A treatment center (abbreviation BHP ) is a facility with a predetermined structure at which injured and / or sick people receive emergency medical care after they have been examined . From there the transport to further medical care facilities takes place if necessary.
The term treatment center is defined in DIN 13050 . Other names for the treatment center were bandage center (replaced designation) and field hospital (no longer in use). In Austria and Switzerland one speaks of a medical aid center (SanHiSt).
A treatment center is always required if further medical measures are necessary on site to restore the stability of the patient's transport, but not enough rescue equipment is available ( mass casualties , disasters ). Coordinated treatment and transport of patients is also made possible by a treatment station in confusing locations with several patient trays. A treatment station can also be set up as a precautionary measure within the scope of medical security services at events.
At the treatment center, there are paramedics of various qualifications, rescue personnel (e.g. paramedics and paramedics) and emergency doctors , as well as helpers for registration, for carrying aids, technology (e.g. lighting), logistics or for the care and support of the helpers deployed. The care service takes over the uninjured / not ill affected persons at the treatment center and takes them to their own facilities (which may be in the local area in individual cases, but are strictly speaking no longer included in the treatment center). Specially trained emergency services ( emergency pastoral care / crisis intervention ) are regularly on duty at the treatment center for acute psychosocial help for patients and other affected persons . Under certain circumstances, these form a separate section “Psychosocial emergency care”. Appropriate collection points may be set up for relatives.
Fixed buildings or medical tents or containers are preferably used as the treatment station. In exceptional cases, it is also possible to set up a treatment center in the open air without protection from the weather. The treatment center should be as close as possible to the damaged area, but not itself exposed to any danger. When choosing a location, the proximity to the place of deployment, the possible risk from sudden changes in location, accessibility with regular road-bound rescue equipment, proximity to suitable landing sites for air rescue equipment and the suitability of the site and any existing infrastructure (e.g. electricity and water supply) must be considered.
In terms of operational tactics, the treatment center is usually coordinated by a separate operational section leader, section manager or “head of treatment center”. The capacity of a treatment center differs depending on the location; the usual sizes are suitable for 25 patients or 50-100 patients (per time unit, usually an hour). One speaks then of a BHP25, BHP50 etc.
In Germany, the "Working Group of Heads of Professional Fire Brigades in North Rhine-Westphalia" (AGBF-NRW) has laid down detailed minimum standards for a treatment center, its structure and staffing levels. This concept has spread in the course of the preparations for the soccer World Cup 2006 in Germany, even if it has mostly been slightly changed in individual federal states, it can be regarded as a quasi-standard. According to this, a BHP50 (treatment station for 50 persons affected per hour) is set up and operated by around 135 emergency services, the space requirement is around 1500 square meters (30 m × 50 m).
Civil treatment places
A treatment center is divided into the following areas:
- Sighting or triage ,
- if necessary also: decontamination (depending on the concept with a special inspection).
Other areas can be added as required, for example:
- Infection area,
- Death bed.
The patient deposit (Switzerland: patient collection point) does not belong to the treatment center, but is in front of it and is more or less organized as the starting point for the patients who are then taken to the treatment center.
It is a place on the edge of the damaged area where injured or sick people are collected and, if possible, first treated. The focus here is primarily on immediate life-saving measures . It is transported from the patient support to the treatment center.
If there is sufficient capacity for rescue equipment and clinic spaces, they can be transported directly to the hospitals; a treatment station is then not necessary in full (possibly only for the "remaining" patients, e.g. slightly injured people).
Immediate transport from the patient table to a (nearby) hospital must also be urgently considered if the patient's condition is life-threatening, but this risk to life cannot be averted with the options available on-site. This can be assumed, for example, in the case of threatening internal bleeding.
The viewing area forms the entrance to the treatment center. Here injured / sick people transported from the damaged area are briefly examined. Uninjured people are handed over to the care service, injured / sick people are divided into different inspection categories ( triage ) and assigned to the treatment teams in the treatment area.
Usually, each patient is assigned an injured person attachment card at this point at the latest , which from then on is used for recording (e.g. with a numbering system) and documentation of the medical measures carried out or ordered as well as recording of personal details (registration).
If the patients are contaminated by hazardous substances, a decontamination should be carried out in front of the inspection area (if necessary with one's own quick inspection).
On the one hand, all necessary medical measures are carried out here in order to restore the patient's transport stability. Another essential function is the bridging treatment, care and temporary accommodation of difficult, but not life-threatening, damaged patients until they are removed.
Depending on the requirements, the treatment area is divided into care for the severely and slightly injured or even more detailed according to the classification into viewing categories I - IV (Roman 1-4). This facilitates the overview and the sensible allocation of resources (more highly qualified personnel and special material can be bundled for the more seriously injured). Depending on the size of the treatment center, additional management levels are necessary here.
The transport takes place with a suitable rescue equipment to a suitable hospital . Expert coordination of the vehicles is necessary here so that they do not block themselves. The rescue equipment is usually made available at a rescue equipment holding area and coordinated there by a manager and helpers. In this way, only the vehicles required in each case are sent to the treatment center and spatial equalization results. At the latest when they are removed, the names and data of the patients with the assigned target hospital must be recorded (registration) so that information can be given about their whereabouts. In the best case, there is both an entry and exit register so that no affected person is overlooked and the head of operations has a good overview at all times.
Military treatment places in Germany
The medical service of the Bundeswehr comprises the medical service in the Bundeswehr and has been organized by the Central Medical Service of the Bundeswehr (abbr .: ZSanDstBw) since October 2000 . The Bundeswehr Medical Service Command (KdoSanDstBw) is the higher command authority directly subordinate to the Federal Ministry of Defense .
In the military area, the treatment stations operated by the military medical service are staggered. First aid is provided by self-help and comrade help and first aiders . The injured person is given emergency care in a wounded nest and handed over as quickly as possible to the San troop of the Battalion San train or a mobile medical troop .
The aid station TVP short, the through parts of the Sanitätszugs a staff and supply company of an association is operated directly in the battle zone, focusing attention to the urgent medical care, and performs its patient the more rearward dressing station shortly HVP to, by the brigade Medical company is operated and carries out further treatment. During missions abroad, the respective main first aid station is increased in terms of personnel and material and operated as a rescue center (RZ) (see also Dornier Transportables Hospital ).
At the division level, these were subordinated to the division medical regiments and a mobilization-dependent hospital regiment, from which the field hospital was operated. Today, seriously injured or sick soldiers are quickly brought to a clinic in their home country ( military hospital ) after stabilization in a treatment facility close to the damaged area, if necessary also by air transport with MEDEVAC .
- K. Maurer, H. Peter, JW Weidringer (Hrsg.): The treatment place. 2nd edition, Stumpf and Kossendey-Verlag, Edewecht 2001, ISBN 3-932750-58-6
- Framework regulation for major accidents (Austrian Red Cross)
- Implementation regulations for emergencies small / medium / large (Austrian Red Cross) (PDF file)
- Business game and simulation of the process in a medical aid station (treatment station)
- Standard concept BHP50 Rhineland-Palatinate (PDF; 5.1 MB)
- Standard concept BHP50 North Rhine-Westphalia (PDF; 2.2 MB)