ATLS® and TDSC® : how it fits together. A treatment concept for mass casualty and terrorist-related mass casualty situations, life-threatening and special scenarios

Terrorist-related mass casualty incidents represent a medical and organizational challenge for all hospitals. The main reasons are the special patterns of injuries, the onset and development of the scenario, the lack of information at the beginning, the overall number of casualties and the number of uninjured but involved patients presenting at the hospital. Due to these circumstances and the high percentage of penetrating injuries with a permanent risk of uncontrollable bleeding and other life-threatening complications, a strategic and tactical initial surgical care is necessary. For these special terrorist-related mass casualty (MasCal) situations, the Terror and Disaster Surgical Care (TDSC (R)) course was developed and imparts special medical and surgical knowledge as well as a scenario-based training in surgical decision-making. The TDSC (R) course focusses on the scenario-related provision of surgical care and distribution of the limited resources to enable survival for as many patients as possible. To improve individualized trauma care course formats, such as the Advanced Trauma Life Support (ATLS (R)) were established and are nowadays widespread in Germany. It could be shown that standardized approaches and algorithm-based treatment could improve the outcome of trauma victims. Faced with the present day permanent risk of a possible terrorist-related MasCal situation, the question arises how and to what extent elements and principles of both course formats (TDSC (R) and ATLS (R)) could be used to improve and organize the initial care in a terrorist-linked MasCal incident. For the first time it is shown that the key elements of both courses (primary survey of the ATLS (R) and the TDSC (R) principles: categorization, prioritization, disposition and realization) could be established and integratively used to structure the initial intrahospital medical and surgical care.