检伤分类技术在大型创伤事故中的应用

目的 总结运用检伤分类技术在大型创伤事故救治中的经验。方法 对我科2000年6月至2001年6月组织实施的7起大型创伤事故中86名伤病员运用实施检伤分类技术。结果 明显缩短了急救时间，提高了抢救成功率，降低了患者死亡率。结论 救治前的充分准备工作是及时救治的首要环节；全面准确的伤情判断和病员分类是降低死亡率的关键；而高素质、技术全面精湛的护士则是实施此项技术的成功保证。     

汶川地震后送伤员的伤情调查分析

目的：调查分析汶川地震后送伤员的伤情。方法：对汶川地震后2周转来长海医院的34例地震伤员伤情进行调查，重点对伤员伤情、分类、救治方法进行分析。结果：受伤现场伤员急救、分类与转送，对合并软组织损伤的骨折伤员选择性应用外固定支架、积极修复软组织损伤，辅以积极的心理评估与干预，能有效地提高地震伤治愈率，减少并发症的发生。结论：总结汶川地震后送伤员的伤情特点与救治经验，为地震伤员的救治提供了初步依据和方法。     

创伤评分在地震伤员伤情评估中的应用

目的探讨创伤评分在大批量地震伤员救治过程中进行伤情评估的意义。方法应用创伤评分对大批量地震伤员进行伤情评估,并根据伤情严重程度分类安置,开展救治。结果对地震伤员采用创伤评分进行创伤严重程度评估,保证了急救护理工作的顺利开展,提高了地震伤员的救护质量。同时也可以作为伤情变化的再评估的工具。结论创伤评分对地震伤员进行伤情评估优化了救治流程,为有效救治赢得宝贵的时间,为后续的急救护理工作顺利开展创造了条件。     

创伤评分在地震伤员伤情评估中的应用

目的 探讨创伤评分在大批量地震伤员救治过程中进行伤情评估的意义.方法 应用创伤评分对大批量地震伤员进行伤情评估,并根据伤情严重程度分类安置,开展救治.结果 对地震伤员采用创伤评分进行创伤严重程度评估,保证了急救护理工作的顺利开展,提高了地震伤员的救护质量.同时也可以作为伤情变化的再评估的工具.结论 创伤评分对地震伤员进行伤情评估优化了救治流程,为有效救治赢得宝贵的时间,为后续的急救护理工作顺利开展创造了条件.     

第八届全国灾害急救危重病医学学术会议暨创伤脓毒症、中毒救治新进展推广学习班

为加快建立与国际接轨的现代灾害医学救援体系（EMS），进行迅速、科学、正确的灾害院前急救及伤员转运和后续治疗，减少伤员死亡率和伤残率，提高我国灾害医学救援及危重病救治的整体水平，定于2012年4月18—21日在辽宁省大连市召开第八届全国灾害急救危重病医学学术会议暨创伤脓毒症、中毒救治新进展推广学习班。     

重特大交通事故伤员的应急处置和院前急救

重特大交通事故作为突发性公共危机,伤员的院前急救越来越受到传媒和广大人民群众的关注,卫生医疗急救机构一方面要在事故发生后迅速做出反应,科学调度;另一方面,在伤员受伤现场及转送途中实施有效的救护措施,为下一步的院内抢救争取时间,最大限度地降低伤残率,减少死亡。现就我市一起特别重大交通事故中416名伤员的院前急救情况做一总结,借以探讨在特大型交通事故应急医疗救援过程中的应急处置和院前急救。     

突发事件一体化紧急医疗救援模式的探讨

目的:探讨一体化救援模式在突发事件救治作用.方法:建立指挥机构,加强人员培训,制订突发事件救援预案、急救工作手册[1],建设城乡大急救网络.结果:在柳州市区域近年来发生的突发事件救援中,市急救指挥中心响应迅速,现场处置及时,伤员快速安全转运,院内专科治疗及时、有效.结论:急救一体化紧急救援模式可有效、快捷地抢救生命,迅速安全转运,提高医疗救治水平,降低死亡率和致残率.     

第八届全国灾害急救危重病医学学术会议暨创伤脓毒症、中毒救治新进展推广学习班

为加快建立与国际接轨的现代灾害医学救援体系（EMS），进行迅速、科学、正确的灾害院前急救及伤员转运和后续治疗，减少伤员死亡率和伤残率，提高我国灾害医学救援及危重病救治的整体水平，定于2012年4月18—21日在辽宁省大连市召开第八届全国灾害急救危重病医学学术会议暨创伤脓毒症、中毒救治新进展推广学习班。会议由中国中西医结合学会主办，委托辽宁省大连市大连大学附属中山医院承办。     

高速公路交通事故伤中颅脑损伤伤员的救治体会

随着高速公路的发展，高速公路交通事故也日益增多。颅脑损伤在高速公路交通事故创伤中占有较大比重犤１犦。我院为沪－杭－甬高速公路杭州段交通事故急救单位，现将我院救治的神经外科伤员的特点和救治体会报告如下。资料和方法１．我院自１９９８．８～２００１．３共接诊伤员４４０例，除现场死亡３４例外，神经外科住院病人３５例。２．３５例神经外科病人中，男３１例，女４例，男女之比为７．７５：１，年龄２１～７８岁，≤４５岁２９例，占８５．３％。轻型颅脑损伤（GCS１３～１５分）２３例，占６５．７％，其中头皮撕裂伤１１…     

地区交通事故伤流行病学特点和调查研究

目的 探讨丽水市辖区道路交通事故伤的主要特征和发生规律,为区域性事故预防和控制以及救治研究奠定基础.方法 回顾性统计分析丽水市2008至2011年,交通管理部门及120急救中心的事故登记信息,研究丽水市公路交通伤的特点及分布规律.结果 2008至2011年,丽水市共发生交通事故4620起,死亡1101人,受伤4936人;月均事故发生为96起,其中1月、2月、11月和12月事故高发;每周六发生事故次数最多,周三最低;中午12点至下午3点,下午5点至晚9点两个时段死亡事故最为多发,晚11点至凌晨3点最低;受伤人员中,男女之比为2.69:1,年龄段以18～50岁所占比例最大(63%),损伤部位以四肢所占比例最大(52.7%),颅脑外伤次之(23.5%);不同年龄段、不同性别、不同地域、不同的交通方式交通事故发生率不同.结论 预防交通事故应针对不同人群、不同地域、不同时段和不同交通方式,采用不同的管理方法 和措施,制定相应的交通管理政策和急救流程.     

道路交通伤研究进展

目前全球每年因车祸死亡的人数已超过100万,伤1500万。道路交通伤的发生有不断增多趋势,且死伤者以青少年居多,多发伤居多。事故原因主要为人的因素,24岁以下年轻人与70岁以上老年人多发,有一定的事故倾向。粘性标准可作为最有效的伤情指数。综合治理,加强交通安全的研究、管理与教育,健全医疗服务系统,加强创伤急救,缩短急救反应时间是减少交通事故、降低死亡率的必要措施。     

Motorcycle accidents in China

Objective： To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005.
Methods： We collected data on possession of motor- cycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package.
Results： During 6 years, the number of motorcycle accidents were up to 122 300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26 200 deaths and 157 500 injuries in 2005. The mortality per 10 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles （P〈0.01）.
Conclusions： China has attached great importance to the management of traffic safety, which is beneficial to con- trol and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.     

Trauma care systems in Japan

The trauma care system in Japan was set up in the 1960s in response to social problems caused by traffic accidents and has since been altered extensively. First-aid and patient transfer are performed by emergency personnel belonging to a fire station. Instead of 'western-style trauma centres', three types of facilities exist: (1) primary emergency care facilities for treating mild cases not requiring hospitalisation; (2) secondary emergency hospitals directed to treating moderately severe disease or injury; (3) tertiary emergency hospitals corresponding to the emergency departments of university hospitals, or lifesaving emergency centres, able to manage the most severe cases such as myocardial infarction, cerebrovascular accident and polytrauma. Although the quantity of emergency facilities and hospitals appears sufficient, the quality of emergency care needs to be improved. This could be accomplished by the unification of small hospitals to create larger hospitals, and/or by the establishment of trauma centres, as well as by improvements in relevant education and training.     

Road crash in China from 2003 to 2005

Objective： To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.
Methods： The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.
Results： From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100 000 persons and per 10 000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450 000 and deaths to 99 000, with the mortality rate per 10 000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2 % and 26.6 % of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.
Conclusions. At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.     

Pilot study of injured patients seen in the University of Port Harcourt Teaching Hospital, Nigeria

A 12-month pilot study of injured patients seen in the Emergency Department of the University of Port Harcourt Teaching Hospital was carried out. Trauma (28.8 per cent) was the main reason for emergency visits; 82.1 per cent of the patients were under 31 years of age. Domestic accidents were the commonest cause of trauma (42.5 per cent), followed by criminally motivated injuries (30.4 per cent), road traffic accidents (26.0 per cent), industrial (0.5 per cent) and other accidents (0.6 per cent). The overall mortality rate due to trauma was 5.4 per cent and within the period of study, trauma was the most common cause of deaths in hospital (10.1 per cent). Road traffic accidents were responsible for 67.9 per cent of these deaths, followed by criminally motivated injuries (16.1 per cent). Domestic, industrial and boat accidents caused 7.6 per cent, 5.4 per cent and 3.1 per cent deaths, respectively. Injury Severity Scores (ISS) among 419 patients showed a 100 per cent mortality for those with scores above 35. There were 48 prehospital, 19 emergency room and 14 in-hospital deaths among patients with an ISS below 35. The deaths resulted largely from delayed transportation of victims to the hospital and partly from inadequate emergency medical services. To reduce the current high rate of preventable deaths from injury, we recommend (i) ambulance services for early transportation of victims to the hospital and (ii) improved emergency medical care.     

Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran

Objective： To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran.
Methods： In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period （2006 and 2007） and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization.
Results： There were 202 males （80.5%） and 49 females （19.5%）. The mean （＋SD） age of fatalities was 34.1 （＋21.5） years. Pedestrian-vehicle accidents were the most common cause of trauma （100 cases, 39.8%）. The most common cause of death was central nervous system injury （146 cases, 58.1%）. The other causes were skull base fractures （10%）, internalbleeding （8%）, lower limb hemorrhage （8%）, skull vault fractures （4%）, cervical spinal cord injury （3.6%）, airway compromise （3.2%）, and multifactor cases （5.1%）, respectively. Thirty-six fatal injuries in 30 victims （12%） mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head （72.2%） and cervical spine （13.8%） regions were the two most common sites for undi- agnosed injuries.
Conclusion： Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.     

Management of simple thoracic injuries at a level I trauma centre: can primary health care system take over?

BACKGROUND: Overtriage is a problem for all trauma systems, including the Greek emergency system. In this study we examined the performance of the primary care emergency system in the treatment of patients with simple thoracic injuries, in the area of a Level I hospital. Our aim was to form organizational proposals and treatment and referral guidelines in an effort to improve the system's performance. METHODS: We reviewed the notes of 488 patients with a thoracic injury as their main complaint, seen and immediately discharged from the A+E department of a Level I hospital. RESULTS: Falls and road traffic accidents were the most common mechanisms of injury. The majority of the injuries were rib fractures or rib cage contusions. Many patients sought medical advice several days after the injury. Fifteen patients required conservative treatment for orthopaedic injuries. Clinical examination, X-rays and abdominal ultrasound were the most useful tests. CONCLUSIONS: Detailed clinical examination, time from injury and a chest X-ray usually identifies the patients who can safely be treated in primary health care facilities. Simple radiology services (X-ray and US) and training of general practitioners in basic emergency care principals in primary care health centres would reduce the number of referred patients with simple thoracic injuries.     

四肢脊柱交通伤的救治

四肢和脊柱是交通伤中最常见的致伤部位之一。交通伤的院前救治是我国交通伤救治中最薄弱的环节,为此,应该逐步增设院前急救网点,建立院前-院内一体化创伤救治服务体系,加强院前急救员的培养训练工作。在四肢脊柱交通伤的救治中,首先应抢救危及生命的严重创伤,但同时也要兼顾骨折的及时处理。详细了解致伤机制和全面查体是防止交通伤漏诊的重要方法。在四肢交通伤骨折的救治中,特别是对多发伤伤员的急救,外固定器技术具有明显的优越性。带锁髓内钉技术治疗四肢长管状骨骨折也可取得满意疗效。骨盆骨折的早期可采用外固定器稳定骨折,同时采用髂内动脉栓塞等技术积极处理骨盆骨折所导致的大出血。在脊柱交通伤的治疗中,应考虑到脊柱的稳定性和迟发性截瘫等因素,适当确定手术适应证。椎管环形减压术可充分地解除对脊髓的压迫。颈椎骨折常可采用颈椎前路钢板螺钉固定颈椎融合手术。胸腰椎骨折脱位可实施经椎弓根后路短节段内固定手术治疗。     

Injury and pre-hospital trauma care in Hanoi, Vietnam

BACKGROUND: In Vietnam, injury is the leading cause of death in children under 18, and road traffic accidents are the fifth leading cause of death. Information systems for pre-hospital trauma care are insufficient. OBJECTIVES: The objective of this study was to assess injury morbidity and mortality, and the existing level of pre-hospital trauma care in Hanoi city. RESEARCH DESIGN AND SUBJECTS: A cross-sectional study was conducted in seven districts in Hanoi in 2006. We studied 2800 households (11,334 members), 9 hospitals and an emergency service centre. RESULTS: The injury morbidity rate was 1134/100,000 (year(-1)), and the injury mortality rate was 23.7/100,000 (year(-1)). There was no significant difference in age or sex between injury severity levels (p>0.05). Road traffic accidents were the leading cause of injury. Causes of injury mortality differed among different age groups. Only 4% of injured cases were transported to hospital by ambulance. Fifty-two percent of victims did not receive first aid at the site. Pre-hospital trauma care was separately provided by the emergency service centre and hospitals. There was no communication network between the emergency service centre and hospitals, ambulances and hospitals, or between different hospitals. CONCLUSIONS: The results reveal that injury is a major health problem in Hanoi and that the pre-hospital care system lacks both coordination and many vital components. Study results may assist decision-makers in identifying interventions to improve health and safety for the population of Hanoi.     

Weißbuch Schwerverletztenversorgung der DGU

The white paper published by the German Society for Trauma Surgery in 2006 on the treatment of serious injuries calls for the nationwide establishment of regional trauma networks and the certification of national and regional trauma centres, as well as centres for the basic care of seriously injured persons. The hospitals involved are to be provided with precise requirements regarding qualifications of the round-the-clock personnel, the management, as well as regarding equipment. A national trauma centre must commit itself to taking in seriously injured patients at any time, as well as being able to treat two seriously injured patients simultaneously. Also, the management level of basic care centres should comprise a specialist physician with additional qualifications in trauma surgery, and the centre should provide a 24-h emergency service for the emergency treatment of seriously injured patients. Appropriate treatment of the 8.5 million accidents occurring annually in Germany and causing injuries which require treatment is an important issue from an economic point of view. Of the total cost of treating a seriously injured person of 500,000 EUR, the rescue and hospital costs total only 6.9%, but are relevant for the follow-up costs. Thus, any investments in this regard also make economic sense.