汶川地震2周2283例急诊伤员分检方案的总结与探讨
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摘要
目的回顾性分析四川大学华西医院在汶川地震后采取非常规方法(传统分检方法结合灾害救援的特点)分检伤员的效果,为建立大型灾害事件伤员分检处理流程,及时合理配置医疗资源,提高医疗救援水平提供参考。方法以华西医院在震后两周内接诊的所有地震伤员的诊疗信息数据为基础,对伤员伤情严重程度和所需医疗干预的迫切程度进行分检。结果按伤情严重程度和所需医疗干预的迫切程度对伤员进行分检,使危重伤员得到了及时处理,一般伤员得到了足够重视,轻伤员被及时分流,从而充分合理地利用了医疗资源,使各类伤员都得到了最恰当的处理。结论重大灾害事件发生后,伤员分检方法的选择要因地制宜,不应局限于传统的分检方法。采用灾害救援伤员分检方式分检地震后大批伤员,可使重伤员不延误病情,轻伤员不浪费医疗资源,使有限的医疗资源得到充分合理地利用。
Objective To discuss the mode of triage patient in Emergency Department of West China Hospital of Sichuan University after the Wenchuan earthquake and the major experience during the process. Method The patients' severity level of injury and waiting time for medical care in Emergency Department were analyzed after earthquake in 2 weeks. Result 375 patients were triaged into the severity level and get the treatment followed the triage systems gave the highest rate of survival and lowest rate of over triage and under triage. Conclusion In the calamity of Wenchuan earthquake with large number of casualties, Emergency Department automatically shifted into disaster mode and triage victims by the irregular triage systems. In this situation, medical staff do not just triage the patients to the Emergency Department or to see a doctor, but triage the victims to the medical care immediately and efficiently. By the new triage system, the West China Hospital saves more lives in less time.
Objective To discuss the mode of triage patient in Emergency Department of West China Hospital of Sichuan University after the Wenchuan earthquake and the major experience during the process. Method The patients' severity level of injury and waiting time for medical care in Emergency Department were analyzed after earthquake in 2 weeks. Result 375 patients were triaged into the severity level and get the treatment followed the triage systems gave the highest rate of survival and lowest rate of over triage and under triage. Conclusion In the calamity of Wenchuan earthquake with large number of casualties, Emergency Department automatically shifted into disaster mode and triage victims by the irregular triage systems. In this situation, medical staff do not just triage the patients to the Emergency Department or to see a doctor, but triage the victims to the medical care immediately and efficiently. By the new triage system, the West China Hospital saves more lives in less time.
引文
1Milzman DP,Boulanger BR,Rodriguez A,et al.Pre-existing disease in trauma patients:A predictor of fate independent of age and ISS.J Trauma,1992,32(2):236-243.
2Champion HR,Sacco WJ,Hannan DS,et al.Assessment of injury severity:The triage index.Crit Care Med,1980,8(4):201-208.
3Winkler JV,Rosen P,Alfry EJ.Prehospital use of the Glasgow Coma Scale in severe head injury.J Emerg Med,1984,2(1):1-6.
4Meredith W,Rutledge R,Hansen AR,et al.Field triage of patients based upon the availability to follow commands:A study in29,573patients.J Trauma,1995,38(1):129-135.
5Kirkpatrick JR,Youmans RL.Trauma index:An aide in evaluation of injury victims.J Trauma,1971,11(8):711-714.
6Yoshimura N,Nakayama S,Nakagiri K,et al.Profile of chest injuries arising from the1995Southern Hyogo Prefecture earthquake.Chest,1996,110(3):759-761.
7Bywaters EGL,Beal D.Crush injuries and renal function.Br Med J,1941,1:427-434.
8Collins AJ,Burzstein S.Renal failure in disasters.Crit Care Clin,1991,7(2):421-435.
9Osler T,Hales K,Baack B,et al.Trauma in the elderly.Am J Surg,1988,156(6):537-543.
10Morris JA,MacKenzie EJ,Edelstein S.The effect of pre-existing conditions on mortality in trauma patients.JAMA,1990,263(14):1942-1945.
11Sacco WJ,Copes WS,Bain Jr LW,et al.Effect of preinjury illness on trauma patient survival outcome.J Trauma,1993,35(4):538-542.
12Emerman CL,Shade B,Kubincanek J.A comparison of EMT judgment and prehospital trauma triage instruments.J Trauma,1991,31(10):1369-1375.
13Ornato J,Milnek EJ,Craren EF,et al.Ineffectiveness of the Trauma Score and the CRAMS Scale for accurately triaging patients to trauma centers.Ann Emerg Med,1985,14(11):1061-1064.
14Benson M,Koenig KL,Schultz CH.Disaster triage:START,then SAVE:a new method of dynamic triage for victims of a catastrophic earthquake.Prehosp Disaster Med(in press).
2Champion HR,Sacco WJ,Hannan DS,et al.Assessment of injury severity:The triage index.Crit Care Med,1980,8(4):201-208.
3Winkler JV,Rosen P,Alfry EJ.Prehospital use of the Glasgow Coma Scale in severe head injury.J Emerg Med,1984,2(1):1-6.
4Meredith W,Rutledge R,Hansen AR,et al.Field triage of patients based upon the availability to follow commands:A study in29,573patients.J Trauma,1995,38(1):129-135.
5Kirkpatrick JR,Youmans RL.Trauma index:An aide in evaluation of injury victims.J Trauma,1971,11(8):711-714.
6Yoshimura N,Nakayama S,Nakagiri K,et al.Profile of chest injuries arising from the1995Southern Hyogo Prefecture earthquake.Chest,1996,110(3):759-761.
7Bywaters EGL,Beal D.Crush injuries and renal function.Br Med J,1941,1:427-434.
8Collins AJ,Burzstein S.Renal failure in disasters.Crit Care Clin,1991,7(2):421-435.
9Osler T,Hales K,Baack B,et al.Trauma in the elderly.Am J Surg,1988,156(6):537-543.
10Morris JA,MacKenzie EJ,Edelstein S.The effect of pre-existing conditions on mortality in trauma patients.JAMA,1990,263(14):1942-1945.
11Sacco WJ,Copes WS,Bain Jr LW,et al.Effect of preinjury illness on trauma patient survival outcome.J Trauma,1993,35(4):538-542.
12Emerman CL,Shade B,Kubincanek J.A comparison of EMT judgment and prehospital trauma triage instruments.J Trauma,1991,31(10):1369-1375.
13Ornato J,Milnek EJ,Craren EF,et al.Ineffectiveness of the Trauma Score and the CRAMS Scale for accurately triaging patients to trauma centers.Ann Emerg Med,1985,14(11):1061-1064.
14Benson M,Koenig KL,Schultz CH.Disaster triage:START,then SAVE:a new method of dynamic triage for victims of a catastrophic earthquake.Prehosp Disaster Med(in press).
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