Der Rettungsdienst bei einem Massenanfall von Verletzten

Auch in Österreich fordern Großschadensereignisse immer wieder viele Todesopfer und zahlreiche Verletzte. Das Vorgehensmodell, nach dem den betroffenen Personen am Ort des Geschehens vom Rettungsdienst geholfen wird, ist österreichweit einheitlich geregelt und in ganz Mitteleuropa ähnlich. Durch die Unvorhersehbarkeit sowie der Einzigartigkeit dieser Ereignisse und deren Umfeldbedingungen lassen sich kaum allgemeine Aussagen über mögliche Optimierungspotenziale tätigen oder ideale Vorgehensweisen für bestimmte Szenarien festlegen. Dies alles wird nun erstmalig durch die im Zuge dieser Magisterarbeit entwickelten Simulation ermöglicht. Weiters bietet das Programm durch die Planspiel-Oberfläche zusätzlich eine ausgezeichnete Schulungsmöglichkeit für künftige Führungskräfte, mit deren Hilfe sie sich besser in mögliche Szenarien hineinversetzen, die genauen Abläufe vor Ort kennenlernen und sich auf ihre Verwendung als Einsatzleiter vorbereiten können. Die Literaturübersicht am Beginn dieser Arbeit zeigt deutlich, dass das Thema „Simulationen im Rettungsdienst“ in der wissenschaftlichen Literatur stark an Aktualität gewinnt. Besonders im Bereich des Massenanfalls von Verletzten, zu welchem auch die hier vorgestellte Simulation zählt, ist noch enormes Forschungs- und Entwicklungspotenzial vorhanden.Major incidents in Austria have kept claiming a great number of fatalities and injuries. The procedure model the emergency medical services used to aid the concerned on location is regulated consistently throughout Austria and similar within the entire central european region. The unpredictable nature of such incidents as well as their uniqueness and peripheral conditions hardly allow for more general statements on potential improvement or an assessment of an ideal approach to certain scenarios. The simulation developed in the course of this thesis now opens this possibility for the first time. Furthermore, the management game interface of this program additionally offers an excellent way to train future executives, helping them to imagine potential scenarios more vividly, become acquainted with the detailed routines on location and prepare for their employment as operating directors. The literature survey at the beginning of this thesis clearly indicates that the topic of “simulations in rescue services” is quickly gaining topicality in scientific literature. The field of Mass Casualty Incidents especially, which includes the simulation introduced above, shows enormous capacities in science and development

Modelling Emergency Medical Services

Emergency Medical Services (EMS) play a pivotal role in any healthcare organisation. Response and turnaround time targets are always of great concern for the Welsh Ambulance NHS Trust (WAST). In particular, the more rural areas in South East Wales consistently perform poorly with respect to Government set response standards, whilst delayed transfer of care to Emergency Departments (EDs) is a problem publicised extensively in recent years. Many Trusts, including WAST, are additionally moving towards clinical outcome based performance measures, allowing an alternative system-evaluation approach to the traditional response threshold led strategies, resulting in a more patient centred system. Three main investigative parts form this thesis, culminating in a suite of operational and strategic decision support tools to aid EMS managers. Firstly, four novel allocation model methods are developed to provide vehicle allocations to existing stations whilst maximising patient survival. A detailed simulation model then evaluates clinical outcomes given a survival based (compared to response target based) allocation, determining also the impact of the fleet, its location and a variety of system changes of interest to WAST (through ‘what-if?’ style experimentation) on entire system performance. Additionally, a developed travel time matrix generator tool, enabling the calculation and/or prediction of journey times between all pairs of locations from route distances is utilised within the aforementioned models. The conclusions of the experimentation and investigative processes suggest system improvements can in fact come from better allocating vehicles across the region, by reducing turnaround times at hospital facilities and, in application to South East Wales, through alternative operational policies without the need to increase resources. As an example, a comparable degree of improvement in patient survival is witnessed for a simulation scenario where the fleet capacity is increased by 10% in contrast to a scenario in which ideal turnaround times (within the target) occur