The management of polytraumatized patients in Germany.

Polytrauma care in Germany is well organized and follows clear-cut demands: (1) to reduce the therapy-free interval, (2) to ensure qualified and sufficient preclinical treatment, (3) to minimize transportation time, and (4) to immediately transport the patient to an adequate level trauma center. These concepts include wide use of rescue helicopters that are based in 51 stations and cover the entire country. In addition, there is a countrywide system of emergency physician ambulances. All rescue forces are coordinated by special rescue coordination centers to ensure maximum efficacy. Specially trained emergency physicians are taken to the scenes of accidents in the helicopters or emergency physician ambulances and provide aggressive and advanced shock and trauma treatment at the scene. The patients then are carried to high level trauma centers by air transport. In the trauma centers, standardized diagnostic and treatment protocols are applied by trauma surgery teams who care for the entire trauma, including orthopaedic trauma. In addition to stopping mass bleeding, basic concepts include aggressive infusion shock therapy, early machine oxygenation, and instant stabilization of all open, all major pelvic, and all lower limb long bone fractures. These management concepts have decreased the lethality numbers in polytrauma from 40% in 1972 to 18% in 1991. Most polytrauma survivors can be rehabilitated socially to an excellent to acceptable degree.