The mass casualty attack ( MANV ) describes a situation in which a large number of those affected have to be cared for. This can be the case, for example, in the case of railway accidents , bomb attacks , large-scale NBC emergency situations , epidemics or plane crashes . In order to include not only injured people, but also those who are ill or “only” those in need of care, the abbreviation MANV is sometimes associated with mass attacks on those in need of care and assistance . In many state laws there is also the term major damage situation (also called major accident , especially in Austria ). Since there are regularly many injured or in need of care, the term is synonymous with mass casualties.
In the event of a mass casualty casualty, the regular ambulance service in a region quickly reaches the limits of its capabilities. Typical is the overstrain of the first arriving rescue equipment, which is faced with considerable medical and organizational requirements. On the other hand, it is not regarded as an MANV if there is a peak demand in which several individual emergencies happen to have to be supplied at the same time or if special material such as special protective equipment or rare technical equipment is necessary for individual emergencies, which may also have to be brought from a further distance .
Definition according to DIN
The German standard DIN 13050 : 2015-04 (terms in rescue services) differentiates the mass incidence of injured or sick people (MANV) (No. 3.29) as an "emergency with a large number of injured or sick people as well as other injured or affected people" from the disaster as an "event that goes beyond the major damage event with substantial destruction or damage to the local infrastructure, which cannot be managed within the framework of medical care with the resources and operational structures of the rescue service alone." The declaration of a disaster is the responsibility of the administrative structures of the district or the district City. Disasters can also be declared when the infrastructure is destroyed without a large number of injured or sick people (e.g. floods). On the other hand, there can be a mass casualty of injured people, for example, in a pile-up without the legal requirements for a disaster being relevant.
Levels of care
Depending on the extent and scope of the mass accumulation, the need for input resources varies considerably. For this reason, the federal government, in cooperation with the federal states, has defined four levels of care in civil protection with fixed criteria, on the basis of which such a major damage situation can be analyzed and the consequent decisions made. These levels also define the necessary protection potential and goals. This classification originally goes back to the "Planning Platform of the German Association of Cities". However, it should always be noted that the specific planning of measures varies greatly from one location to another. In big cities z. B. completely different supply options and daily provisions than in a more rural area, in which a much smaller number of injured can present the emergency services with considerable capacity problems.
The examples given mark “milestones” in German disaster control, which repeatedly gave rise to new concepts.
Care level 1
- Description: standardized everyday protection
- Scope of those affected: 5 to 50 people
- Risk category: everyday dangers, applies to the whole of Germany
- Protection goals: Assistance for individual emergencies within the scope of the rescue service
- Protection potential: Ambulance service (including supra-local assistance)
- Legal basis: rescue service laws of the federal states
- Examples: traffic accidents with coaches or fires in residential complexes
Care level 2
- Description: standardized, comprehensive basic protection
- Scope of those affected: 50 to 500 people
- Risk category: not commonplace, but manageable with the available forces, can occur throughout Germany
- Protection goals: Assistance for extraordinary damage events
- Protection potentials: in addition to level 1: rapid response groups, other smaller disaster control units
- Legal basis: disaster control or aid laws of the federal states
- Examples: railway accidents ( ICE accident in Eschede , train accident in Brühl ) or Oktoberfest attack
Care level 3
- Description: increased protection for endangered regions and institutions (transnational and international help required)
- Scope of those affected: 500 to 1000 people
- Risk category: increased risk, e.g. B. in metropolitan areas due to the infrastructure, particularly dangerous industrial plants, increased risk of attack
- Protection goals: Assistance for loss events that cannot be covered with the potential of the basic protection
- Protection potentials: in addition to level 2: operational units ; in accordance with a risk analysis (e.g. special training of helpers, stocking of medicines or special technical rescue equipment)
- Legal basis: disaster control or aid laws of the federal states, federal-state agreements
- Examples: the Ramstein flight conference accident or the Los Alfaques tanker truck accident
Care level 4
- Description: Special protection with the help of special forces
- Scope of those affected: over 1000 people
- Risk category: designated special protection
- Protection goals: jointly defined, extraordinary hazard situations (e.g. in the contaminated area)
- Protection potentials: e.g. B. Analytical Task Force
- Legal basis: federal-state agreements
- Alerting the Medical Task Force
- Examples: Hamburg storm surge of 1962 , flood in Central Europe in 2002 or the accident at the Love Parade in 2010
After the attacks on September 11, 2001 and in the course of the planning for the soccer world championship in 2006 , the care of around 1000 patients in the area of levels 3 and 4 became the planning factor. This should also be retained as a target approach for German disaster control.
Supraregional assistance at MANV (ÜMANV)
One of the hallmarks of assistance in the event of a mass casualty is the supra-regional assistance. For this purpose, the term ÜMANV was coined (Ü = “supra-regional help”). The medical task force is of particular importance here .
ÜMANV subgroups were created for standardization, under which supraregional help can be requested. The following classification has established itself in specialist circles:
The design of these groups differ in detail: Some operational plans set fixed specifications for the number of rescue equipment to be dispatched and the size of the treatment centers, while others only list the possibilities of the dispatching centers, which can then vary widely.
Such ÜMANV groups are established in Hesse and North Rhine-Westphalia due to official requirements. In Bavaria , the concept was introduced by the Bavarian aid organizations from November 2005 as part of the planning for the 2006 World Cup. Other German federal states have different definitions, none at all or only locally valid definitions for supraregional assistance.
The first goal of coping with an MANV is to restore adequate supply options as quickly as possible. For this reason, operational resources are brought in from neighboring regions and, if necessary, provided reinforcement forces (e.g. rapid response groups, disaster control units ) are alerted. In addition, an expanded management structure is being created in which an operations management team ( organizational manager , chief emergency doctor and auxiliary staff) coordinate the measures.
Patient care can be broken down as follows:
The patients are placed on a patient support by first aiders and rescue workers, if possible outside the immediate danger area. The ambulance / medical service takes over the patient there and carries out life-saving emergency measures. For an overview, a first triage may be carried out here. If possible, the patients are already recorded (registered) here with their name and location so that they can be assigned later (e.g. to house numbers or train wagons). They are sent to a central supply ( treatment center ) as quickly as possible or, if necessary, to decontamination beforehand .
The DIN 13050 defines the "Patient File" as follows: A point on the border of the danger zone, are collected at the injured or ill and to the extent possible erstversorgt. There they are handed over to the rescue / medical service for transport to a treatment center or further medical care facilities.
If the patients are contaminated with toxic substances, they must be freed from them before further treatment so that the substances are not passed on. Depending on the situation, this takes place near the patient support, but at the latest immediately in front of the treatment area.
If sufficient rescue equipment is not available or further measures have to be carried out in order to be able to transport a patient, one or more treatment stations are set up. A concept “BHP-B 50” developed in North Rhine-Westphalia for a treatment area on 2000 m² provides for the care of at least 50 affected persons per hour. The aim of the treatment center is to make or maintain a patient ready for transport. For this purpose, the treatment area is divided into different areas for viewing and depositing the patients according to their need for treatment, the patients are marked in green, yellow, red (acute vital threat), blue (no chance of survival) or black (dead). As a rule, the treatment center should be set up and operated by neighboring units (district level) of disaster control. During an operation, the emergency services of the own district are tied to the damage area in the patient tray. The treatment center is operated until the last patient has been removed.
After emergency medical care and the establishment of transport stability, the patients are transported to suitable hospitals. The patients are registered by name at the latest before they are removed and reported to information or search centers so that relatives can be informed promptly about their whereabouts.
The "Transport" section in NRW is coordinated by the conception of the PTZ-10 (patient transport train). The PTZ-10 consists of 4 × RTW (ambulance vehicles), two of which are additionally manned by an ambulance, 4 × KTW (ambulance vehicles) and a KdoW (command vehicle). In the case of an MANV, this sub-section is subordinate to the section head "Medical Rescue" OrgL / LNA ( Organizational Head of Rescue Service / Head of Emergency Doctor ). The leader of this stage of operation is a paramedic with group leader qualification , platoon leader or association leader (the necessary qualification results from the size of the damage).
The patients are distributed to hospitals as sensibly as possible. This means that suitable care options are selected (e.g. seriously injured people in specialized clinics and trauma centers) and that individual hospitals are not overloaded. For this purpose, the bed certificate from the rescue control center is used; for large-scale operations, wave plans for transport management are also prepared in some places (e.g. Munich). The term patient atlas is also used for this purpose.
It is common for hospitals to adapt to the increased number of patients with an internal flow chart and to free up capacities as quickly as possible (e.g. by canceling operations that are not absolutely necessary and alerting off-duty staff). If necessary, auxiliary hospitals even have to be built, for example if routes cannot be used or regular hospitals can no longer accept patients.
Life-saving equipment holding area
The rescue equipment stopping place (formerly also ambulance stopping place) is set up close to the treatment place in order to hand over the patients to be transported to the vehicles under the guidance of the transport coordinator. The helipad is a special rescue equipment stop . Because of the proximity to the damaged area, there is usually only little freedom of movement at such stopping places, which is why the other emergency vehicles that are waiting are usually called up in a targeted manner from a provision room further away.
In the staging area units not yet used on-site (eg. As are fast-groups ) and other life-saving equipment ( RTW , KTW , NAW etc., even armored personnel carriers and buses) from the work site removed to there not to block the way. The handling via a staging room ensures that the emergency services are fed to the deployment site as required.
In the space available to hold units ready to be approached via locally at major incidents and their location should still not been determined.
The collecting area refers to the place where units that are to be used outside of the local area collect and are combined to form a larger unit. Collection rooms are usually planned in advance. The journey then takes place together.
Care and other care
In addition to the mass influx of injured and sick people, a high number of uninjured people can also be expected. These are collected by the care service and placed in emergency shelters or forwarded to other accommodations or relatives. Catering units may also be used. The psychosocial emergency care (PSNV) is provided by emergency chaplains and crisis intervention teams - if necessary within a separate operating section. At the request of the overall operational management, PSNV can also take place within the treatment center. These PSNV specialists are then only active at the treatment center within the framework of PSNV and must not be seen as a medical reserve.
In Switzerland, there are the following MANV levels, depending on the suspected number of injured people:
Every rescue service in the canton should manage an event of this level themselves and be able to cope with it with the resources from day-to-day business (possibly with partner help).
- Requires advanced on-site guidance
- Resources from day-to-day business are no longer sufficient for the emergency services
- That is why SRZ (Schutz & Rettung Zürich) makes some of its funds available in a standardized way
- Support from members of the militia fire brigade
- Assignment: Medical officer on call
- Major alarm at the rescue service SRZ (and the affected rescue service)
- Additional offer: command vehicle, medical aid station, logistics specialist, media service, further personal support
- Assignment of officers on call: medical services, fire brigade, protection & rescue Zurich
- Highest MANV alert level
- Rear Management Staff in Operation (TOC)
- Contingent: medical aid stations, support from professional and militia fire brigades, possibly partner rescue services, civil protection, medical groups of the base fire brigades, Samaritan associations and other partners
- Line-up: officers on call, ambulance, fire brigade, protection & rescue Zurich
- Orsec-Novi plan , the French emergency plan
- J. Bittger: Major Accidents and Disasters - Mission Tactics and Organization . Schattauer-Verlag, Stuttgart 1996, ISBN 3-7945-1712-1 .
- H. Peter: Emergency doctor and paramedic at MANV - tasks of the first rescue team to arrive . 3. Edition. Stumpf and Kossendey, Edewecht 2001, ISBN 3-932750-61-6 .
- JW Weidringer u. a .: Mass attacks of injured and sick people . In: Hazards and Warning , "Schriften der Schutzkommission", Volume 1. Federal Office for Civil Protection and Disaster Aid, Bonn 2009, pp. 9-25, ISBN 978-3-939347-11-9 , corrected ISBN 978-3-939347-11 -8 .
- Concept for supra-local help with an MANV - Federal Office for Civil Protection and Disaster Aid (BBK)
- ↑ DIN German Institute for Standardization e. V. (Ed.): DIN 13050: 2015-04 Terms in rescue services .
- ↑ from page 12 of the slides accompanying the paper “Limits of Emergency Medicine”, held by Frebel from the “Medical Director Rescue Service in Germany” working group, undated
- ↑ Operation concept ÜMANV - mass incidence of injured persons with supra-local support (PDF) Working group MANV supra-local
- ↑ Medical service concept NRW "Treatment center readiness NRW" (BHP-B 50 NRW) 2009 (PDF) Ministry of the Interior of the State of North Rhine-Westphalia, Institute of the Fire Brigade (IDF).
- ^ Staff magazine Schutz & Rettung Zürich. (PDF) In: Page 18. Zurich Protection and Rescue, accessed on March 25, 2015 .
- ↑ The processes vary from canton to canton. The information relates to an example from the Canton of Zurich.