Objective To investigate the mass casualty triage system and its application, to provide evidence and advice for its future standardized use. Method Based on the principles and methods of systematic reviews, we searched MEDLINE (1950 to 2008), The Cochrane library (Issue 2, 2008) and CBM (from establishment to May 2008) to identify papers written in English of Chinese which described mass casualty triage systems or triage systems specific to the aftermath of earthquakes. We extracted information on name, grades, criteria, main characteristics and application of each triage system from the papers involving mass casualty triage systems. We also extracted information on setting, personnel performing the triage, grades, and characteristics from those papers describing any specific triage system for earthquake. We compared the colour of tags, codes and other materials used in different triage systems. Result We included 38 English and 6 Chinese papers. For mass casualty triage systems, we identified 7 primary triage methods with 4 grades.Three of these had relevant application reports. There were 6 secondary triage methods with 3-5 grades, and none had relevant application reports. Four tag methods were identified. Seven papers, 2 of which were published in China, reported specific secondary triage methods for earthquakes. Conclusion Based on the current evidence, there is no universally accepted mass casualty triage system with documented reliability and validity. No triage system has been developed specifically for the wounded in earthquakes. There are large differences between the triage methods for earthquake and other mass casualty incidents. Future research should focus on the development of a reliable and valid mass casualty triage system, aimed at maximizing the capacity for medical rescue.
目的：研究四川汶川大地震骨折伤员的日常生活活动（ADL）能力受限的特点，为地震骨折伤员的康复治疗提供依据。方法：对因2008年5月12日四川汶川地震后1月仍在华西医院骨科病房诊治的36例骨折伤员，进行生活状况问卷，记录其早期并发症，根据Barthel指数评定不同性别和不同部位骨折伤员各项ADL能力，统计伤员各项ADL等级构成比，比较不同性别和不同部位骨折伤员总ADL评分。结果：本次地震骨折伤员以下肢骨折多见，其次是躯干骨折（主要是脊柱骨折），上肢骨折相对少见；且ADL下降明显，尤其是躯干骨折和下肢骨折伤员；而早期并发症以伤口感染为主。结论：地震骨折伤员ADL明显下降，加强ADL能力训练尤其重要，临床康复措施主要集中于下肢和脊柱骨折的康复；早期并发症的防治主要是预防伤口感染。
Objective To analyze retrospectively the overall situation of medical rescue in the First Affiliated Hospital of Guangxi Medical University after the Wenchuan earthquake, so as to provide references for the emergency preparation for the disaster of earthquake. Methods Analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the hospital. The software Microsoft EXCEL was used for data management, and SPSS 13.0 was used for statistical analysis. Results From May 22 to May 26, 91 cases from the disaster area had been treated in the hospital, of which 90 were from Mianyang and 1 from Chengdu. These patients included 44 males with a median age of 38 (27, 53) years old and 47 females with a median age of 51 (33, 62) years old. Most patients were sent to the hospital within the first 10 or 11 days after the earthquake, with 86.8% hospitalized after 10 days and 22.0% after 11 days. The number of outpatients reached its peak of 37.1% of all the outpatients (33 cases) within 34 days after the earthquake. The wounded were mainly admitted into the Department of Orthopaedics, with 34.81% of the patients having lower limb fracture, 18.26% having spine fracture, and 12.59% suffering pelvis fracture. Only 2 out of the 89 patients died. One death was due to 60% burning injury and 1 died of multiple catastrophic injuries. Conclusion Based on the data, it is important to develop an emergent plan for medical rescues after an earthquake disaster and to strengthen the reserve of medical supplies, personnel training, scientific field triage and the construction of information platforms.
目的:了解地震住院伤员的身心状态,进行针对性心理干预。方法:采用方便抽样,应用作者根据应激理论设计的应激身心反应调查表［1］,通过对地震伤员的观察和访谈,对在2008年5月12日至5月30日在四川大学华西医院住院的371名地震伤员进行身心状态的评估,并进行有针对性的心理干预。结果:①地震伤员灾后急性期心身应激反应较严重,其中出现频率最多的症状是睡眠困难,对突然的噪音或声音感到紧张害怕,心情沮丧,感到身体紧张,心情难以平静;②不同性别地震伤员身心反应存在一定差异,女性反应症状重于男性;③年龄在小于12岁、12～18岁和41～50岁年龄段地震伤员的身心反应与其他年龄段地震伤员的身心反应存在差异;④地震伤员的身心反应与其性别、年龄、文化、个人受伤情况有关。结论:地震伤员灾后身心反应严重,急性期给予针对性心理干预十分重要。
ObjectiveTo explore the possible association between early injury assessment indexes and the length of stay (LOS) in first-line hospitals, in order to help the hospitals take advantage of resource effectively and transfer victims reasonably during earthquakes. MethodWe retrospectively analyzed the medical information of 3 576 traumatic patients injured in the Wenchuan Earthquake who were transferred to 242 first-line medical institutes between 14:28, May 12th and 14:30, May 19th in 2008. Three kinds of 15 variables were extracted for the analysis, including gender, age, heart or lung disease, pre-hospital time, head injury, trunk injury, open injury, crush injury, asphyxia, body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure, and Glasgow coma score. Multiple stepwise linear regression analysis was performed to identify the factors associated with LOS. ResultsThe multiple linear regression analysis showed that age as well as other six factors affected LOS significantly (P<0.05). The partial regression coefficients of age, pre-hospital time, head injury, trunk injury, crush injury, complication of cardiac or pulmonary disease, and Glasgow coma score were -0.062, 0.157, 3.703, 4.111, 12.602, 14.762 and -1.312, respectively. ConclusionsEarthquake trauma patients with older age, long pre-hospital time, head injury, trunk injury, heart or lung disease, crush injury, and lower Glasgow coma score are at increased risk for extended LOS.
Objective To analyze the outcome of patients with abdominal injury (AI) in the Chengdu Army General Hospital within 48 hours after the Wenchuan earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of AI patients. Methods Data on the AI patients within 48 hours after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 33 AI inpatients were treated which was 3.1% of the total inpatients. The AI inpatients suffered severe and complex injuries, and one of them died (mortality rate: 3%). Conclusion As a second-line Grade-A hospital,prompt triage is very important to patients who were rescued 48 hours after the earthquake. Reasonable damage control surgery and remedies prepared by medical staff from different specialties after the operations may decrease mortality rate.
Objective A retrospective summary of the planning, organization, and implementation of the transprovince transfer of patients injured in Wenchuan Earthquake with an emphasis on experiences that may be helpful in future emergency rescue and patient transfer. Methods We collected the daily reports of a patient transfer team attached to the Sichuan Rescue Headquarters from May 12 through May 31, 2008. Results Under the guidance of policy made by the coordinating group of the Ministry of Health, and with the close cooperation of the railway and airline departments the transferring group transferred 10 373 patients in the period studied. The transfers were from 11 disaster areas, including Chengdu, Mianyang, and Deyang, to 20 cities and provinces, including Chongqing, Jiangsu, and Zhejiang. There were no casualties during transfer, and thus the biggest peacetime government-organized trans-province patienttransfer in China’s history achieved success. Conclusion Trans-province patient transfer is an effective measure to compensate for inadequate medical materials, relieve pressure on medical rescue, and guarantee quality of treatment. In the future, emergency plans for different types of disasters will be established, the information platform will be improved, and transfer procedures will be specified.
摘要:目的:探讨地震伤员中膝关节损伤的机制、类型及处理方法。 方法:对我院收入住院的2728例 5·12汶川特大地震伤员伤情特点进行分析,筛选出有膝关节损伤的病例进行分析。 结果: 膝关节损伤前三位分别是髌骨骨折(42.15%)、胫骨平台骨折(21.05%)、股骨髁骨折(13.16%),这与人们在地震时奔跑摔伤以及被房屋倒塌砸伤有很大关系。结论:地震后膝关节损伤其发病率、受伤机制、损伤类型、合并伤情况及治疗处理均有其特点,总结这些特点和规律将对地震伤膝关节损伤患者的处理产生积极作用。Abstract: Objective: To investigate the knee joint injury mechanisms, types and treatment of the earthquake wounded. Methods: Analysis the characteristics of the 2728 cases of West China Hospital from 5.12 Wenchuan earthquake wound, screen out the cases of knee joint injury. Results: Patellar fracture (42.15%),tibial plateau fracture(21.05%), femoral condyle fracture (13.16%), were the top three of knee joint injuries, which have a great relationship with falling down and (or) injured by collapsed houses when people were running in the earthquake. Conclusion: After the earthquake the knee joint damages its disease incidence rate, is injured the mechanism, the damage type, the merge wound situation and treatment processing has its characteristic, will summarize these characteristics and the rule damages patient’s processing to the earthquake wound knee joint to have the positive role.
目的 总结大型灾害情况下，急诊伤员信息收集流程，为制定大型灾害救援提供证据支持。 方法 回顾性分析汶川地震（2008年5月12日－6月2日）和玉树地震（2010年4月14日－5月1日）伤员信息收集方法，总结两次地震伤员信息收集管理过程中发现的问题及取得的经验。 结果 通过制作地震伤员登记表、调整病历收集与管理模式、分诊提前、伤员信息登记提前，调整急诊功能分区、头像采集技术的使用、成批伤员信息资料袋和分诊信息卡的应用，最大限度地保证了伤员信息收集的完整性。 结论 地震伤员信息资料的准确性、完整性、及时性在伤员的救治、伤员的查找、伤员的转归和各类医疗信息的收集，以及制定大型灾害事故应急预案等方面起着非常重要的作用。