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Background <p>In the first minutes of life-threatening incidents, prehospital care is shaped less by comprehensive treatment than by command, coordination, and threat-adapted decision-making.</p> Objective <p>This article reviews the concepts of leadership that may be helpful for medical providers to follow while managing through the chaos of the initial minutes in a&#xa0;life-threatening event.</p> Methods <p>A&#xa0;narrative review using current guidelines (TCCC, TECC, TREMA, and AWMF recommendations) combined with selected literature addressing issues related to multiagency cooperation, triage, communication, and decision-making.</p> Results <p>Medical leadership during the chaotic phase follows a&#xa0;threat-based, phase-specific logic rather than a&#xa0;linear treatment routine. Priorities are personnel protection, situation assessment, shared scene organization, concise command information, and close coordination with police. Early medical action should remain limited to a&#xa0;small number of immediately effective interventions, particularly hemorrhage control, basic airway measures, and rapid extraction. Casualty assessment starts as tactical pretriage under threat and only later develops into more structured triage and command processes. Typical errors arise from switching too early to a&#xa0;purely clinical mindset, unclear release decisions, communication failure, and role ambiguity.</p> Conclusion <p>The chaotic phase requires situation-adapted prioritization rather than completeness. Effective medical leadership recognizes transitions between threat phases early, actively structures communication and interfaces, and deliberately transfers provisional decisions into more stable care processes.</p>

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Medizinisches Führen in der Chaosphase lebensbedrohlicher Einsatzlagen

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Raphael Röttinger

摘要

Background

In the first minutes of life-threatening incidents, prehospital care is shaped less by comprehensive treatment than by command, coordination, and threat-adapted decision-making.

Objective

This article reviews the concepts of leadership that may be helpful for medical providers to follow while managing through the chaos of the initial minutes in a life-threatening event.

Methods

A narrative review using current guidelines (TCCC, TECC, TREMA, and AWMF recommendations) combined with selected literature addressing issues related to multiagency cooperation, triage, communication, and decision-making.

Results

Medical leadership during the chaotic phase follows a threat-based, phase-specific logic rather than a linear treatment routine. Priorities are personnel protection, situation assessment, shared scene organization, concise command information, and close coordination with police. Early medical action should remain limited to a small number of immediately effective interventions, particularly hemorrhage control, basic airway measures, and rapid extraction. Casualty assessment starts as tactical pretriage under threat and only later develops into more structured triage and command processes. Typical errors arise from switching too early to a purely clinical mindset, unclear release decisions, communication failure, and role ambiguity.

Conclusion

The chaotic phase requires situation-adapted prioritization rather than completeness. Effective medical leadership recognizes transitions between threat phases early, actively structures communication and interfaces, and deliberately transfers provisional decisions into more stable care processes.