Objective To analyze the characteristics of patients transferred by ambulances to emergency department before and after coronavirus disease 2019 epidemic, in order to improve the efficiency of emergency triage, optimize the utilization of emergency resources, and provide a reference for standardized tiered medical services in different situation. Methods The patients’ information collected through Wenjuanxing questionnaire was extracted, who were transferred by ambulances to the Emergency Department of West China Hospital of Sichuan University between December 27th, 2018 and April 28th, 2019 (before epidemic), or between December 27th, 2019 and April 28th, 2020 (during epidemic), or between December 27th, 2020 and April 28th, 2021 [in regular epidemic prevention and control period (REPCP)]. The general information, sources, reasons for referral, disease spectrum and triage levels of patients in the three periods were compared. Results There were 3993, 2252 and 1851 cases before epidemic, during epidemic, and in REPCP, respectively. The differences in gender and age among the three periods were not statistically significant (P>0.05). The percentage of referrals from tertiary hospitals in each period was 74.00%, 72.65%, and 76.12%, respectively, which was higher in REPCP than that during epidemic (P<0.05). The percentage of direct referrals from emergency department in each period was 41.00%, 42.14%, and 44.46%, respectively, which was higher in REPCP than that before epidemic (P<0.05). The percentage of two-way referrals in each period was 37.79%, 36.63%, and 34.36%, respectively, which was lower in REPCP than that before epidemic (P<0.05). During epidemic and in REPCP, the proportions of referrals due to “need for surgery” (24.72%, 27.84%, and 28.74%, respectively) and “request by family members” (49.64%, 53.33%, and 56.24%, respectively) increased compared with those before epidemic (P<0.05), while the proportion of referrals due to “critical illness” decreased compared with that before epidemic (40.20%, 35.21%, and 33.17%, respectively; P<0.05); the proportion of referrals due to “diagnosis unknown” decreased in REPCP compared with that before epidemic (15.50%, 13.90%, and 11.89%, respectively; P<0.05). The proportion of acute aortic syndromes in REPCP increased compared with that during epidemic (3.46%, 2.98%, and 4.65%, respectively; P<0.05), the proportion of trauma in REPCP increased compared with that before epidemic (13.72%, 15.76%, and 17.77%, respectively; P<0.05), and the proportion of pneumonia/acute exacerbation of chronic obstructive pulmonary disease during epidemic and in REPCP decreased compared with that before epidemic (8.44%, 3.73%, and 3.84%, respectively; P<0.05). The proportion of critically ill patients referred in each period was 72.88%, 75.58%, and 79.15%, respectively, which was the highest in REPCP (P<0.05). Conclusions The epidemic has a significant impact on emergency ambulance referrals, and emergency triage needs to be continuously optimised and improved in staff, facilities, processes and management. It is necessary to further improve the implementation of hierarchical diagnosis and treatment, strengthen information communication between referral and emergency departments of receiving hospitals, and improve referral efficiency.
Objective To investigate the transferring methods of earthquake casualties accepted by the Department of Emergency, discuss the requirement for rescue materials in pre-hospital transference and provide information for transferring casualties after disasters in future. Methods Traumatic types and conditions of the wounded admitted by the Department of Emergency of West China Hospital within 3 weeks after Wenchuan earthquake,were collected. The characteristics of the wounded transferred by ambulances and helicopters were analyzed. Results Of the 2 338 wounded, ambulances transferred the most accounting for 60.56%, helicopter transferred 13.47%, and the other transport modes took up 25.96%. As for the macrotraumas, ambulances transferred more than helicopter and other transport mode did (Plt;0.05), while there was no statistical significance between helicopters and other transport modes(Pgt;0.05). Conclusion After the disaster, a field first-aid command system should be immediately established, casualties should be triaged concisely, an appropriate transference mode should be decided according to the degree of injuries and sufficient rescue materials should be provided based on different transference modes.
Objective To explore the utilization of emergency materials for mass disaster. Methods We retrospectively analyzed the 2 338 casualties from Wenchuan earthquake who visited our emergency department from 2:28 PM, May 12 to 2:28 PM, June 2. The injury condition and demand on emergency materials at different phase were also analyzed.Results mong the 2 338 casualties, the most common injuries were fracture, skin or soft tissue injury, and brain injury. Primary drugs are tetanus immune globulin, normal sodium and antibiotics. The injury condition and demand on medical resource were different at different phase. The demand on emergency materials depended on the category and severity of injury. Conclusion It is necessary to make a good medical resource planning for mass disaster. The catogory of injury and demand on emergency materials are different at different phase.
American Heart Association issued American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2020. A sixth link, recovery, has been added to both the adult out-of-hospital cardiac arrest chain and in-hospital cardiac arrest chain in this version of the guidelines to emphasize the importance of recovery and survivorship for resuscitation outcomes. Analogous chains of survival have also been developed for adult out-of-hospital cardiac arrest and in-hospital cardiac arrest. The major new and updated recommendations involve the early initiation of cardiopulmonary resuscitation by lay rescuers, early administration of epinephrine, real-time audiovisual feedback, physiologic monitoring of cardiopulmonary resuscitation quality, double sequential defibrillation not supported, intravenous access preferred over intraosseous, post-cardiac arrest care and neuroprognostication, care and support during recovery, debriefings for rescuers, and cardiac arrest in pregnancy. This present review aims to interpret these updates by reviewing the literature and comparing the recommendations in these guidelines with previous ones.
Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasound-guided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites. Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included, and their basic information, physiological indicators (heart rate, blood pressure), laboratory examination indicators, physical signs, treatment methods and prognosis were collected. The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group. Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1. The bleeding, infection, nerve injury, length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry. The correlation between the pressure measured in the manometry group and creatine kinase (a representative index of acute poisoning severity score) was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease. Results There was no significant difference between the manometry group and the control group in new or aggravated infection, bleeding, nerve injury (such as numbness and anesthesia), hospital treatment time, final detumescence time of the affected limb, or final adverse prognosis (P>0.05). There was a positive correlation between the measured pressure and creatine kinase (rs=0.286, P=0.002). Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is, the more serious the poisoning condition may be. In addition, ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients or the final swelling reduction time of the affected limb, and does not increase the incidence of bleeding, infection, nerve damage or eventual adverse prognosis events. It has clinical practicability and feasibility.