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24th European Congress of Trauma & Emergency Surgery 

Prof. Dr.

PD Dr.

Prof.

Retained bullet fragments which have traversed the colon and adjacent soft tissues do not result in increased surgical site sepsis

Visceral trauma

Research

IntroductionThe role of retained bullets in the setting of colonic gunshot wounds (GSWs) remains controversial. This study reviewed our experience with a conservative approach and aimed to determine the outcome of these patients.MethodsThis was a retrospective study conducted over a nine year period at a major trauma centre in South Africa. All patients who underwent laparotomy for colonic GSWs were reviewed. The primary outcome was to determine whether there was any difference in the incidence of abdominal sepsis when comparing those with retained bullets versus those who did not.ResultsA total of 255 patients were included. 144 (64%) had retained bullets while 111 (36%) patients did not. Among the 144 patients who had retained bullets, 29 (20%) developed abdominal sepsis. There was no significant difference in the rate of abdominal wound sepsis or intra-abdominal sepsis. There was no difference in any outcome parameters between the two groups.ConclusionRetained bullets following colonic GSWs did not appear to have any influence on the development of abdominal wound or intra-abdominal sepsis. The bullet should only be retrieved if it is practical to do so.No

ePoster presentation

Univ. Prof. Dr. med.

Prof. Dr. med.

Univ. Prof. Dr. rer. medic.

Prehospital triage algorithms for mass casualty incidents in Germany and its neighboring countries – A survey of rescue services and comparison of european recommendations for triage algorithms and its potential implications

Disaster & military surgery

Trauma and Emergency surgery | Miscellaneous

Introduction: Preclinical triage is vital during mass casualty incidents(MCI). Several triage algorithms are in use internationally, with intentions to consent algorithms for increased quality[1]. In Germany, specific triage categories can legally only be determined by a doctor, which limits the use of international algorithms preclinical. This study examined the preclinical triage methods in Germany and compared them with those of neighboring countries.Materials and Methods: 212 medical directors of rescue services in Germany were surveyed using Unipark EFS Survey Software. The survey was sent out on 25.07.2024 and was not repeated. A literature search was done to identify triage systems in other European countries.Results: The response rate was 34,4%(n=73). 98,6% use preclinical triage algorithms. 53,4% use mSTART, 24,6% use PRIOR (tailored for the German healthcare system), 4% use START, 1.4% use SALT, 18% use others. The literature revealed that France, Austria, Poland, and Czechia suggest using START. Switzerland and the Netherlands use their own algorithms[2;3].Conclusion: Most rescue services in Germany use a triage algorithm, often the government's recommendation, mSTART. However, existing differences within Germany and neighboring countries could hinder triage in translational MCIs. Different categories and approaches could lead to various prioritization. Intentions to harmonize triage, such as in the US, should be considered.Lerner EB et al.(2011).Mass casualty triage: an evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep.5(2):129-37. doi: 10.1001/dmp.2011.39.Becker, D et al.(2022).MANV-H Algorithmus – Ein Algorithmus zur Triage bei einem Massenanfall von Verletzten für den Hospitalisationsraum. Version 4Smits M et al.(2022).Reliability and validity of the Netherlands Triage Standard in emergency care settings: a case scenario study. Emerg Med J.39(8):623-627. doi: 10.1136/emermed-2021-211359.No

PD Dr. med. habil.

Field triage criteria and trauma team activation: Is there a difference between emergency-physician and emergency technician staffed rescue teams?

Polytrauma

Emergency surgery

The Emergency Medical Service (EMS) in some European countries operates on a two-tiered system, consisting of units staffed with paramedics only (EMT) and units staffed with emergency physicians (P-EMS). Severely injured patients are usually treated by both P-EMS and EMT and Trauma team activation (TTA) is typically initiated by these prehospital rescue teams. This study aimed to investigate the impact of field triage recommendations on TTA and determine if there is a difference in TTA accuracy based on the alerting units, EMT or P-EMS.Method: Analysis from a 3-month observation period, including adult patients with acute trauma admitted to an emergency department by EMS. A total of 3,753 cases were included. We analysed on-scene criteria leading to TTA. We differentiated between high-risk criteria for severe injuries (HRSI) and moderate-risk criteria for severe injuries (MRSI) and categorized TTA according to national guidelines. The need for emergency department treatment or TTA for each patient was retrospectively assessed using post hoc criteria defined by expert consensus.Results: TTA was much more common in P-EMS compared to EMT (64% vs. 6%). Trauma team activation occurred in 46% of cases by P-EMS due to HRSI criteria (14% for EMT) and in 25% of cases when MRSI criteria were present (44% for EMT). The positive predictive value (ppW) for TTA by EMT was 50.3%, and over-triage was 49.7%. Under-triage occurred in 35.9%. In the P-EMS group, over-triage was 44.5% and under-triage 15.6%. EMT group had more under-triage cases (84.5%) despite a significantly higher over-triage rate of 76.6%.Conclusion: P-EMS had a higher percentage of cases with HRSI criteria trigger TTA. EMT treat a higher proportion of cases based on MRSI criteria for TTA. In the retrospective assessment of the need for TTA, differences primarily arise concerning assignment based on HRSI or MRSI. The EMT group exhibits a higher overtriage and undertriage rate compared to the P-EMS group.No

Is a pre-hospital POC-lactate-measurement a sufficient triage tool? Recent study results and field experience

BackgroundField triage protocols frequently struggle to accurately identify severely injured patients. Measuring serum lactate could enhance existing triage scores. We present data from recent studies reporting the usefulness of POC-lactate measurement, along with initial results from an ongoing prospective prehospital multicenter trial.MethodsOver a 20-month period, we performed two retrospective cohort studies at a level one trauma center, analyzing trauma team activations (TTA) based on the mechanism of injury (MOI). The primary endpoint was the correlation between serum lactate (and age) with ISS and mortality. Validity was assessed using the area under the curve (AUC) of the ROC curve, and a logistic regression model was used to predict the likelihood of an ISS greater than 15.ResultsWe were able to include 250 patients during these study-periods. Mean age was 43 years (Min.: 11, Max.: 90, SD: 18.7) with a mean ISS of 8.4 (SD: 8.99). LAC showed a sensitivity of 0.82 with a specificity of 0.62 with an optimal cut-off at 1.72mmol/l to predict an ISS>15. The AUC of the ROC for LAC was 0.764 (95% CI: 0.67-0.85). The LAC+AGE model provided a significantly improved predictive value compared to LAC (0.765 vs. 0.828, p<0.001). The adjusted odds ratio (OR) for age >65 being associated with an ISS>16 is 9.7 (p<0.001; 95% CI: 4.01 – 25.58) and for lactate >2.2mmol/L being associated with an ISS>16 is 6.29 (p<0.001; 95% CI: 2.93 – 13.48). A lactate level of >4mmol/L results in a 36-fold higher risk of severe injury with an ISS>16 (OR 36.06; 95% CI: 4 – 324.29).ConclusionSerum lactate concentration can predict injury severity in certain cases. Our studies identify age over 65 and lactate levels above 2.2 mmol/L as risk factors for severe injury in trauma patients in our cohort. Prospective trials will have to proof the value of a POC-Lactate-measurement in the field. No

Prof. Dr. med. habil

Implementation of the medical service deployment register of the German armed forces (SanDstlEinsRegBw)

Introduction: According to the maxim of the medical service of the German Armed Forces, soldiers deployed abroad should receive medical care in the event of illness or accident that meets the professional standard in Germany. To deliver scientifically sound evidence about the fulfillment of this maxim, and enable structured data acquisition, the implementation of the medical service deployment register of the German Armed Forces (SanDstlEinsRegBw) is required. The aim of this research project is a retrospective gap-free documentation and analysis of the treatment of sick and injured deployed soldiers of the German Armed Forces.Methods: All soldiers of the German Armed Forces repatriated to the German Armed Forces Central Hospital in Koblenz, a level 1 trauma center and a NATO role 4 treatment facility, between January 2002 and December 2022 were included in this study. A local stand-alone IT infrastructure, including a standardized input mask, was developed to enable data acquisition from self and companion help to discharge from hospital.Results: The modular structured input mask was tested for workability with fictional examples. Here we demonstrated good usability. The actual input mask has eigth different modules. They include information about demography, the country of deployment, the mechanism of injury, the initial treatment and medical care, the diagnosis, as well as details about evacuation and outcome.Discussion: The modular structured input mask enables data analysis of the whole rescue chain and comparison to other registers like the TraumaRegister DGU®. The goal is the establishment of prospective data acquisition in all medical treatment facilities of the German Armed Forces. To achieve this goal, small adjustments to the input mask may be needed. The inclusion of multiple medical disciplines will optimize the treatment of our soldiers aboard and allow sufficient planning of personal and material resourcesNo

Resiliency of the Ontario healthcare system for conflict with a near-peer adversary: A population-based modeling study

Background: The threat of conflict between near-peer adversaries provides unique challenges to any healthcare system. As evidenced by the Ukraine–Russia conflict, sustained combat across broad geographic areas has led to a large number of casualties. Furthermore, the utilization of thermobaric and incendiary weapons has been associated with high proportions of combined multisystem blunt, penetrating, thermal, and blast injuries. The management of large volume of casualties with complex injuries will require significant resources. Military and civilian healthcare systems that may face a sustained and large evacuation of casualties to the homeland for definitive and rehabilitative care must plan accordingly.Methods: Actual healthcare resource utilization was calculated between 01/01/2017-31/03/2023 in Ontario (ON), Canada through analyses of population-based administrative datasets. Resources were stratified into ward, intensive care, burn care, and rehabilitation and expressed as mean weekly bed days. We then modelled the weekly addition of evacuated casualties into the healthcare system with the outcome expressed as added capacity required. Clinical scenarios which vary in patient volume (84,140,280 new patients/week) and duration (4,12,26 weeks) were modelled. Models were limited to trauma centres or the entire healthcare system.Results: The proportion of additional weekly bed days required across scenarios is outlined in Table 1.Conlcusions: Given that ON hospitals (ICU, burn, ward, and rehab) typically run close to or exceed their funded capacity, additional casualty volumes will require new resources and innovative strategies to manage patient flow.No

Brazil's urban war zones: The critical need for strengthening trauma medicine

Introduction: Violent deaths in Brazil have risen yearly, making urban areas resemble conflict zones. Data from the Department of Public Safety highlight high trauma rates, showing an urgent need for improved trauma care. Frequent non-fatal assaults further strain public healthcare and increase costs. Most victims are young adult males, whose mortality affects Brazil"s economy, with homicides costing 2.3% of GDP in 2007. Training professionals and equipping hospitals could reduce mortality and lower expenses.Methods: A review of national homicide data shows a similarity between Brazilian cities and conflict zones. In 2023, Brazil recorded 37,693 intentional deaths, averaging 103.12 per day, with men making up 91.77% of victims. From 2020 to 2023, 151,602 homicides and 145,289 attempted homicides added a heavy load on pre-hospital services, which handled 3.5 million trauma cases, averaging 2,748 per day in 2023 alone.Results: A 2024 U.S. Department of Defense report found Brazil"s violent death rates exceed some conflict areas. During military operations in the Middle East from 2001 to 2014, 7,088 fatalities occurred—far fewer than Brazil"s 2023 homicides. Ranked among the top 20 countries for intentional homicides, Brazil sees more violent deaths yearly than global terrorism from 2019 to 2021. In 2004, violence costs accounted for 5.1% of GDP, impacting healthcare and lost workforce contributions.Conclusion: Brazil urgently needs a trauma care system to respond effectively to violence, reducing long-term costs and improving patient outcomes. The scale of violence in urban centers now resembles conflict zones, making stronger trauma infrastructure essential to address this public health crisis and support urban safety.References:CERQUEIRA, Daniel; BUENO, Samira (coord.). Atlas da violência 2024: retrato dos municípios brasileiros. Brasília: Ipea;2024.FERREIRA, Ana Cecília Gonzalez Galvão (coord.). Mapa de segurança pública, 2024. Available at: gov.br.No.

Principles of wound ballistics and their clinical implications in firearm injuries

Introduction. Ballistics is the science that studies the trajectory, range, and effects of projectiles. The principles of wound ballistics (Figures 1-2) are of interest to the surgeon because they allow the optimization of the diagnosis and treatment of patients injured by firearms. The objective of this study is to review the updated information of wound ballistics that may aid in the diagnosis and treatment of gunshot wounds. Methods. A literature review, limited to observational studies in English and Spanish published between January 2014 amd March 2024 was performed using the PubMed, Scopus, and Embase databases. Studies included for full review included those that described wound ballistics and its relationship with patients" treatment, whereas studies about weapon design, experimental, forensic, historical studies, and reports on pediatric population were excluded.Results. Eleven articles from 28 publications met the inclusion criteria underwent full review. The most frequent mechanisms of injury included temporary cavitation (indirect damage), permanent cavitation (direct damage), complex fragment cavitation, laceration, microvascular damage, and ischemia propensity to vascular injury depdendent on bullet type.Conclusions. The principles of wound ballistics are applicable to the diagnosis of potential injuries and treatment of gunshot wounds in adults.Figure 1. Mechanisms of projectile injury in the formation of the permanent tract and the temporary cavity. (A) Effects of the projectile fired from a pistol or low-velocity firearm. (B) Effects of the inclination of a projectile fired from a military rifle or high-velocity firearm.Figure 2. Projectile movements. (A) Yawing: Deflection of the projectile in its longitudinal axis. (B) Tumbling: Spinning action beyond 90º forward around the center of mass. (C) Precession: Complex spiral movement of the bullet tip resulting from the gyroscopic stabilizing effect around its center of mass.No

When non-lethal weapons turn lethal: A case study of cervical vein injury by non-lethal projectile

Introduction: Non-lethal weapons are designed to incapacitate personnel or material temporarily while minimizing fatalities, injuries, property damage, and environmental impact. However, the use of rubber bullets, particularly when striking the face or cervical region, still poses a risk of injury or death. This study reports a case of a 23-year-old male who sustained a cervical injury from a non-lethal weapon during a law enforcement crowd dispersal operation.Case Report: The patient, transferred from an urgent care unit (UPA) to the emergency department, was hemodynamically stable, presenting with a penetrating cervical injury in Zone 2, with hematoma and local bleeding. A cervical CT scan revealed a projectile lodged in the right lateral cervical region. The patient then developed hemodynamic instability, and an exploratory cervicotomy was performed. During surgery, injuries to the right external and internal jugular veins were identified and repaired.Discussion: Rubber bullets allow law enforcement to control riots and uprisings using a gradual force. However, improper use can lead to fatal injuries, highlighting the importance of cautious application.Conclusion: The patient responded well to treatment and was discharged without complications. While non-lethal weapons are effective when properly used, they still carry risks, particularly when misused.References: 1. Faria DB. Armas não letais: uma solução para o uso gradual da força [Internet]. 2014 Jan 3 [cited 2024 Oct 1]. Available from: https://conteudojuridico.com.br/consulta/artigos/37946/armas-nao-letais-uma-solucao-para-o-uso-gradual-da-forca2. Morais AL de, et al. Tratamento de fratura órbito-zigomática decorrente de acidente com projétil de bala de borracha. Rev. cir. traumatol. buco-maxilo-fac [Internet]. 22º de setembro de 2023 [citado 1º de outubro de 2024];23(2):44-8. Disponível em: https://periodicos.upe.br/index.php/rctbmf/article/view/35.No.

Trauma from explosions. Description of injuries and review of factors associated with mortality

Introduction. The treatment of patients injured by accidental or intentional explosions by healthcare professionals requires an in-depth understanding of the many factors associated with the reported high mortality and morbidity. Currently, there are few studies that describe the risk factors for mortality and the profiles of blast injuries (Figure 1) in the civilian or military population.Methods. A review of articles published between January 2014 and March 2024 regarding explosions and meeting inclusion criteria was undertaken to identify injury patterns and to compare risk factors predictive of mortality in the civilian and military population.Results. Sixteen articles underwent full review. The average age of injured people with a male percentage of 79.4% was 40 years (SD ± 3.65). They were older in the civilian group when compared to the military (40 vs 24.5 year-old, respectively). While there was no difference in the overall number of injuries between the two groups there was an increase in the incidence of injuries at the cranial and thoracic level in the civilian population compared to the military population (31.9% and 20.4% vs 18.1% and 9.9%, respectively). The civilian population had a not significantly lower risk of death (OR = 0.96; 95% CI = 0.82 - 1.13).Conclusion. While there are consistent similarities between victims of civilian and war-related explosions (Figure 2), the general rule is that clinical experience with one type of explosion cannot be directly transferred to other types.No.

Mistakes and complications in the treatment of mine-explosive and gunshot wounds in children

Introduction.Children become accidental or secondary participants in military operations and are admitted to civilian children's hospitals, where, often, the staff has no experience in treating mine-explosive and gunshot wounds. The course of the wound process in such injuries has its own characteristics, therefore, the management of such patients according to the standards of treatment of ordinary acute trauma leads to complications.Material & MethodsDuring the period from 2014-2024, 156 children with mine–explosive and gunshot wounds were treated. The main locations of wounds were lower limbs – 134 (46.7%), upper limbs – 47 (16.4%) and head – 50 (17.4%). Thoracoabdominal injury was detected in 37 (12.9%), spinal injury in 19 (6.6%) children. Among all children, 25 traumatic limb amputations and 56 open bone fractures were noted. Purulent and necrotic complications were detected in 35 (22.4%) patients during the postoperative period. In this regard, when transferring patients to the specialized Center, the following mistakes of care were revealed: refusal to perform a full revision of wounds during the debridement (4), completion of debridement by closing the wound with primary sutures (26), absence or inadequate drainage of the wound (11), the use of early reconstructive surgery in conditions of infection (4), amputation of the affected limb with primary stump formation (9), inadequate subcutaneous fasciotomy of muscle cases with long-term limb ischemia (1), primary internal osteosynthesis with open fractures in conditions of surgical infection (1).ResultsA satisfactory result was achieved in all cases.ConclusionsCompliance with the principles of military field surgery in the treatment of wounds during the medical aid to children with mine-explosive and gunshot wounds makes it possible to avoid the complications, preserve the rehabilitation potential and return the child to the social environment in a short time.No

ePoster terminal 2 (ground floor, red light)

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ePoster session 14
Disaster and Military medicine I: Triage, prepardness and blast injuries

Appointment

Chairs

Topic

Programme

ePoster session 14Disaster and Military medicine I: Triage, prepardness and blast injuries

Appointment

Chairs

Topic

Programme

ePoster session 14
Disaster and Military medicine I: Triage, prepardness and blast injuries