基于马尔可夫链的水面舰艇作战减员评估

本文通过分析舰艇被多次命中的特点,对水面舰艇承受打击的能力进行量化,建立了合理的命中概率数学模型;将随机过程中的马尔可夫链应用于舰艇被多次命中的减员评估,并通过示例计算出舰艇被多次命中下的减员状况,取得了较好的效果,为水面舰艇作战减员评估提供了一种有效方法。     

The breakdown of an emergency system following a gas explosion in Osaka and the subsequent resolution of problems

Osaka, a modern urban metropolis in Japan, experienced a tragic gas explosion in 1970 when the dispatch room of the City Fire Department was in the process of being moved to a new building. Many unforseen problems arose during this disaster: eg, there was an overall lack of leadership, confusion of communication, a need for triage, and lack of control of mass media. The Osaka Medical Association organized a committee to resolve these problems. Their conclusions and recommendations were that a control headquarters be established at the scene of disaster, the number of ambulances and EMTs be increased, disaster tags be utilized, a special radio frequency be created, and a computer-aided command and control system for fire fighting and ambulance services be introduced. These recommendations have all been followed.     

海勤人员战伤救护知识培训现状调查

目的 了解海勤人员战伤救护知识培训现状,为进一步系统有效地开展培训提供依据.方法 根据海勤人员的工作环境、战备训练及现代海战伤救治特点和规律自行设计问卷,对潜艇艇员、潜水员共计217人进行调杳.结果 特殊伤现场救护和心理应激渊适培训在潜艇艇员和潜水员之间差异有统计学意义(P<0.05).特殊武器伤现场救护培训内容中的生物武器伤和化学武器伤救护知识的培训,在潜艇艇员和潜水员之间差异无统计学意义(P>0.05);对核武器伤和新概念武器伤救护知识的培训,在潜艇艇员和潜水员之间差异有统计学意义(P<0.05).结论 战伤救护知识的培洲已在海勤部队开展,自救瓦救6项技术培训较好,新概念武器伤和特殊伤救护知识的培训开展较差.心理应激调适知识培训欠缺.     

Analgesic use in contemporary burn practice: Applications to burn mass casualty incident planning

BackgroundDetermining the amount of analgesics required will help burn centers improve their ability to plan for a burn mass casualty incident (BMCI). We sought to quantify the amount of analgesics needed in an inpatient burn population. We hoped that assessing the analgesic use in daily burn care practice will potentially help estimate opioid needs in a burn mass casualty incident (BMCI).MethodsWe included patients with burns covering equal to or less than 30% total body surface area (TBSA), admitted from spring 2013 to spring 2015. Patient records were reviewed for analgesics and adjuncts, pain scores, age and TBSA. The doses of the different opioids administered were converted into morphine equivalent doses (MED).ResultsWe enrolled 141 acute burn survivors with a mean TBSA of 8.2 ± 0.6%. The lowest daily average MED per person was 24.6 ± 2.0 mg MED, recorded on the day of injury. The daily average MED per person increased until it peaked at 52.5 ± 5.6 mg MED at day 8 post-burn. Then, it declined to 24.6 ± 3.4 mg MED by day 14. Bivariate regression analysis of average MED by TBSA showed a significant positive correlation (p < 0.001). The analysis of average MED by age showed a significant negative correlation (p < 0001).ConclusionOur study quantified opioid requirements in an inpatient burn population and identified TBSA (positively) and age (negatively) as significant predictors.     

The Halifax Explosion a century later: Lessons for our time

A brief historical account of the Halifax Explosion, one of North America's greatest mass urban trauma casualty events of the 20th century. This disaster, in Halifax, Nova Scotia, was the result of the cataclysmic explosion of a fully loaded World War I munitions ship on the densely waterfront of that city, resulting in nearly 2000 fatalities and 9000 injured. It remains a case study in response to disasters which overwhelm local medical capabilities.     

A systematic literature review of criteria and models for casualty distribution in trauma related mass casualty incidents

IntroductionMass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities.ObjectiveTo review models and criteria affecting the distribution of casualties during the trauma-related mass causality incidents.Materials and methodsA systematic literature search in the scientific databases which included: PubMed, Scopus and Web of Science was conducted. Relevant literature which was published before August 2017 was searched. Neither the publication date nor language limitations were considered in the literature search. All the trauma-related mass casualty incidents are included in this study. Two independent reviewers conducted the data extraction and quality assessment of the documents was considered using a checklist developed by the researchers.ResultsLiterature search yielded 4540 documents of which 493 were duplicated and removed. After reviewing the titles and abstracts of the remaining documents (4047), only 73 documents were considered relevant. Finally, the inclusion and exclusion criteria were applied and only 30 documents were considered for data extraction and quality assessment. The study found 491 criteria to be affecting the distribution of casualties following trauma-related mass casualty incidents. These are categorized as pre-hospital (triage, treatment and transport); hospital (space, staff, stuff, system / structure); incidents’ characteristics and others. The criteria which were extracted from the models are termed as “model extracted” while the other labeled as “author suggested”.ConclusionTo the best of our knowledge, this is the first systematic literature review on criteria affecting distribution of casualties following trauma-related mass casualty incidents based on the pre-hospital and hospital capacities.Systematic review registration numberThis review was registered in international prospective register of systematic reviews (PROSPERO) with registration number CRD42016049115.     

Precise Formulation and Evidence-based Application of Resource-constrained Triage

Objectives: To develop a precise mathematical formulation of resource‐constrained triage, denoted the Sacco triage method (STM), to develop an evidence‐based application to blunt trauma, and to compare the STM with the simple triage and rapid treatment (START) method. Methods: Resource‐constrained triage is modeled mathematically as a classic resource allocation problem. The objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time‐dependent victim survival probabilities based on an initial assessment and expected deterioration. For application to blunt trauma, an “RPM” score, based on r espiratory rate, p ulse rate, and m otor response, was used to predict survivability. Logistic function‐generated survival probability estimates for scene values of RPM were determined from 76,459 blunt‐injured patients from the Pennsylvania Trauma Outcome Study (PTOS). The Delphi method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. STM was compared with START across various criteria of process and outcome. Outcome was measured by expected number of survivors in simulated resource‐constrained casualty incidents. Results: In this mathematical simulation, RPM was a more accurate predictor of survivability from blunt trauma than the Injury Severity Score and the Revised Trauma Score, as measured by calibration and discrimination statistics. STM resulted in greater expected survivorship than START in all simulations. Conclusions: Resource‐constrained triage is modeled precisely as an evidence‐based, outcome‐driven method that maximizes expected survivors in consideration of resources. The lifesaving potential and operational advantages over current methods warrant scrutiny and further research.     

基于战术战伤救治的野战救护实践教学模式在护理本科生《野战护理学》课程中的应用

目的探讨基于战术战伤救治的野战救护实践教学模式在护理本科生《野战护理学》课程中的应用效果。方法便利抽样法选取第二军医大学2012级41名护理本科生为研究对象,在前3次理论课中融入战术战伤救治(tactical combat casualty care,TCCC)理论精华,在后2次实践课中利用动物组织、仿真模拟人、标准化伤员模拟战伤和大规模伤亡,分别开展TCCC关键救护技术实战化训练和野战救护综合模拟演练。演练后对学生进行问卷调查,了解其自我感知变化和对教学质量的评价。结果护生对战创伤救护知识、能力和态度的自我感知均实现了积极的显著性提升,一致认为此次教学改革是一种创新的实践教学模式。结论基于TCCC的野战救护实践教学改革取得了较好效果,今后还需不断贴近战场实际,更新救治理念,完善训练模式,进一步提高训练效果。     

Simulation technology for resuscitation training: A systematic review and meta-analysis

Objectives

To summarize current available data on simulation-based training in resuscitation for health care professionals.

Data sources

MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and reference lists of published reviews.

Study selection

Published studies of any language or date that enrolled health professions’ learners to investigate the use of technology-enhanced simulation to teach resuscitation in comparison with no intervention or alternative training.

Data extraction

Data were abstracted in duplicate. We identified themes examining different approaches to curriculum design. We pooled results using random effects meta-analysis.

Data synthesis

182 studies were identified involving 16,636 participants. Overall, simulation-based training of resuscitation skills, in comparison to no intervention, appears effective regardless of assessed outcome, level of learner, study design, or specific task trained. In comparison to no intervention, simulation training improved outcomes of knowledge (Hedges’ g) 1.05 (95% confidence interval, 0.81–1.29), process skill 1.13 (0.99–1.27), product skill 1.92 (1.26–2.60), time skill 1.77 (1.13–2.42) and patient outcomes 0.26 (0.047–0.48). In comparison with non-simulation intervention, learner satisfaction 0.79 (0.27–1.31) and process skill 0.35 (0.12–0.59) outcomes favored simulation. Studies investigating how to optimize simulation training found higher process skill outcomes in courses employing “booster” practice 0.13 (0.03–0.22), team/group dynamics 0.51 (0.06–0.97), distraction 1.76 (1.02–2.50) and integrated feedback 0.49 (0.17–0.80) compared to courses without these features. Most analyses reflected high between-study inconsistency (I² values >50%).

Conclusions

Simulation-based training for resuscitation is highly effective. Design features of “booster” practice, team/group dynamics, distraction and integrated feedback improve effectiveness.     

美军战伤救治院前急救新理念

本文通过梳理总结美军伊拉克和阿富汗战争院前急救的经验教训,从院前伤员信息记录模式、液体复苏理念、战场出血控制策略、"战术后送"概念四个方面,综合分析美军院前急救的新理念和策略。