Newsletter 2/2016 – Editorial – Benedikt Friemert
You may be surprised that a trauma surgeon has written this editorial. The background is the first civil vascular trauma course for trauma surgeons, which was held very successfully in cooperation with VASCULAR INTERNATIONAL at the BG Hospital in Murnau from June 30 to July 2, 2016.
In times of a growing number of terrorist attacks – not only in the Middle East but increasingly also in Europe and Germany – injury patterns that played a subordinate role in European civil societies during the past decades are now reoccurring again and again. I am talking about bullet and explosion wounds as well as penetrating traumas in general as we know them from war zones and crisis areas. Especially when it comes to these penetrating wounds, vascular and other traumas play a central role. On the one hand, haemorrhagic shock due to bleeding vessels needs to be mentioned in this context, on the other hand also acute vessel occlusions resulting from intima injuries of the vessel due to bullet wounds. As the recent past has shown, these attacks take place not only in metropolitan areas, where there is a high density of hospitals with the appropriate specialist expertise, but increasingly in more rural areas. Hospitals in these areas mainly have general and visceral surgeons or trauma surgeons, but only seldom vascular surgeons. Therefore, it is essential that German trauma surgeons get involved in penetrating injuries and the necessary treatment algorithms nationwide again. This was the reason why we decided to also offer this type of course, which has been held successfully at the Federal Armed Forces for many years, to civil colleagues. The central objective of this course was to give the trauma surgeons handling instructions, practical exercise and expertise for emergency cases in order to achieve haemorrhagic and perfusion control for the affected extremities with the goal of extremity preservation. The focus was not so much on final care, but on the training of vascular emergency measures in order to transport the patient to an appropriate hospital capable of providing adequate final care with the shortest possible ischaemia time.
The course was held in the BG Hospital in Murnau. Trauma surgeons from all BG Hospitals as well as from Switzerland and Austria and other civil hospitals were present. Everybody agreed that the course was excellently organised and its content was accurately adapted to what the colleagues had lacked in providing care for the above-mentioned patients. Thus, execution and contents of the course were considered a success for the planned objective. Due to the successful pilot course, further courses for vascular trauma emergency cases are planned for the future.
In the context of increasing terrorist activities with bullet and explosion traumas, I would like to recommend to all surgical and trauma surgical colleagues to also get involved in emergency care of vascular injuries and to acquire expertise for these situations, because unfortunately the extent, the dates and places of terror activities are not foreseeable. One day all of us might ourselves in a situation where we have to treat such patients.
Professor Benedikt Friemert, OTA