Keeping the big picture in Terror-MASCAL-A new hospital concept

Abstract

Two key positions have been defined for the in-house management of patients in the context of aterrorism-related mass casualty incident (Terror-MASCAL). The senior triage coordinator (LArS) categorizes the injured according to injury severity using algorithms. The central operational and medical coordinator (ZONK) disposes and prioritizes the injured for treatment measures, considering the injury severity and the available treatment capacities. The dynamics and complexity of aTerror-MASCAL combined with the high number of patients requires comprehensible documentation. The evaluation of an incident exercise of aTerror-MASCAL revealed deficits in its documentation. Based on the deficits identified, requirements have been defined. The article presents the management and documentation aids of aGerman national trauma center. The hospital with its currently available resources is abstractly represented via the Trauma Tactics Board (TTB). Patients with their individual injuries are represented by identification cards on the TTB. The ZONK can prioritize and dispose further treatment based on the information about the available resources and the patient-specific injury pattern. The patient registry continues to document the patient's other medical findings. Important external and internal information is noted in an event register. The entire documentation process on the TTB is documented by camera. Documentation aids are required to fulfil the core tasks of the ZONK. By using the documentation aids, ahospital can prepare for aTerror-MASCAL within ashort time. Lack of daily practical application of the documentation aids should be compensated for by regular practice and interdisciplinary exchange of experience.