It must be expected that the number of patients coming from Ukraine will increase going forwards. In principle, persons injured in the war in Ukraine will be assigned to hospitals centrally using Germany’s regional cloverleaf principle that was established for COVID-19. Trauma surgeons from the TraumaNetzwerk DGU® (TraumaNetwork DGU®) will now be involved in the assignment process professionally as consultants who will assess the degree of severity of each injury. They will also be able to assess what resources will be required, and to assign patients to hospitals with suitable capacities and specialists quickly and systematically within the network. Benedikt Friemert, who was involved in assigning the first seriously injured patients to hospitals, explains what duties will be given to trauma surgeons: “The first stage was to consult on which patient can be treated at a local or regional centre. We had to make sure that for the most serious cases we acquired capacities with the inter-regional centres. It was as much a case of assessing who needed to be sent to a high-capacity centre urgently due to the complexity of their injuries. It also made a difference what surgical specialisations the hospital in question had.” As Clinical Director for Trauma Surgery, Orthopaedic, Septic and Reconstructive Surgery, and Sports Trauma Surgery at the Bundeswehrkrankenhaus Ulm (Federal Military Hospital in Ulm), Benedikt Friemert has extensive experience treating patients injured in conflicts. “A burn suffered in a bomb explosion, for example, differs significantly from a burn suffered in a house or car fire. This also determines which type of specialist hospital bed you select for this patient. This is only possible with the right expertise,” says Friemert.
Assigning patients according to the cloverleaf principle proved a success during the pandemic. “The principle makes sense, but it was developed for a pandemic so now it needs to be adapted for treating war-injured patients. It requires trauma surgery structures. In the Bundesländer of Berlin and Brandenburg, trauma surgeons are already fully integrated into the coordination process," says Prof Gerrit Matthes, Head of the German Trauma Society’s Section for Emergency Medicine, Intensive-Care Medicine and Medical Care of Serious Injuries (NIS) and Federal Moderator for the Brandenburg TraumaNetworks. In some Bundesländer, like North Rhine-Westphalia and Baden-Württemberg, Federal Network Officers are responsible for coordinating patients injured in the war in Ukraine and are able to fully exploit the existing structures to help them with their work. “We recommend applying this principle to other Bundesländer too. What it needs is a corresponding regional policy,” says Matthes.
The medical treatment being provided in German clinics is in addition to medical treatment in hospitals in Ukraine or other countries that are also helping out. Going forwards, it is expected that we will see more patients who have already received initial treatment for gunshots and explosion-related injuries or other typical war injuries, as well as patients who require further treatment in Germany for complications or reconstructive surgery. The excellent collaboration we have established among our team of trauma surgeons, visceral surgeons, anaesthetists, nurses and other specialists will be hugely important here. “These lengthy treatment procedures require special interdisciplinary or inter-professional expertise in trauma surgery, expertise that can be coordinated quickly via the TraumaNetwork. The network has been in operation since 2008, its processes are now part and parcel of daily routine and providing quick and qualified assistance doesn’t require any additional organisational elements. We want to use the network to do our bit to reducing the consequences of the conflict,” says General Secretary of the German Trauma Society, Prof Dietmar Pennig. The German Trauma Society’s Section for Field Surgery, Disaster Surgery and Tactical Surgery (EKTC) is offering a variety of courses to train doctors in treating gunshots and explosion-related injuries. “Many trauma surgeons have never dealt with war injuries before, and this sort of treatment requires special expertise. We have set up a weekly webinar on war injuries specifically to provide this expertise,” says Senior Field Doctor, Prof Axel Franke, Head of the EKTC Section.
The TraumaNetwork clinics are ready to treat Ukrainian patients any time. Many of these clinics have already asked if they can provide any assistance, and if so how. The German Trauma Society has already extended this offer of assistance to the Ukrainian Ambassador to Germany, Dr Andriy Melnyk, and is in close contact with the Federal Ministry of Health.
TraumaNetzwerk DGU® (TraumaNetwork DGU®)
Thanks to the German Trauma Society’s TraumaNetwork, Germany has a nationwide medical treatment structure that brings together more than 650 hospitals and facilitates the electronic exchange of patient data. Between 2015 and 2019, an average of around 28,000 seriously injured patients were treated and documented every year. The clinics that are linked to one another as part of a general certification process focus on different types of treatment. The German Trauma Society’s TraumaNetwork was designed to treat serious injuries, specifically in the context of multi-injury incidents. The 53 networks are made up of inter-regional, regional and local centres which have been audited and contractually bound to one another through a certification process regarding their medical care and communication structures. As a result, these networks cover the majority of intensive-care capacities in Germany. The centre of the network is organised around 14 clinics, comprising eight local, four regional and two inter-regional centres.