Luebeck`s Documentation System in mass casualty incidents at sea

Especially Ro-ro passenger ships, which are often carrying between 1000 and 3000 passengers and cargo at the same time, are at potential risk for mass casualty incidents with a huge number of injured or totally struck victims. Rescue operations at sea will be compromised by maritime and weather conditions and by a delay of arrival of the rescue forces and -material at the scene of the incident. Supplying medical support at sea requires a special tactical concept, specially trained forces and an international applicable triage system.

A new tactical concept for co-ordination of rescue-procedures at major maritime incidents has been developed for the German coastline. One of the first tasks in a case of a major incident at sea will be to send out a team, which ideally should consist of:1. a leading emergency doctor,2. a specialized officer of the fire-brigade, 3. a nautical officer (of the coastguard) and 4. an assistant for communication.

This group should be transferred to the averaged ship as soon as possible, if feasible. Their special purpose is to check the situation, to find out further rescue needs on board, to assist the master of the ship and to find out if the platform is safe for rescue teams. Further rescue teams, especially emergency medical technicians, doctors, medical equipment and, if needed, more staff and equipment for fire-fighting purposes will be called out as soon as the averaged ship will be declared a safe platform to act on scene. The initial aim will be the immediate life-saving treatment on board, as the evacuation of crew and passengers will be a highly dangerous and time-consuming act. Hence, the maritime emergency transportation has to be considered only for patients, who have to be treated in a hospital immediately. Preferably, patients should be treated and monitored on board of the averaged ship or on the next safe platform. This is the indication for a clear stage of triage - based on a reliable and simple documentation system.

Therefore, we use a system of triage tags and documentation logs. Two components - triage tags in four different colours and documentation logs- are the basis of our triage system. Requirements: · Immediate accessibility · Easy to use · Long durability · Low cost · Unambiguous and individual marking · Reliable fixation · Compatibility with triage systems on land

The triage tags are polyethylene cards sized about 20 cm by 15cm divided in two halves with a vertical perforation in the middle, serially numbered, colour coded for clearly visible marking and layouted according to triage priority. Both halves are identically printed. A mark in the perforation line will be visible on both halves of the card. The tags are divided along the perforation exact, when the patient leaves the scene of accident in a boat, a helicopter or, later, in an ambulance, eventually accompanied by a doctor. It is possible to mark the injured body regions with one line on both cards or an illustration can be used. One part of the card stays with the patient, the other part will be collected by the co-ordinator. For the international use of this system, the cards are bilingual with an English and German version on the same card. This will allow rescue co-operation, co-ordination across the German borderline as well as communication with non-German-speaking crews and passengers.

The colour shows the triage classification. Red: Severely injured patients requiering immediate care Yellow: Patients with no immediate life threatening injuries Green: is for slighty injured patients Blue: deceased persons Front side: Individual marking of patients showing their condition and triage classification Back side: Documentation of medical treatment and personnel data It is necessary to know that this system in a monolingual otherwise identical German version is already well established in many German ambulance systems on land for major casualty documentation. The only difference is the lack of the English subtitles. The bag for the German rescue services on land contains additional documentation logs for treatment areas, hospital assignment, triage area, for the information service and for quality control purposes. This system is already widespread and accepted by prehospital desaster management staff. In addition we created further national editions for adjacent North Sea and Baltic Sea States. We have combined the English subtitles with the Danish, Swedish, Norwegian, Polish and Russian. Also a bilingual French-English edition is in preparation. The international use of a unified documentation system would have a major impact for international maritime rescue operations. At present, most of the national documentation systems are only based on requirements of the Geneva Convention, which do not include medical information. Summary: · The bilingual setup is the basis for maritime needs · The compatibility is the basis for international SAR-co-operation · A colour identification and international medical documentation improve the quick response to medical needs along the rescue chain · This is no replacement of but additional support for the data collection according to the Geneva Convention. *Extract of a presentation on the 6th International Symposium on Maritime Health Manila/Philippines, November 2001 by W. Baumeier, L. Bahlmann, V. Doerges, K. Gerlach, P. Schmucker, Department of Anaesthesiology, Medical University Luebeck, Germany Updated on August 28th, 2003

Contact: Dipl.-Ing. Dr. med. Wolfgang Baumeier Anaesthesiology Dept. University Hospital Schleswig-Holstein, Campus Luebeck Ratzeburger Allee 160 D-23538 Luebeck, Germany Tel. +49-451-5000 (pager 455) Fax +49-451-500 3504 Email : baumeier@medinf.mu-luebeck.de