突发事故致批量伤员的应急救治探讨

目的探讨批量伤员救治的接诊流程,以提高批量伤员的应急救治水平。方法 2009年7月～2012年3月我院急救中心接诊批量伤员共156人,通过启动绿色通道应急预案,快速分拣合安排至不同的救治区域,施行应对突发批量伤员处理预案,完善批量伤员的急救流程并运用于实践,共治愈149人,因病情危重,抢救无效死亡7人;抢救及时率达到100%。结果 156例中4例重型颅脑损伤患者到院后1～3h内死亡,3例多发伤致失血性休克到院30～60min内死亡,149例通过医院各科室的通力合作、全力抢救,均安然度过危险期治愈出院。结论绿色通道应急预案可以为救治重症伤员争取宝贵时间;在批量伤员的救治处理中起着至关重要的作用。因此,熟悉绿色通道流程,在实践中不断完善抢救流程可以显著提高批量伤员的急救效果。     

一体化绿色通道新模式在批量伤员急救诊治中的临床应用

目的:探讨急诊一体化绿色通道新模式在批量伤员急救诊治中的临床应用方法:回顾分析2009～2017年急诊科运用传统模式及新模式处理的批量伤员病例数为研究对象,对批量伤员患者院内救治中的各个环节时间,转归情况等方面资料比较.结果:“包干制”一体化组批量伤员的急诊检查、急诊等待、特殊检查、急诊手术、普通住院天数、ICU住院天数时间均短于传统组.结论:“包干制”一体化绿色通道新模式,各个环节紧密配合,提高批量伤员救治的及时性和连贯性,提高医生的责任感,争取患者时间,提高创伤救治率.改善患者预后及缩短住院时间有所帮助,具有可行性.     

批量伤员救治中护理风险因素分析及防范对策

 目的 探讨批量伤来诊时医院急诊科的护理风险及管理对策.方法 通过对批量伤员院内急救中的风险因素进行分析,采取加强护理组织管理、完善应急预案、加强护士专业培训、针对关键环节进行重点管理等措施.结果 通过以上措施有效防范了风险事件的发生,提高了护理工作质量和伤员满意度.结论 实施风险管理,是保障批量伤急救护理质量的关键.     

大批量伤员院前和院内急救流程

如何组织对大规模爆炸伤、烧伤、挤压伤等危重伤员的院前和院内急救 ,是军队医院平时和战时面临的重要课题。为此 ,我们通过 4年来对 2 1批次2 0 3例各类事故伤员的急救 ,总结了一套院前和院内急救流程 ,不仅使院前、院内急救程序化 ,提高了救治成功率和救治质量 ,而且对现代战争中大批量伤员的急救具有借鉴和指导意义。1　院前急救流程院前急救 ,主要是现场急救和途中救治 ,是挽救生命 ,提高救治成功率的关键阶段。在这一阶段 ,我们主要建立了以下流程 ,并强调切实抓好流程的各个环节。1 1　接警与出救　开通“1 2 0”值班电话。值班员接…     

制定批量车祸伤员早期急救程序提高未来作战保障能力

批量伤员指同一种或多种致伤因素,同时造成4人次以上的伤员.批量伤员的特点是突发性强、伤员数量多、伤情复杂、抢救难度大[1].确保救治工作紧张、有序、快捷有效的完成是急诊急救的一项基本任务,是对应急抢救组织管理的严竣挑战,更是我军未来作战面临的课题.自2006年以来,我院承担昆明市周边高速公路,管辖里程536 km的创伤急救抢救任务.     

火车转运汶川地震批量伤员的检伤分类

面对重大灾害事故所致的批量伤员,首要的医疗救援措施就是快速检伤分类,将众多的伤员分为不同等级,按伤势的轻苇缓急有条不紊地展开医疗急救和梯队顺序后送,从而提高灾害救援效率[1,2].因此,检伤分类是灾害医学的重要组成部分,是灾害医疗救援的首要环节.汶川"5.12"特大地震造成大规模人员伤亡,其中数万人死亡,数十万人受伤.     

论多发伤急救的时效性

多发伤是一种"时间依赖性疾病",急救时存在"时间窗",一旦时间延误或超过救治的"时间窗",患者可能会失去最佳的救治机会,伤死率、并发症发生率将会增加。多发伤急救的时效性,体现在救治的"时间窗"内,通过采取正确、有效的救治措施,达到最佳救治效果;要求在最短的时间内进行伤情评估、快速急救、术前准备等。多发伤急救的时间理念,已由越快越好的定性过程发展到精确的定量过程;分清个体伤员救治的时效性及批量伤员救治的群体时效性,对决定多发伤急救的优先顺序意义重大;要保证多发伤急救的时效性,必须建立一个与之相适应的制度和流程,在救治各个环节上遵循损害控制外科策略。     

严重交通事故多发伤324例救治分析

对324例交通事故多发伤伤情资料及救治情况进行回顾性分析,认为：交通事故引起的严重多发伤发生年龄多在16－40岁的青壮年,受伤部位多见腹部、头部、胸部、四肢和骨盆;伤员主要死亡原因依次为颅脑损伤、胸腹部外伤引起的休克、MOF、呼吸衰竭。强调此类伤员的急救应重视现场急救和伤员转运,综合复苏、及时手术能有效地提高伤员的生存率。     

军队医院成批伤员救治流程研究简介

军队医院成批伤员救治流程研究简介。文章说,成批伤员病情复杂,危急凶险,抢救难度大。大量伤员同时需要救治,而且危重伤员居多时,需要熟练的急救和复苏技术,按照常规流程无法完成救治任务。可按照卫生勤务学原则,根据伤情,对伤员进行鉴别分类,实行分级救治、后送医疗、紧急疏散     

海军医学研究系列讲座（34） 美国海军伤员分类情况介绍

伤员分类是军队卫勤保障工作的重要组成部分,是提高战伤救治率的关键。美国海军把伤员分类视为伤员救治过程中最重要的环节,在伤员伤情严重、战场情况复杂、作战训练任务艰巨的情况下,充分利用各种保障资源,对伤员实施科学合理的分类救治。分类救治贯穿于美国海军战场或突发事件中,从同伴和卫生员急救开始一直到伤员进入救治流程、接受手术治疗和ICU治疗的全过程。现将美国海军伤员分类情况介绍如下。     

成批烧冲复合伤的组织管理和早期治疗

目的 探讨成批烧冲复合伤有效的组织管理和早期救治方法。方法 总结和分析一批16例特重烧伤复合冲击伤患者早期救治过程中的组织管理经验和临床资料。结果 应急预案启动及时,伤员救治过程组织严密;全部伤员在早期抢救中顺利度过休克期,有10名伤员及时分流和转运,其中1名在救护车转运途中出现心跳呼吸骤停,予以成功复苏。结论 及时启动应急预案、协调指导有利于迅速有效组织成批伤员救治的工作,专家组指导下各组负责的医疗制度有利于提高成批伤员救治的效率,正确认识烧冲复合伤的临床特点、早期有效的液体复苏、尽早封闭烧伤创面和防治多脏器功能不全的是治疗成批烧冲复合伤的有效方法。     

建立成批烧创伤急救体系,提高平战时救治能力

本文浅谈了成批烧创伤救治的经验与教训,分析了我国成批烧创伤急救体系的现状,提出应建立符合我国国情的成批烧创伤急救体系,通过课程学习与专科基地训练,加强研究与交流等措施,提高我国平战时成批烧创伤救治的能力.     

烧伤12批187例救治的总结分析

目的：总结分析成批烧伤救治的最佳工作程序,提高早期多数量伤员的伤情判断和处理能力,使救治工作准确有序的按计划进行。方法：①伤员原地救治;②伤员转送外地救治;③伤员原地和转送并举。结果：烧伤12批187例治愈161例,其中112例恢复原工作,32例生活完全自理,并且有一定的工作能力,17例生活不能自理。死亡26例,其中休克期9例,感染期17例。结论：成批烧伤早期救治的环境条件和伤情判断分类均很重要,尽早建立救治的工作程序,才能保证每名伤员救治措施落实,也可随时发现伤员病情变化,及时对症处理。避免在忙乱中延误病情而影响救治效果。     

Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated “critical” by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann–Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol.     

Emergency radiology and mass casualty incidents—report of a mass casualty incident at a level 1 trauma center

The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1–8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.     

Are you ready?��lessons learned from the Fort Hood shooting in Texas

On November 5, 2009, a US Army psychiatrist allegedly opened fire with one or more handguns, killing 12 military personnel and one civilian at Fort Hood in Killeen, Texas. The most severely wounded casualties were transported to Scott and White Memorial Hospital, a Level I trauma center and tertiary care teaching hospital in Temple, Texas associated with the Texas A&M University College of Medicine. Ten victims arrived in a 1-h period with another two arriving in the second hour, necessitating an emergency response to a mass casualty event. Our radiology department's response was largely unplanned and was therefore the result of many spontaneous actions and ideas. We share our experiences and from them formulate guidelines for a general radiology surge model for mass casualty events. It is our hope to raise awareness and help other radiology departments to prepare for such an unexpected event.     

Evaluations over the medical emergency responding to chemical terrorist attack

The use of chemical warfare agents intentionally has become a great concern in the arena of the cold war. On the other hand, there has always been a threat on civilian population due to their mass destruction effects, including psychological damage and a great deal of discussion how to respond to it in terms of medical management. It is very important to provide the best lifesaving medical care and triage in a chemical-contaminated area. Mass casualties exposed to chemical agents require immediate medical intervention to save their lives and should be classified in accordance to medical care priorities and available medical sources, including antidotes and sophisticated health facilities. Establishing the decontamination area for chemical casualties where it is located at the suitable place with respect to the wind direction is necessary. To overcome the mass destruction effects of chemical warfare agents following the terrorist attack, we must have the emergency medical response plan involving experienced triage officers and medical care providers to be able to perform medical management in the chemical-contaminated area and health facilities.     

Combat "Category A" calls: evaluating the prehospital timelines in a military trauma system

AIM: To establish the pre-hospital timelines for seriously injured UK military casualties on OP HERRICK. POPULATION: All consecutive MERT and MERT-E mobilizations from Camp Bastion, Helmand Province, between 04 May 06 and 18 Jun 07. METHODS: Interrogation of MS Access database compiled from paper patient report forms for each casualty transported. RESULTS: 528 patients were transported. 84.6% (456) were battle casualties. There were 192 GSW and 233 casualties with blast/fragmentation injuries. 189 of 528 (35.7%) were UK Service personnel. Median time from injury to handover at the emergency department for UK military T1 casualty subset was 99 minutes. CONCLUSION: The public perception of excessive timelines for pre-hospital care in Afghanistan has been distorted. The ground truth is a pre-hospital time less than one quarter of the cited 7 hours for the seriously injured subset of UK Service personnel.     

一批35例烧伤伤员远程转运组织工作的成功经验

目的 总结组织35例烧伤伤员一次性远程转运的成功经验.方法 2006年5月黑龙江某地35例不同程度烧伤伤员,通过航空转运至北京.对转运的组织、指挥工作中的成功经验进行分析、总结.结果 专家医疗组到达后,经20h充分做好转运前准备工作,经4h航空转运,全部伤员均安全、顺利到达接收地.结论 转运前迅速处理危及生命的并发症,稳定伤情,防治继发损伤;制定转运计划,安排转运工具、人员,备齐相关器材、药品,协调出发地、接收地的陆空、空陆衔接,尽量缩短转运时间;任务布置明确,落实确实,责任到人是保证本批伤员长途转运成功实施的关键.     

三甲医院应对突发大规模群体性创伤的策略和方法:附南京7.28丙烷爆炸案急救报告

目的 探讨大型综合性医院应对突发性大规模群体性创伤的策略和方法.方法 回顾南京7.28爆炸案大规模群体性创伤伤员救治过程,总结大规模创伤救治的经验.结果 急诊科2小时45分钟共救治124人,其中严重多发伤及复合伤(ISS≥16)34人(27.4%).行清创手术118人次,损害控制性手术10例(8.1%).死亡1例(0....