Acute Care Surgery: Fortschritt

oder nur alter Wein in neuen

Schläuchen?

PD Dr. med. Beat Schnüriger

Universitäre Klinik für Viszerale Chirurgie und Medizin

Inselspital Bern

Notfälle

Elektiv

UVCM: 35-40% Notfallpatienten

Notfälle

Elektiv

Zertifizierung (Tumor-, Darmzentrum…)

Onkologische Standards

Register

Spezialisierung

Stiftungen

Forschung

uvm…

Notfälle

Elektiv

Zertifizierung

Onkologische Standards

Register

Spezialisierung

Stiftungen

Forschung

uvm…

????

ACS Patient

• ≠ elective surgical patient (different

concepts)

• Acute surgical disease/illness

• Acutely deranged physiology

– SIRS, Sepsis, Coagulopathy, Hypothermia

• Decision making critical - Time matters

(min – hours)

Abdominal

Compartment

Syndrome

Appendicitis acuta

Ileus

Fournier gangrene

HVI perforation

Trauma

Foreign body

Incarcerated hernia

Abdominal

Compartment

Syndrome

Appendicitis acuta

Ileus

Fournier gangrene

HVI perforation

Trauma

Foreign body

Incarcerated hernia

Acute Care Surgery

Trauma Surgery

Emergency Surgery

Critical Care

Acute Care Surgery

Trauma Surgery

Emergency Surgery

Critical Care

Algorithms Decisions Knowledge

Historical Timeline

• 2003 - Meeting of ACS, AAST, WEST, EAST on future

in emergency and trauma surgery.

• 2005 - ACEP survey: 75% of EDs identify inadequate

on-call specialty coverage

• 2005 - AAST renames previous ad hoc committee -

Acute Care Surgery Committee

• 2006 - IOM report - confirms shortage of on call

specialists

• 2007 - Development of curriculum, certification criteria,

and site visits

• July 2008 - First formal AAST ACS Fellowship

• EDs and trauma centers are overcrowded

• Emergency care is highly fragmented

• Critical specialists are often unavailable to provide

emergency and trauma care

• The emergency care system is ill-prepared to handle a

major disaster

• EMS and EDs are not well equipped to handle pediatric

care

• In 2006, 122 EDs handled 1.475 million

ED visits

• Overall, 39% of visits were for trauma or

surgery

Trauma- and Emergency Surgery is:

• A significant part of surgery, with major impact on

outcome and resources

• With regard to training = the responsibility of every

surgeon, regardless of specialty

• A matter where surgeons should collaborate, not

compete

• A global problem, requiring international collaboration

• An urgent matter, and the initiative should come from

the surgeons, not from politicians

Sten Lennquist, Söderköping/SE, Oral Presentation at ECTES Amsterdam, May 10, 2015

Fast and accurate diagnosis

Critical Care

Surgical treatment («DC»)

Resuscitation

Definitive Reconstruction

Reoperation

Rehabilitation

«The ACS-Surgeons are recognized for their

availability, expertise, and improved outcomes

for urgent surgical problems»

George C. Velmahos, MD, ACS and Trauma-Director, MGH Boston