1. 1988-31.12.1991, we at our rescue helicopter station "Christoph 22" identified the special circumstances, which arise for the trauma anaesthesiologist during prehospital treatment of entrapped trauma patients. During the time frame of our study, we observed a continuous increase of patients suffering an entrapment trauma (from 8.3% to 15.9%). Motor vehicle accidents were the primary cause of entrapment (78.4%). Patients with an entrapment trauma in comparison to those without, to a much higher degree suffered more severe injuries (proportion of multi-system trauma: 49.4% versus 26%). Upon arrival of the trauma anaesthesiologist at the scene, the vital functions in the majority of the cases were already disturbed and unstable. The emergency medical measures required at the emergency scene therefore had to be timely and to the point and taken in close coordination with the technical rescue team. The proven procedures which we apply in such cases will be illustrated. Hospital of preference should, if possible, always be a trauma center.

History of emergency medicine in Germany.

The beginnings of organized emergency care can be traced through military history dating back to the Middle Ages. In 1769, the first civilian rescue society was established to look after shipwrecked persons. Sociological and technical requirements of the late 19th century led to the formation of different rescue associations and to writing of regulations for rescue and ambulance services. The development of quality assurance was interrupted by World War I. Around 1930, the rescue service was mostly the responsibility of the Red Cross and fire brigades but included the first actions of emergency physicians. Today the rescue service functions to bring a physician, often an anesthesiologist, to the victim as quickly as possible. Modern rescue laws fix a lead time of 5 to 15 minutes for a professional rescue service to reach the scene. The medical equipment and qualifications of personnel treating life-threatening trauma and diseases have improved, and in this context, the role of the anesthesiologist is important.

[Light and scanning electron microscopy studies of the pleura. A contribution to the pathogenesis of spontaneous pneumothorax in young patients]. / Licht- und rasterelektronenmikroskopische Untersuchungen der Pleura. Ein Beitrag zur formalen Genese des Spontanpneumothorax beim jungen Menschen.

In a prospective study of 10 patients (7 men, 3 women, mean age 26.2 years), who underwent thoracotomy because of recurrent spontaneous pneumothorax, we performed light and scanning electron microscopic investigations of the resected pleura. The purpose of our work was to explain pleural changes which allowed the penetration of air through the intact wall of the blebs. In 8 of 10 cases we found small bullae at the top of the upper lobe, the remaining 2 showed up with massive pleural scar. The morphological and ultrastructural findings indicated that the presence of air induced a reactive process at the visceral pleura which led to degeneration and scarification. The changes consisted of simple membrane formation up to complete destruction of the pleural layer. The development of blebs is due to an air fistula coming out of the lung parenchyma. Penetration of air through the bleb's wall is explained with the increasing pressure inside and the dehiscence of degenerated pleural structure. In our opinion spontaneous pneumothorax in young people is caused by a localized disease of the upper lobe. The pleural changes are the visible effects of a degenerative process induced by air fistula from lung parenchyma. Therefore wedge-resection of that region is a rational therapy in patients with spontaneous pneumothorax.

[Lung injuries: diagnosis and surgical strategy]. / Lungenverletzungen: Diagnostik und operative Strategie.

Between 50 to 60% of all polytraumatized patients have a thoracic injury with a mortality of 30 to 60%. The first diagnostic steps involving symptoms such as in- or expiratory pain, emphysema of the skin, flail chest or sipping noise lead via clinical examination to first and often definitive therapeutic procedures, i.e. intubation, artificial respiration and insertion of chest tube. X-ray of the chest, computed tomography as well as ultrasonic screening and monitoring of arterial blood gases are important in in-door technical diagnosis. The decision for emergency room thoracotomy or a regular or delayed operation has to be made at times. Complications (20%) to consider are pneumo- and haematothorax, pleural rind, pneumonia, broncho-pleural fistula and most of all pleural empyema.

Closure of lung leaks by fibrin gluing. Experimental investigations and clinical experience.

In 28 male Wistar rats a standardized lung incision was closed by running suture and in half of the animals by additional application of fibrin adhesive. The animals were sacrificed 30 minutes and 5 days postoperatively. A significantly higher tolerance to increased inflation pressure was found in the fibrin-treated group. Ten patients undergoing pulmonary resection had conventional closure of parenchymatous lesions with additional fibrin gluing. Under positive air way pressure ventilation the sealing effect proved to be better after application of fibrin adhesive to the sutured area.

[Closure of pleura and lung lesions with fibrin adhesive. Experimental studies]. / Verschluss von Pleura-Lungen-Läsionen mittels Fibrinklebung. Experimentelle Untersuchungen.

The effect of the fibrin adhesive on the gas density of pleura-lung-sutures was investigated in 28 male Wistar rats. Standardized pleura-lung-lacerations were closed by additional fibrin adhesive application in combination with fibrinolytic inhibitors. 30 minutes and 5 days after operation the animals were sacrificed and manometric and micromorphological examinations performed. In good histo-compatibility the additional application of the fibrin adhesive proved to be a proper technique in elevating the pressure tolerance of pleura-lung-sutures significantly.