[Clinical Treatment After Terrorist Attacks - Structures and Processes in Hospitals for Terror-related Mass Casualty Incidents]

Due to several peculiarities the clinical treatment after terror-related mass casualty incidents (TerrorMASCAL) differs from handling a conventional MCI. For this reason, TerrorMASCAL situations should get attention as an own entity in hospitals emergency preparedness and response. Among other challenges hospitals surrounding the emergency area will have to deal with a large amount of non-triaged, non-treated and seriously harmed patients, some of them with unfamiliar and disfiguring injuries. In addition, the hospitals themselves can be endangered as a target of further terrorist attacks. Therefore, security concepts depending on the individual circumstances must be elaborated in consultation with the local police authorities.The incident's clinical management should be put in hands of specially trained in-house institutions. Operational and tactical tasks close to patients ("on site") should be separated from strategic and administrative responsibilities ("in the background"). The function of an "Emergency Operational and Medical Coordinator" (EOMC = ZONK) is installed to manage initial diagnostics and therapy for seriously injured victims by prioritization and scheduling available clinical resources.In order to structure the process of emergency admission for numerous patients a triage- and holding area as well as specific in-house treatment areas for different severities of injury should be set up. The clinical triage should follow a consistent algorithm that is based on the cABCDE approach. It is recommended that this algorithm should be defined in hospitals disaster and emergency planning.Surgical strategies concerning the treatment of terror victims might be oriented according to the principles of "tactical abbreviated surgical care" (TASC). This means that in extreme cases the initial measures have to be concerted to save as much lives as possible while accepting a reduced individual outcome.