Major Accidents - Experience from Three Real-Life Incidents

Major accidents play a considerable role below the catastrophe level among the large-scale emergencies. At first they are attended with the means of the local emergency services. An adequate management with the objective of achieving the quality level of individual medicine rather than that of catastrophe medicine is rarely possible without the support of national emergency service resources [1]. Thus, the people from the local emergency services who are responsible for onsite activities are often faced with widely differing leadership, equipment and communication structures. On the other side, the non-local personnel face not only problems with the necessary integration but also those arising from a lack of knowledge about local emergency services, the regional and transregional hospital structures as well as access routes to the nearby hospitals. The major problems in the management of major incidents in the 1970s and 1980s arose from an existing imbalance between the needed and the available number of qualified helpers [2] as well as, in many cases, the lack of the necessary equipment to handle the massive number of injured individuals. By means of better training and thus higher qualifications not only of the emergency physicians but also of the paramedical staff, differentiated and better trained leadership structures as well as the more flexible provision of equipment suitable for major incidents rather than for catastrophes, the emphasis and problems have been shifted. This is illustrated for the example of three widely differing, although rare in their dimension, but still highly possible accident scenarios.