成批烧伤早期处理中几个问题的探讨

目的：探讨成批烧伤早期救治与航空转运的经验。方法：总结2001—06—23发生在甘肃省某地一批22例成批烧伤伤员的早期救治与航空转运工作。结果：13名伤员分4批次被安全转送至西安、重庆和北京，1名轻伤员留原地治疗，8名伤员死亡。结论：提高基层医院成批烧伤应急水平与改善其基本装备十分必要，建立全国范围的航空救治组织迫在眉睫。     

特大成批危重烧伤患者35例的成功救治经验

目的 介绍一组特大成批危重烧伤患者成功转运救治的经验.方法 2006年5～8月,解放军总医院第一附属医院烧伤科主持并参加了一组35例特大成批危重烧伤患者伤后6h急救、空中和陆路长途转运、后续治疗的工作.35例患者均为男性,年龄22.4±8.7(17～46)岁,烧伤面积13.6%±12.9%(4%～75%)TBSA;特重度烧伤3例,重度烧伤29例,轻度烧伤3例;全部患者均有头面部烧伤,32例患者伴有中、重度吸入性损伤,20例伴双手深度烧伤(计39只手).当地医院行15例气管切开,17例四肢切开减张.经充分的转运前准备后,35例患者经4h空中和陆路长途转运,顺利抵达接收地.收入解放军总医院第一附属医院烧伤科的23例病情相对危重患者中,并发多器官功能障碍综合征(MODS)1例、特重2例、病重12例,均有不同程度的心、肺、肝、肾功能及凝血功能异常.入院后连续月余予以全方位抢救治疗,先后进行手术48例次.结果 35例患者全部救治成功(包括其他医院的12例),功能及外观恢复满意.结论 本批烧伤患者早期救治延迟,转运路途远,伤情重,并发症多,接诊及救治难度大.救治过程中有以下几点体会:从现场救治、长途转运到后续治疗,应组织得力、分工明确、团结协作;整体治疗应尽量规范统一,强调个体化治疗;尽快处理危及生命的并发症;尽早封闭烧伤创面,从源头上清除感染根源,使用抗炎药物,减轻炎症过度反应.强调营养、代谢和免疫调理、凝血功能障碍的纠正等是本批患者成功救治的关键;重视应用整形美容的原则和技术处理面部和手部等关节部位创面,是功能和外貌恢复良好的保证.     

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。     

滇南地区102例烧伤患者长途转运中的护理体会

威胁生命的大面积烧伤大多发生在院外,入院前处理不当和入院不及时是造成救治失败的重要原因[1].滇南地区地处边疆,山高路险,大多数路况较差,给伤员长途转运带来较大的挑战.为提高烧伤患者长途转运护理质量,我科从2006年6月~2010年12月,对急诊出诊的烧伤病人采取启动转运预案、转运前准备、转运中护理及注意事项、信息沟通、转运交接等5条措施,确保烧伤病人院前专业治疗护理的连续性,取得了良好的效果,现总结如下.     

汶川地震灾后群体伤员转运接收和护理管理

突发事件中批量伤员转运接收和护理管理工作,直接影响伤员救治质量和医护人员工作效率。汶川地震医疗救援中,我院承担了140例伤员的转运接收和护理任务,护理部充分准备、准确实施、加强管理,确保了汶川地震灾后批量伤员的转运接和救治工作规范有序,高效快捷。     

北京市接收汶川地震转运伤员过程中的伤检与流程

目的 通过对四川汶川大地震中需要长途转运伤员病情的了解和生命体征的检测,探讨地震期间大规模伤员转运的伤检与流程特点. 方法 北京市卫生局赴四川抗震救灾救护转运队第二分队共接收转运伤员197例,其中男106例,女91例;年龄6～81岁,平均37.5岁.在整个转运过程中,行2次"两查四对一评分";并在转运途中保持各医疗小组间的密切合作. 结果 197例伤员中,194例安全转运,3例伤员在接收时因病情不稳定送回原医院继续治疗.转运的194例伤员中,181例病情平稳,未诉不适,7例骨折伤员在搬运及车辆行进中诉患肢疼痛,2例挤压综合征伤员诉胸闷、气短,2例胸部挤压伤的伤员因路途颠簸而加重胸部疼痛,另外2例伤员诉头晕,恶心.所有不适伤员均给予生命体征监测及对症治疗. 结论 在地震期间大规模转运伤员时,充分的准备、严格的伤检及良好的医护配合,是完成安全转运的保证.转运途中,各医疗小组间密切合作,对伤员伤情的详细了解,必要的监护及治疗,充分的医患交流及认真详尽的后期交接足伤员成功转运的关键.     

63例特重烧伤休克期转运的体会

目的探讨特重烧伤休克期转运的可能性。方法收集分析近5年9批63例伤后48h内转运的特重伤员资料。结果全部伤员均成功平稳转运,除2例分别于伤后9、19天死于多脏器功能衰竭外,余61例全部治愈。结论特重烧伤原则上应就地抗休克后转运,当治疗条件太差时,应迅速补充血容量后在继续补液的同时用快速平稳的运输工具转运。     

批量烧伤208例救治分析

2001年1月-2010年12月,我们先后救治了49批208例烧伤伤员。总结平时批量烧伤伤员的救治成功经验,提出＂三通、二库、一床＂在战时大批量烧伤伤员救治中的重要意义,对建立战时相关救治体系进行初步探讨。现分析报告如下。     

成批特重烧伤病员航空转运的护理

2001—06下旬甘肃某地发生燃爆事故，致伤22例，经诸多专家研究决定将具备转运分流条件的13名伤员分4批次空运到不同省份的烧伤研究所及烧伤中心治疗，同机先后有16名护理人员配合整个空运工作，使得整个转运工作有条不紊，现将转运护理体会报告如下。     

阿尔及利亚地震灾后中国危重伤员远程空中转运

目的 总结紧急远程航空医疗运送的经验，分析影响空运的多种因素。方法 通过2003年5月阿尔及利亚地震灾后，中方5名危重伤员的航空转运的实践，就转运计划、医务人员和医疗设备的配置、空中监护、心理干预等对远程航空医疗运送的作用和影响进行分析和总结。结果 5名危重伤员均安全转运至目的地。结论 制订周密的转运计划和进行细致的安排是成功转运的重要条件；灾害伤员的心理干预对安全转运有着特殊意义。     

Battlefield Advanced Trauma Life Support (BATLS)

The vast majority of casualties will only require a common sense approach to their preparation for evacuation, by asking simple questions, most problems can be identified and resolved prior to the evacuation. Ask? Are aeromed teams available to undertake this task? (Contact them). If aeromed teams are unavailable but can offer advice, talk to them. Where is the onward destination and are they expecting the casualty. (Check). Is the destination suitable for the casualty and the aircraft type? (Check). What level of training is required to transfer the casualty? (Cbt Med Tech/RGN/MO). Are the appropriate aeromed stretchers and harnesses available? (If not get them). Are all the casualty's documentation and X-rays available for transportation with the casualty? (Check). Does the casualty require a secure airway, intravenous access or fluid resuscitation prior to or during flight? (Ideally, the casualty must be as stable as possible prior to flight). Are all i.v. lines taped and secure. (Check them). Is there sufficient oxygen supply on board for the casualty's(ies) needs to complete the journey and cope with delays? This especially applies if the ventilator is air or oxygen driven. Has the electrical medical equipment required for transportation been cleared for use on the aircraft? (Talk to the aircrew). This equipment may be necessary for in-flight monitoring. Even simple tasks such as counting a pulse rate using the carotid artery, may be impossible in a vibrating airframe. How is the casualty going to be positioned on board the aircraft and does the escort have access? (Find out). If the flight is tactical and at night, the air-crew may be using night vision goggles, can any light be used in the cabin? (On chinooks the crew may be able to provide a blacked out area; in other aircraft torches with green filters will have to be used and monitoring undertaken by touch. Check the situation with the crew and be prepared to adapt). It is very difficult to care for a casualty in the air, particularly on a helicopter. It is extremely important to prepare the casualty properly prior to the flight. A few extra minutes on the ground preparing the casualty may ultimately save their life. However, the tactical situation or the condition of the casualty may dictate the scoop and scoot approach, rather than stay and play.     

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。     

Airway and ventilatory equipment in field anesthesia: what's new?

Advances in medical technology provide the modern day field anesthetist with the extra edge to meet the challenges faced in the harsh environment of the battlefield and enhance the survivability of casualties. The tasks of triage, resuscitation, and administration of anesthesia can be facilitated with the use of new airway devices, portable ventilators, and monitoring devices. Before such equipment is used in the field, the anesthetist must carefully weigh the advantages and disadvantages and must be cognizant of the limitations of individual devices in different environmental settings. These devices should ideally be portable, lightweight, rugged in construction, durable, easy to use (requiring minimal training and supervision), readily replaceable, and cost-effective.     

A mass casualty while in garrison during Operation Desert Storm.

In the theater of operations, rear echelon hospitals by doctrine receive patients who have been stabilized by forward hospitals. Occasionally, mass casualties will occur in the rear area, but rarely from combat causes. This report documents a mass casualty occurring in garrison from an anti-tank weapon misfiring. All rear echelon hospitals, regardless of their mission, must be prepared for the acute care of combat mass casualties.     

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.     

Flugtag-88 (Ramstein Air Show Disaster): an Army response to a MASCAL

A successful response to a mass casualty event must include trained personnel, adequate facilities, and abundant supplies. The medical staff must strictly adhere to triage and classification standards. Landstuhl Army Regional Medical Center (LARMC) triaged, within 30 minutes, 120 casualties from the Ramstein Air Show Disaster--14 patients were admitted, 86 were stabilized and transferred to German facilities, 16 were treated and released, and 4 were expectant. There were 6 subsequent transfers to LARMC. Seven patients were operated upon that day, 7 patients were eventually transferred to Brooke Army Burn Unit, and 3 patients underwent subsequent delayed reconstructive surgery.     

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.     

批量伤员急救流程的优化

目的优化批量伤员急救流程,提高急救水平。方法采用作业重组理论,对批量伤员的急救流程进行优化,并应用于批量伤员的急救实践。结果自2004年6月～2008年7月我院接诊了16批次批量伤员,总人数133人,其中ISS≥16者17人。治愈129人,死亡4人。结论急救流程的优化在批量伤员的急救处理中发挥重要作用,合理的急救流程能够显著提高批量伤员的急救效果。     

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.