[Ventilation Patients between Acute Care and Long-term Out-of-Hospital Ventilation - Routine Documentation based Analysis of the Care Situation]. / Beatmungspatienten zwischen Akutversorgung und außerstationärer Langzeitbeatmung.

BACKGROUND: The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation. MATERIAL AND METHODS: In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital. RESULTS: In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community). CONCLUSION: Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable.

[Ventilation Patients between Acute Care and Long-term Out-of-Hospital Ventilation - Routine Documentation based Analysis of the Care Situation]. / Beatmungspatienten zwischen Akutversorgung und außerstationärer Langzeitbeatmung.

BACKGROUND: The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation. MATERIAL AND METHODS: In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital. RESULTS: In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community). CONCLUSION: Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable.

Surgery in times of COVID-19-recommendations for hospital and patient management.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeons have had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. PURPOSE: To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safely accommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergency surgery and oncological patients or jeopardizing the well-being of hospital staff. CONCLUSIONS: The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life while maintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards and operating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidently and successfully undertake their respective clinical duties.

[Complete information technology blackout in hospitals : Development of a concept for maintaining patient care]. / Vollausfall der Informationstechnologie im Krankenhaus : Entwicklung eines Konzepts zur Aufrechterhaltung der Patientenversorgung.

The complete blackout of information technology (IT) in a hospital represents a major incident with acute loss of functionality. The immediate consequence is a rapidly progressive loss of treatment capacity. The major priority for the acute management of such an event is to keep patients safe and prevent life-threatening situations. A possibility to channel the uncontrolled loss of treatment capacity in order to achieve the aforementioned protective target is the immediate organization of an analog system for baseline emergency medical care. The switch over from a fully operational routinely functioning system to a reduced emergency state occurs daily in hospitals (night shift, weekends, public holidays) and reflects the controlled reduction of the treatment capacity. This process and the procedures associated with it are universally known, the functions are clearly defined and planned in advance by duty rotas and the interplay of clinics in the organizational schedule is regulated in detail. In order to accomplish this strategy analog instruments are necessary. These must all be conceived, established, practiced and evaluated in advance with the clinics and departments. Ultimately, all isolated IT blackout concepts must be amalgamated into a compatible and functioning total framework. This structure must be maintained for as long as a partially or totally functioning IT has been reinstated.

[Advanced medical post within hospitals as possible tactical instrument for handling mass casualty incidents]. / Der Behandlungsplatz innerhalb eines Krankenhauses als mögliches taktisches Werkzeug zur Bewältigung eines Massenanfalls von Patienten.

BACKGROUND: An important instrument for handling mass casualty incidents in preclinical settings is the use of an advanced medical post. In certain circumstances, however, the establishment of such an advanced medical post on or close to the incident site is impossible. Terrorist attacks are a prime example for this. The highest priority for hospitals during mass casualty incidents is to adjust the treatment capacity to the acute rise in demand and to sustain its functionality throughout the duration of the incident. By establishing an advanced medical post within hospitals during certain types of mass casualty incidents these aims could potentially be accomplished. AIMS: The aims of this pilot study were to test the practicability of the establishment of an advanced medical post within a university hospital and to identify potential problems. The results provide the foundation of a generalized concept, which will then be integrated into the hospital emergency plans. METHODS: After the formation of a multiprofessional expert committee, different areas within the hospital were evaluated based on spatial and tactical considerations. Predefined questions were assessed and harmonized with respect to organization, vehicle management, communication, leadership and patient transport through the means of a practice run. RESULTS: The establishment and operation of an advanced medical post within the hospital were easily possible. The consequent deployment of section leaders enabled the smooth coordination of transport and an unobstructed simulated patient flow. The management of the treatment area by a senior emergency physician and a senior emergency medical service officer in close cooperation with the operational hospital lead proved to be a useful concept. Technical problems with communication within the hospital were resolved by using wireless phones and the installation of a digital radio repeater. DISCUSSION: During acute scenarios with only short prior notice, the authors prefer concepts that supplement the normal hospital operation through additional staff and material. In circumstances with prior notice of more than 60 min an advanced intrahospital advanced medical post, staffed by civil protection units, could be a concept that enables the absorption of the first patient arrivals within the first hour of a mass casualty incident without disturbing the functionality of hospitals to any great extent. Further practice runs are, however, necessary to further develop and adjust this concept to real-life circumstances.

[Comparison of two models of a treatment area with respect to treatment times in critically ill patients : A pilot study]. / Vergleich zweier Modelle eines Behandlungsplatzes im Hinblick auf die Versorgungszeiten kritischer Patienten : Eine Pilotstudie.

BACKGROUND: In the case of a mass casualty incident an advanced medical post (AMP) plays a central role in the medical care by ambulance service and civil protection units. Besides the traditional organization with one triage category per medical services tent, it can also be structured in a mixed form (i.e. a defined number of patients with different triage categories are assigned to each medical services tent). To date it remains unclear which organization format is better in order to rapidly evacuate those patients with the highest priority. METHODS: The Medical Task Force of Lower Franconia treated 50 identical and standardized training patients including 18 triage category red/emergency (36%), 12 triage category yellow/urgent (24%), 18 triage category green/non-urgent (36%) and 2 triage category black/dead (4%) in the course of a scheduled field exercise within two consecutive training sessions (first session: classical structure, second session: mixed structure). The training patients were represented by a dynamic patient simulation, whereby simulation cards showed injury patterns and the external appearance of the patients at a defined point which required certain interventions. The patients' conditions changed when these measures were accomplished or neglected. The length of stay of the patients with the triage category red/emergency at the AMP (start of triage to start evacuation) as well as the overall number of evacuated patients were collated and compared. RESULTS: Out of 18 patients with the triage category red/emergency, 13 patients in each session were evacuated in one pass. During the first session the mean evacuation time at the AMP was 25 min and during the second session the mean evacuation time was 18 min. After the end of the 90 min of exercise time in the first session 14 non-critical patients (triage categories yellow/urgent and green/non-urgent, n = 30) were still left at the AMP (16 evacuated) and in the second session 12 (18 evacuated). CONCLUSION: Depending on the mission requirements the mixed form of AMP organization can provide several advantages. In addition to rapid operational readiness and high flexibility the patient distribution by triage category could be processed better and the evacuation time of critical patients could be shortened.

An investigation into the effects of real vs. stimulated cases and level of experience on the distribution of visual attention during induction of general anaesthesia.

In anaesthesia, patient simulators have been used for training and research. However, insights from simulator-based research may only translate to real settings if the simulation elicits the same behaviour as the real setting. To this end, we investigated the effects of the case (simulated case vs. real case) and experience level (junior vs. senior) on the distribution of visual attention during the induction of general anaesthesia. We recorded eye-tracking data from 12 junior and 12 senior anaesthetists inducing general anaesthesia in a simulation room and in an actual operating room (48 recordings). Using a classification system from the literature, we assigned each fixation to one of 24 areas of interest and classified the areas of interest into groups related to monitoring, manual, and other tasks. Anaesthetists gave more visual attention to monitoring related areas of interest in simulated cases than in real cases (p = 0.001). We observed no effect of the factor case for manual tasks. For other tasks, anaesthetists gave more visual attention to areas of interest related to other tasks in real cases than in simulated cases (p < 0.001). Experience level did not have an effect on the distribution of visual attention. The results showed that there were differences in the distribution of visual attention by between real and simulated cases. Therefore, researchers need to be careful when translating simulation-based research on topics involving visual attention to the clinical environment.

[Polytrauma following a truck accident : How to save lives by guideline-oriented emergency care]. / Polytrauma nach LKW-Unfall : Wie eine leitliniengerechte Notfallversorgung Leben retten kann.

BACKGROUND: Identification and immediate treatment of life-threatening conditions is fundamental in patients with multiple trauma. In this context, the S3 guidelines on polytrauma and the S1 guidelines on emergency anesthesia provide the scientific background on how to handle these situations. CASE STUDY: This case report deals with a seriously injured driver involved in a truck accident. The inaccessible patient showed a scalping injury of the facial skeleton with massive bleeding and partially blocked airway but with spontaneous breathing as well as centralized cardiovascular circulation conditions and an initial Glasgow coma scale (GCS) of 8. An attempt was made to stop the massive bleeding by using hemostyptic-coated dressings. In addition, the patient was intubated via video laryngoscopy and received a left and right thoracic drainage as well as two entry points for intraosseous infusion. DISCUSSION: In modern emergency medical services, treatment based on defined algorithms is recommended and also increasingly established in dealing with critical patients. The guideline-oriented emergency care of patients with polytrauma requires invasive measures, such as intubation and thoracic decompression in the preclinical setting. The foundation for this procedure includes training in theory and practice both of the non-medical and medical rescue service personnel.

[Anaesthesia procedures and invasive vascular access in severely injured patients at trauma room admission in Germany : An online survey]. / Anästhesiologisches Vorgehen und invasive Gefäßzugänge bei der klinischen Erstversorgung von schwer verletzten Patienten in Deutschland : Onlineumfrage.

BACKGROUND: The continuous monitoring of vital parameters and subsequent therapy belong to the core duties of anaesthetists during acute trauma resuscitation in the trauma room. Important procedures may include placement of arterial lines and central venous catheters (CVCs). Knowledge of indication, performance and localization of invasive catheterisation of trauma care in Germany is scarce. METHODS: After approval of the German Society of Anaesthesiology and Intensive Care Medicine we conducted an online survey about arterial and central venous catheterisation of severely injured patients with consideration of common practice used by anaesthetists in German trauma rooms. Data are presented in a descriptive manner. RESULTS: Of 843 hospitals invited for the survey, 72 (8.5%) had complete and valid data and were thus included in the analysis. Of these, 47% were supra-regional (level 1) trauma centres, 38% regional trauma centres and 15% local trauma centres. The annual mean injury severity score (ISS) of admitted patients to these hospitals was 21 ± 10. In the trauma room, the responding hospitals place CVCs (49%) and arterial lines (59%) only in haemodynamically unstable patients, whereas 24% (CVC) and 39% (arterial line) do when pathological laboratory tests were confirmed. Standard operating procedures (SOPs) merely exist for placement of either arterial lines (25%) or CVCs (22%) in multiple trauma resuscitation. The decision to perform CVC or arterial line placement is usually (79%) at the discretion of the attending anaesthetist. The preferred anatomical access site for CVCs is the right internal jugular vein (46%) and for arterial lines the radial artery (without side preference) (57%), respectively. Of the responding hospitals, 49% prefer landmark-guided CVC-puncture (91% of arterial lines) instead of 43% using sonographic guidance (9% of arterial lines). Intravascular electrocardiography monitoring for CVC tip detection is used by 36%. CONCLUSION: In Germany, medical indication and schedule of invasive vascular catheterisation of severely injured patients in the trauma room is rarely regulated by SOPs and often performed at the discretion of the attending trauma team. Sonographic assistance during vascular puncture and electrocardiography for CVC tip detection is not as common as in non-emergency anaesthesia. Further studies are required to explore the real necessity and safety of invasive vascular catheterisation in multiple trauma patients in order to improve trauma care.

[Care for severely injured persons : Update of the 2016 S3 guideline for the treatment of polytrauma and the severely injured]. / Versorgung von Schwerverletzten : Update der S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung 2016.

In 2011 the first interdisciplinary S3 guideline for the management of patients with serious injuries/trauma was published. After intensive revision and in consensus with 20 different medical societies, the updated version of the guideline was published online in September 2016. It is divided into three sections: prehospital care, emergency room management and the first operative phase. Many recommendations and explanations were updated, mostly in the prehospital care and emergency room management sections. These two sections are of special interest for anesthesiologists in field emergency physician roles or as team members or team leaders in the emergency room. The present work summarizes the changes to the current guideline and gives a brief overview of this very important work.

[Quality indicators for rescue operations in terrorist attacks or other threats : A pilot study after the Würzburg terrorist attack of July 2016]. / Qualitätsindikatoren für rettungsdienstliche Einsätze bei Terroranschlägen oder anderen Bedrohungslagen : Eine Pilotstudie nach dem Würzburger Terroranschlag vom Juli 2016.

BACKGROUND: Terrorist attacks have become reality in Germany. The aim of this work was, after the Würzburg terrorist attack, to define quality indicators and application characteristics for rescue missions in life-threatening situations. The results can be used to record data from future missions using this template in order to make them comparable with each other. METHODS: After approval of the local ethic committee, the first step was to designate a group of experts in order to define the template in a consensus process. The next step was to perform the consensus process by defining the template. An independent expert for emergency medicine and disaster management reviewed and approved the results afterwards. RESULTS: The expert group defined 13 categories and 158 parameters that will further serve the systematic evaluation of the rescue mission of the Würzburg terror attack. Preliminary results of this evaluation process are given in this paper; the full evaluation has not yet been completed. DISCUSSION: In this study we first describe quality indicators and parameters suitable for the German rescue system in order to evaluate rescue operations for violence caused mass casualties. There is similar international documentation, but it does not specifically focus on life-threatening operations and are not adapted to the German context. CONCLUSION: There is an important need to systematically evaluate rescue missions after mass killing incidents. In this study we report a template of parameters and quality indicators in order to systematically evaluate mass violence events. The presented template is the result of an expert consensus process and may serve as a basis for further development and research.

Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients.

Positioning therapy may improve lung recruitment and oxygenation and is part of the standard care in severe acute respiratory distress syndrome (ARDS). Venovenous extracorporeal membrane oxygenation (vvECMO) is a rescue strategy that may ensure sufficient gas exchange in ARDS patients failing conventional therapy. The aim of this case series was to describe the feasibility and pitfalls of combining positioning therapy and vvECMO in patients with severe ARDS. A retrospective cohort of nine patients is described. The patients received 20 (15-86) hours (median, 25(th) and 75(th) percentile) of positioning therapy while being treated with vvECMO. The initial PaO2/FiO2 index was 64 (51-67) mmHg and the arterial carbon dioxide tension was 60 (50-71) mmHg. Positioning therapy included 135 degrees prone, prone positioning and continuous lateral rotational therapy. During the first three days, the oxygenation index improved from 47 (41-47) to 12 (11-14) cmH2O/mmHg. The lung compliance improved from 20 (17-28) to 42 (27-43) ml/cmH2O. Complications related to positioning therapy were facial oedema (n=9); complications related to vvECMO were entrance of air (n=1) and pump failure (n=1). However, investigation of root causes revealed no association with the positioning therapy and had no documented effect on the outcome. The reported cases suggest that positioning therapy can be performed safely in ARDS patients treated with vvECMO, providing appropriate precautions are in place and a very experienced team is present.

[Trauma centre admission of severely injured or critically ill patients: comparison of estimated and real arrival times]. / Schockraumaufnahme schwerverletzter oder kritisch kranker Patienten: Geschätzte und tatsächliche Eintreffzeiten im Vergleich.

BACKGROUND: During early in-hospital management of the arriving trauma patient the timing of the trauma team alert is an important organisational step. To evaluate the accordance of the estimated and the real arriving time we performed a retrospective data analysis at a level I German trauma centre. METHODS: Retrospective data analysis. Trauma team alerts from September 2010 until March 2011 were analysed. According to the hospitals pre-alert algorithm, trauma team alert took place 10 min before the estimated time of arrival. RESULTS: There were 165 trauma team alerts included in the analysis. The estimated arrival time coincided with the real arrival time in less than 10 % of cases. In 76 % of the cases, the patient arrived in an acceptable time frame with the trauma team waiting less than 14 min. In 3 % of the cases, the patient arrived prior to the trauma team. CONCLUSION: An exact estimation of the arrival time is rare. With a trauma team alert 10 min prior to the estimated time of arrival, an acceptable waiting time can be achieved. Arrival of the patient prior to the trauma team can be avoided.

[Acute respiratory distress syndrome and septic cardiomyopathy : successful application of veno-venoarterial extracorporeal membrane oxygenation]. / Akutes Lungenversagen und septische Kardiomyopathie : Erfolgreicher Einsatz der veno-venoarteriellen extrakorporalen Membranoxygenierung.

A 30-year-old patient was admitted to hospital with fever and respiratory insufficiency due to community acquired pneumonia. Within a few days the patient developed septic cardiomyopathy and severe acute respiratory distress syndrome (ARDS) which deteriorated under conventional mechanical ventilation. Peripheral venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated by the retrieval team of an ARDS/ECMO centre at a paO2/FIO2 ratio of 73 mmHg and a left ventricular ejection fraction (EF) of 10 %. After 12 h va-ECMO was converted to veno-venoarterial ECMO (vva-ECMO) for improvement of pulmonary and systemic oxygenation. Left ventricular function improved (EF 45 %) 36 h after starting ECMO and the patient was weaned from vva-ECMO and converted to vv-ECMO. The patient was weaned successfully from vv-ECMO after 5 additional days and transferred back to the referring hospital for weaning from the ventilator.

Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma.

OBJECTIVES: Whole-body multislice helical CT becomes increasingly important as a diagnostic tool in patients with multiple injuries. Time gain in multiple-trauma patients who require emergency surgery might improve outcome. The authors hypothesised that whole-body multislice computed tomography (MSCT) (MSCT trauma protocol) as the initial diagnostic tool reduces the interval to start emergency surgery (tOR) if compared to conventional radiography, combined with abdominal ultrasound and organ-focused CT (conventional trauma protocol). The second goal of the study was to investigate whether the diagnostic approach chosen has an impact on outcome. METHODS: The authors' level 1 trauma centre uses whole-body MSCT for initial radiological diagnostic work-up for patients with suspected multiple trauma. Before the introduction of MSCT in 2004, a conventional approach was used. Group I: data of trauma patients treated with conventional trauma protocol from 2001 to 2003. Group II: data from trauma patients treated with whole-body MSCT trauma protocol from 2004 to 2006. RESULTS: tOR in group I (n=155) was 120 (90-150) min (median and IQR) and 105 (85-133) min (median and IQR) in group II (n=163), respectively (p<0.05). Patients of group II had significantly more serious injuries. No difference in outcome data was found. 14 patients died in both groups within the first 30 days; five of these died within the first 24 h. CONCLUSION: A whole-body MSCT-based diagnostic approach to multiple trauma shortens the time interval to start emergency surgery in patients with multiple injuries. Mortality remained unchanged in both groups. Patients of group II were more seriously injured; an improvement of outcome might be assumed.

[Extracorporeal membrane oxygenation and severe traumatic brain injury. Is the ECMO-therapy in traumatic lung failure and severe traumatic brain injury really contraindicated?]. / Extrakorporale Membranoxygenierung und schweres Schädel-Hirn-Trauma : Ist der ECMO-Einsatz bei polytraumatisierten ARDS-Patienten mit schwerem SHT wirklich noch kontraindiziert?

Veno-venous extracorporeal membrane oxygenation (ECMO) may be lifesaving in multiple injured patients with acute respiratory distress syndrome (ARDS) due to chest trauma. To prevent circuit thrombosis or thromboembolic complications during ECMO systemic anticoagulation is recommended. Therefore, ECMO treatment is contraindicated in patients with intracranial bleeding. The management of veno-venous ECMO without systemic anticoagulation in a patient suffering from traumatic lung failure and severe traumatic brain injury is reported.

The use of a cognitive aid app supports guideline-conforming cardiopulmonary resuscitations: A randomized study in a high-fidelity simulation.

AIM: Cardiac arrests require fast, well-timed, and well-coordinated interventions delivered by several staff members. We evaluated a cognitive aid that works as an attentional aid to support specifically the timing and coordination of these interventions. We report the results of an experimental, simulation-based evaluation of the tablet-based cognitive aid in performing guideline-conforming cardiopulmonary resuscitation. METHODS: In a parallel group design, emergency teams (one qualified emergency physician as team leader and one qualified nurse) were randomly assigned to the cognitive aid application (CA App) group or the no application (No App) group and then participated in a simulated scenario of a cardiac arrest. The primary outcome was a cardiopulmonary resuscitation performance score ranging from zero to two for each team based on the videotaped scenarios in relation to twelve performance variables derived from the European Resuscitation Guidelines. As a secondary outcome, we measured the participants' subjective workload. RESULTS: A total of 67 teams participated. The CA App group (n = 32 teams) showed significantly better cardiopulmonary resuscitation performance than the No App group (n = 31 teams; mean difference = 0.23, 95 %CI = 0.08 to 0.38, p = 0.002, d = 0.83). The CA App group team leaders indicated significantly less mental and physical demand and less effort to achieve their performance compared to the No App group team leaders. CONCLUSIONS: Among well-trained in-hospital emergency teams, the cognitive aid could improve cardiopulmonary resuscitation coordination performance and decrease mental workload.

[Treatment of polytrauma in the intensive care unit]. / Polytraumaversorgung auf der Intensivstation.

The treatment of severely injured trauma patients (polytrauma) is one of the outstanding challenges in medical care. Early in the initial course the patient's diagnostics have to be scrupulously reevaluated by an interdisciplinary team (tertiary trauma survey) to reduce deleterious sequelae of missed injuries after the initial assessment. Severely injured patients stay in intensive care for an average of 11 days. During this time the patient's therapy has to ensure a high quality evidence-based intensive care treatment and simultaneously has to be tailored to the current individual injuries. Because of the fact that the damage control strategy is gaining increasing acceptance, the intensive care unit plays a pivotal role in the critical time between emergency and elective surgery. Therefore a close cooperation between physicians of the intensive care unit and all surgical disciplines involved is essential to reach the aim of therapeutic efforts. After survival of emergency treatment patients with severe trauma should be reintegrated into social and occupational life as soon as possible.

[Polytrauma management in a period of change: time analysis of new strategies for emergency room treatment]. / Polytraumamanagement im Wandel: Zeitanalyse neuer Strategien für die Schockraumversorgung.

BACKGROUND: Quality management and the early implementation of whole-body multi-slice spiral computed tomography (whole-body MSCT) are becoming increasingly important in the management of patients with multiple trauma. The aim of this study was to evaluate both components with respect to the time factor for treatment. METHODS: The investigation involved a retrospective data analysis of the time needed in the emergency room for the initial stabilization (phase A), completing the diagnosis (phase B) and the emergency room treatment (phase C). The investigation included three groups: trauma patients imaged in the emergency room with conventional imaging procedures (group I), with whole-body MSCT alone (group II) and those who were imaged with whole-body MSCT after the introduction of a quality management system with standard operating procedures (group III). RESULTS: The times for resuscitation (phase A), for diagnostic evaluation (phase B) and for total treatment (phase C) were analyzed. The times for phase A were for group I (n=79) 10 min (interquartile range, IQR 8-12 min), group II (n=82) 13 min (IQR 10-17 min) and group III (n=79) 10 min (IQR 8-15 min; p<0.001). The times for phase B were 70 min (IQR 56-85 min) for group I, 23 min (IQR 17-33 min) for group II and 17 min (IQR 13-21 min; p<0.001) for group III. For phase C the times were 82 min (IQR 66-110 min) for group I, 47 min (IQR 37-59 min) for group II and 42 min (IQR 34-52 min; p<0.05) for group III. CONCLUSION: Quality management and the early implementation of whole-body MSCT can accelerate the treatment work flow. A rapid initial diagnosis represents an important component in the high quality of treatment of polytrauma patients.