地震救援中现场截肢的探讨

目的探讨地震救援中现场截肢手术适应证、手术方法及伦理问题。方法映秀镇地震救援中现场截肢2例共3个肢体，采用局部麻醉，截肢平面靠近压迫物。术后补充等张盐水，补液速度1．5L／h，静脉滴注5％碳酸氢钠溶液150mL。口服头孢克肟胶囊，400mg顿服。结果截肢后2例患者均未出现严重并发症，次日送后方医院行二次截肢。结论灾难救援中现场截肢必须综合考虑，严格掌握适应证，必要的截肢可以挽救伤员生命。     

无国界医生在救援中备灾的重要性

无国界医生致力于应对天灾和战祸所引起的人道医疗危机。灾后实时爆发的人道医疗危机包括急性的外科创伤问题和基础医疗系统的破坏导致疫症发生。本文介绍了无国界医生的救援经验以及专业的备灾体系。     

Looking for resilience: Understanding the longitudinal trajectories of responses to stress

Taking advantage of two large, population-based, and longitudinal datasets collected after the 1999 floods in Mexico (n = 561) and the September 11, 2001 terrorist attacks in New York (n = 1267), we examined the notion that resilience may be best understood and measured as one member of a set of trajectories that may follow exposure to trauma or severe stress. We hypothesized that resistance, resilience, recovery, relapsing/remitting, delayed dysfunction, and chronic dysfunction trajectories were all possible in the aftermath of major disasters. Semi-parametric group-based modeling yielded the strongest evidence for resistance (no or mild and stable symptoms), resilience (initially moderate or severe symptoms followed by a sharp decrease), recovery (initially moderate or severe symptoms followed by a gradual decrease), and chronic dysfunction (moderate or severe and stable symptoms), as these trajectories were prevalent in both samples. Neither Mexico nor New York showed a relapsing/remitting trajectory, and only New York showed a delayed dysfunction trajectory. Understanding patterns of psychological distress over time may present opportunities for interventions that aim to increase resilience, and decrease more adverse trajectories, after mass traumatic events.     

Taxing working memory reduces vividness and emotional intensity of images about the Queen's Day tragedy

Eye movements during exposure to distressing mental images reduce their vividness and emotional intensity, which may be due to both tasks competing for working memory (WM) resources. WM theory predicts an inverted U-shaped relationship between degree of taxing and beneficial effects: greater taxing of WM will more greatly reduce vividness/emotionality, but extremely taxing tasks prevent holding the image in mind, thereby reducing benefits. This study examined whether mental arithmetic (subtraction) tasks during visual imagery reduce image vividness/emotionality ratings, and taxing WM and reduced vividness/emotionality show the predicted quadratic relationship. A non-clinical sample retrieved a distressing image of the Queen’s Day tragedy (which occurred 1–3 months earlier in the Netherlands), and rated it for vividness and emotionality. Participants were assigned to one of four conditions: exposure alone or exposure with concurrent ‘simple’ subtraction, ‘intermediate’ subtraction, or ‘complex’ subtraction. Afterwards, vividness and emotionality were rated again. A reaction time task showed that the subtraction tasks increasingly taxed WM. Consistent with WM theory, exposure with subtraction reduced image vividness and emotionality compared to exposure alone. The expected inverse U-curve relationship was found for emotionality, but not for vividness: simple or intermediate subtraction had more beneficial effects than no dual-task or complex subtraction. Clinical implications are discussed.     

Exchanging information: current United Kingdom developments in the infrastructure to support post-mortem imaging

Through joint working across the Home Office, Ministry of Justice and Department of Health the United Kingdom (UK) has developed a single programme of research and development in the field of less invasive autopsy, forensic and mass fatality imaging. By supporting research and development within these fields the UK has developed an outline for a national core training programme in this field along with the development of the National Forensic Image Management System (FiMag). This symposium paper is a brief overview of this development.     

特大地震灾害救援中的药学服务探索

目的:为今后应急救灾行动中药学服务工作的开展提供参考。方法:结合亲身实践,对"5.12"汶川特大地震医疗救援中所涉及的药学服务相关工作进行回顾性调查、分析和整理。结果:科学的应急预案能使救灾工作忙而不乱,创造性工作能填补预案的不足,应重视临床药师在抗震救灾医疗救援中的作用,而指挥得当、措施有力是工作顺利进行的保障。结论:药学服务在应急医疗救援中大有作为。     

Mass casualty incidents with multiple burn victims: Rationale for a Swiss burn plan

Introduction

Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.

Methods

Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.

Results

Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20–30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources.

Conclusions

Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.