Major incidents

A major incident is one that causes casualties on a scale beyond the usual capabilities of the emergency and healthcare services usual ability to manage. Major incident planning and rehearsal is vital to ensuring an appropriate response. Delivery of a major incident response requires command and co-ordination within and between emergency services, hospitals and specialist charitable organizations. Casualty management will require the set up of major incident infrastructure on scene to effectively extricate, triage, treat and transport casualties to appropriate facilities. There is a role for specialist doctors within the pre-hospital phase of managing a major incident, either within the ambulance command structure or operationally. Debrief and reviewing previous major incidents may identify individual, local and systemic factors that could be altered to improve the response to a future incident.     

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.     

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。     

The “Scandinavian Star” ferry disaster 1990 -a challenge to forensic odontology

Summary With 158 victims, the fire on board the Scandinavian Star was one of the world's worst ferry disasters. A team of identification experts, including dentists, were employed to secure evidence for identification and to remove the victims from the ferry. Four parallel teams, each with 2 dentists, examined and autopsied the victims at the Institute of Forensic Medicine, University of Oslo. Using the INTERPOL Disaster Victim Identification forms and aided by computers, all victims were identified within 17 days. Dental identity could be established in 107 cases (68%).     

REBOA by a non-surgeon as an adjunct during MASCAL

Use of Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of non-compressible hemorrhage is a re-emerging technology that historically is employed by surgeons. We present a case in which REBOA was successfully placed by an emergency physician in a critical mass casualty patient awaiting transfer to the operating table. This case is an example in which emergency physicians, in collaboration with the surgeon, can utilize REBOA to temporize non-compressible hemorrhage when a surgeon is not immediately available.