Trauma Platform Berlin: Establishing a city-wide network for trauma surgery and research

Every trauma center in Germany must submit data to the German trauma register which was introduced in the early nineties by the German Society for Trauma Surgery (DGU). At the time, it was a pioneering initiative internationally speaking. Since then, every patient has received a standardized entry in the database, as they should. But the usefulness of these records has its limits. They serve as a good basis for us to look at general trends like whether or not traffic accidents are on the decline, which injury patterns are more prevalent now compared to the past, or whether the introduction of airbags has affected the type and severity of injuries sustained in car accidents. So these data are useful for epidemiological studies. But the national trauma register is too superficial for what we had in mind here in Berlin. We want to go into greater depth with Trauma Platform Berlin to answer questions of the kind that we posed in our joint lab study: what course do infections take after a stab wound? Can we identify prognostic markers among a patient’s laboratory parameters? But as you might guess from hearing this example, this is only possible on a small scale as it involves collecting a huge amount of data – you’ve got to have the motivation, not to mention the storage capacity.

What motivated you and your colleagues Dr. Tobias Topp (CBF), PD Dr. Denis Gümbel (UKB), Prof. Dr. Thomas Fuchs (Vivantes), and Dr. med. Alexander Ringk (Buch) to establish this platform?

In Berlin, we have a relatively unique set of patients from a metropolitan area of over four and a half million people – sadly with the usual social problems for an area of such size. Over the last five to ten years, we have seen an increase in aggression, in stabbings… things that you used to know only from the movies have become the norm. You can hardly work a shift at the large healthcare providers in Berlin without being affected by knife crime these days. I feel as though the potential for violence has only increased since Covid, or else people’s inhibitions are lower. To put it bluntly, people who used to fight with their fists now turn to knives, while those who used to use knives have moved to guns. 

We have got to respond to this new reality. That’s what motivates us. Again, in very simple terms, trauma surgeons have spent the last twenty years dealing with broken bones, but now we are suddenly seeing bullet wounds, penetrative trauma – including casualties from Ukraine, who are regularly flown over to us. These are totally different patterns of injury with different standards of care and treatment techniques. We have been unused to these injuries for so long, but now they are making a comeback.

What stage are you at in implementing this project? What have you already achieved and what still needs to be done?

The underlying concept for Trauma Platform Berlin is multilayered, with three core pillars: further training for medical and healthcare professionals, research and preventive medicine, and communicating preventive measures to the general public in the city. We first focused on research because we wanted to get started as quickly as possible, and we imagined that this was the area furthest away from contractual obligations and legal hurdles. Two projects are now complete, and the results have already been published: the lab study I mentioned earlier, and another study on emergency thoracotomy (a surgical procedure to open the chest). A third and fourth project are currently in progress. We are essentially using our research to generate the content for the preventive courses that we are planning for ordinary citizens. These had originally been planned for last year, but since we started to think bigger, we need more time: we now want to bring all the Berlin clinics on board through their respective emergency response officers so as to reach as much of the general public as possible. We also want to work with the Berlin Senate because the issues like aggression and stabbings that I mentioned before are not just medical problems – they are also social issues relevant to politics.

As for further training, there are still some final legal hurdles to clear regarding secondments, but I’d say that we are on the home stretch. Once this is sorted, we can get started with the rotation programs. 

We have held an internal Trauma Review Meeting at the Charité since 2017, and it is now held across the whole Platform on a monthly basis. It enables us to recap what is going on with our colleagues throughout the entire emergency response chain: which serious injuries did our respective clinics treat over the last month? What can we all learn from these cases? Where do we see opportunities to improve our processes? 

We still need to recruit a central coordinator for Trauma Platform Berlin, someone who is happy to travel around Berlin and meet in person with the liaison officers in each of the participating clinics – in short, someone who can be a point of contact for everyone and coordinate our studies and rotation programs. Unfortunately, we have yet to fill this role due to a lack of stable funding. This might soon change thanks to a recent development: the trauma surgery center here at Campus Virchow-Klinikum has now become a G-BA Trauma Center!

Congratulations! What does this mean for you – and is there a connection between this new status as a G-BA Center and your work on Trauma Platform Berlin?

As a G-BA Trauma Center, we can now deliver services for other clinics and their patients and receive refinancing from health insurance funds in return. We will take the lead in Berlin, supporting other clinics with tools like telemedicine, as well as acting as a central hospital for the whole region in case of disaster. Our new duties are based on the regulations of the Federal Joint Committee, which is abbreviated as G-BA in German. Certain factors were instrumental in our being awarded this status, including our focus on building networks and further training opportunities across different clinics. We have already been able to address both these aspects while building Trauma Platform Berlin – all thanks to the prize money from Stiftung Charité in 2022. Trauma Platform Berlin was, in a sense, a pilot program that served as a basis for our application to become a G-BA Center. What started as our work with the platform is now our official mission as a G-BA Trauma Center for all the clinics in the Berlin network. It is a great development, a kind of Trauma Platform 2.0 – a long-term structure that will enable us to expand the initial good idea and successful collaboration. Getting it up and running won’t be easy, but we have learned a lot through our work on Trauma Platform Berlin. The cooperation agreements for exchanging data, for instance, will serve as a blueprint for our contracts with the clinics in the G-BA network.

We are delighted to hear how the initiative has taken off. 
Now looking back, what led you to become a trauma surgeon? Did you ever imagine that you would end up in this field?

The short answer: I studied medicine to become a trauma surgeon. It was a pretty straight path. I started out at a medium-level hospital in terms of specialist care, before moving to the university hospital. I have now been at the Charité for 15 years – I joined in 2009 as a specialist-in-training at the Center for Musculoskeletal Surgery. [Märdian laughs:] God, I’m old!

And what would you advise students who are contemplating this specialism, but who are less sure that it is the right choice for them?

For a start, orthopedics/trauma surgery is an extremely broad subject that was only consolidated like this in 2005 on the basis that each area involves musculoskeletal systems. Before then, it was two separate subjects. Students at the Charité who are considering going into trauma surgery should take the compulsory elective module ‘Emergency and Disaster Response Medicine’. We first developed it years ago in coordination with the German army and have taught it every semester since. You get a good insight into just how varied the work of a trauma surgeon is. Even today, I still find it exciting that I never know what kind of injuries I will be operating on tomorrow. You’ve got to take on whatever challenge comes your way.

Marike de Vries & Dr. Nina Schmidt / February 2024