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      Structured analysis, evaluation and report of the emergency response to a terrorist attack in Wuerzburg, Germany using a new template of standardised quality indicators

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          Abstract

          Background

          Until now there has been a reported lack of systematic reports and scientific evaluations of rescue missions during terror attacks. This however is urgently required in order to improve the performance of emergency medical services and to be able to compare different missions with each other. Aim of the presented work was to report the systematic evaluation and the lessons learned from the response to a terror attack that happened in Wuerzburg, Germany in 2016.

          Methods

          A team of 14 experts developed a template of quality indicators and operational characteristics, which allow for the description, assessment and comparison of civil emergency rescue missions during mass killing incidents. The entire systematic evaluation process consisted of three main steps. The first step was the systematic data collection according to the quality indicators and operational characteristics. Second was the systematic stratification and assessment of the data. The last step was the prioritisation of the identified weaknesses and the definition of the lessons learned.

          Results

          Five important “lessons learned” have been defined. First of all, a comprehensive concept for rescue missions during terror attacks is essential. Furthermore, the establishment of a defined high priority communication infrastructure between the different dispatch centres (“red phone”) is vital. The goal is to secure the continuity of information between a few well-defined individuals. Thirdly, the organization of the incident scene needs to be commonly decided and communicated between police, medical services and fire services during the mission. A successful mission tactic requires continuous flux of reports to the on-site command post. Therefore, a predefined and common communication infrastructure for all operational forces is a crucial point. Finally, all strategies need to be extensively trained before the real life scenario hits.

          Conclusion

          According to a systematic evaluation, we defined the lessons learned from a terror attack in 2016. Further systematic reports and academic work surrounding life threatening rescue missions and mass killing incidents are needed in order to ultimately improve such mission outcomes. In the future, a close international collaboration might help to find the best database to report and evaluate major incidents but also mass killing events.

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          Most cited references15

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          The medical response to multisite terrorist attacks in Paris.

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            Pre-hospital management of mass casualty civilian shootings: a systematic literature review

            Background Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. Methods Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. Results From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. Conclusion Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.
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              Essential key indicators for disaster medical response suggested to be included in a national uniform protocol for documentation of major incidents: a Delphi study

              Background Registration of data from a major incident or disaster serves several purposes such as to record data for evaluation of response as well as for research. Data needed can often be retrieved after an incident while other must be recorded during the incident. There is a need for a consensus on what is essential to record from a disaster response. The aim of this study was to identify key indicators essential for initial disaster medical response registration. By this is meant nationally accepted processes involved, from the time of the emergency call to the emergency medical communication centre until medical care is provided at the emergency department. Methods A three round Delphi study was conducted. Thirty experts with a broad knowledge in disaster and emergency response and medical management were invited. In this study we estimated 30 experts to be approximately one third of the number in Sweden eligible for recruitment. Process, structure and outcome indicators for the initial disaster medical response were identified. These were based on previous research and expressed as statements and were grouped into eight categories, and presented to the panel of experts. The experts were instructed to score each statement, using a five point Likert scale, and were also invited to include additional statements. Statements reaching a predefined consensus level of 80% were considered as essential to register. Results In total 97 statements were generated, 77 statements reached consensus. The 77 statements covered parts of all relevant aspects involved in the initial disaster medical response. The 20 indicators that did not reach consensus mostly concerned patient related times in hospital, types of support systems and security for health care staff. Conclusions The Delphi technique can be used for reaching consensus of data, comprising process, structure and outcome indicators, identified as essential for recording from major incidents and disasters.
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                Author and article information

                Contributors
                0049-931-201-30411 , wurmb_t@ukw.de
                Schorscher_N@ukw.de
                P.Justice@LRA-Wue.Bayern.de
                Dietz@kvwuerzburg.brk.de
                rainer.schua@reg-ufr.bayern.de
                Dr.Jarausch@web.de
                Uwe.Kinstle@johanniter.de
                Greiner@kvwuerzburg.brk.de
                ILS.Leitung@stadt.wuerzburg
                joachim.mueller@stadt.wuerzburg.de
                martin.kraus@aelrd-bayern.de
                stefansimon@web.de
                ulrich.wagenhaeuser@bistum-wuerzburg.de
                johannes.hemm@t-online.de
                roewer_n@ukw.de
                matthias.helm@extern.uni-ulm.de
                Journal
                Scand J Trauma Resusc Emerg Med
                Scand J Trauma Resusc Emerg Med
                Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
                BioMed Central (London )
                1757-7241
                19 October 2018
                19 October 2018
                2018
                : 26
                : 87
                Affiliations
                [1 ]ISNI 0000 0001 1378 7891, GRID grid.411760.5, Subsection Emergency and Disaster Relief Medicine, Department of Anaesthesia and Critical Care, , University Hospital of Wuerzburg, ; Oberdürrbacherstrasse 6, 97080 Würzburg, Germany
                [2 ]ISNI 0000 0001 1378 7891, GRID grid.411760.5, Department of Anaesthesia and Critical Care, , University Hospital of Wuerzburg, ; Wuerzburg, Germany
                [3 ]Emergency Medical Services and firebrigade alerting for the counties of Kitzingen, Main-Spessart and the city of Wuerzburg, Wuerzburg, Germany
                [4 ]Emergency Medical Service of the Bavarian Red Cross, Würzburg, Germany
                [5 ]Medical Department, Government of Lower Franconia, Wuerzburg, Germany
                [6 ]Emergency Medical Service of the Maltese Cross, Wuerzburg, Germany
                [7 ]The Johanniter Rescue Emergency Services, Wuerzburg, Germany
                [8 ]Fire and Rescue Integrated Control Centre Wuerzburg, Wuerzburg, Germany
                [9 ]Medical Head of the Emergency Medical Services of Lower Fraconia, Wuerzburg, Germany
                [10 ]Head of emergency pastoral care in the diocese of Würzburg, Wuerzburg, Germany
                [11 ]Department of danger prevention and police operation by the police department of Lower Franconia (Chief Police Officer i.R.), Würzburg, Wuerzburg, Germany
                [12 ]Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Medical Hospital, Ulm, Germany
                Article
                555
                10.1186/s13049-018-0555-5
                6194622
                30340516
                a97471a0-f8ee-4a28-bdd2-7877ea4e1837
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 July 2018
                : 2 October 2018
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2018

                Emergency medicine & Trauma
                terror attack,mass casualties,evaluation,quality indicators,rescue mission

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