Application of triage in medical transport of critically wounded persons after Indonesian tsunami
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Objective To study the role of triage in medical transport of critically wounded persons after earthquake and tsunami disaster.Methods In the medical relief of earthquake and tsunami disaster occurred in Aceh of Indonesia,triage was carried out to screen the critically wounded persons.After the critical wounded persons were transported to the Aceh Airport with helicopters,medical workers from Multi-national Joint Transport Center provided emergency medical service and decided the transport priority according to the triage in Aceh Airport.Results A total of 217 wounded persons were evacuated to the respective medical institutions after brief triage and rapid treatment.Conclusion Triage can make full use of limited medical resources in treatment of critically wounded persons.Keywords:
Triage
Disaster Medicine
Medical evacuation
Medical treatment
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Mass casualty incident (MCI) triage and the use of triage tags to assign treatment priorities are not fully implemented despite emergency medical services (EMS) personnel training during drills and exercises.To compare current field triage practices during both training and actual MCIs and identify any potential barriers to use.During training sessions from November 2015 through March 2016, an anonymous survey was distributed to personnel in 3 distinct types of paid full-time EMS systems: Boston EMS (2-tiered, municipal third-service); Portland Fire Department (fire department-based ALS); and Stokes County EMS (county-based ALS) combined with Forsyth County EMS (county-based ALS). Data included personnel demographics and previous participation experiences in both drill and actual MCIs. Personnel with any prior MCI experience were queried regarding triage tag use and type of algorithm used. Data on barriers to use of triage tags and methods of communication of patient information were also collected. Descriptive statistics were used to analyze responses.Overall survey participation rate was 77.9% (464/596). Among all respondents, 38.7% (179/464) reported participating in both a drill and actual MCI's. In these cases, respondents reported less likely use of triage tags during actual MCI's compared to drills, (34.1 vs. 91.8%, p < 0.01), less likely to complete full triage (16.3 vs. 68.7%, p < 0.01) and less likely to employ geographical triage (56.8 vs. 90.4% p < 0.01). Verbal report was the most common communication method to hospitals (93.1%) when triage tags were not used. Responders reported proximity to the hospital as the most common reason for not using triage tags during an actual MCI (29.5%).Despite being a fundamental skill in MCI response, triage and other standard practices have not always been utilized in actual events despite training. EMS educators and disaster planners should consider strategies to better incorporate MCI practices during real world events.
Triage
Mass-casualty incident
Demographics
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There were great conflicts between medical demands on the one hand and the capacity of the health service provision in the first week of rescue after the Wenchuan Earthquake occurred on the other.It hence reveals the shortage of the triage in the emergency medical system of China.Some studies have noticed the problem,but most of them have focused on discussing the technology of triage.The present paper argues that the management problems of triage are even more serious.It firstly analyses the principles of triage in different emergency situations,and then discusses how to improve the implementation of triage during emergencies through the system construction in Chinese emergency management institutions.
Triage
Economic shortage
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Objective To systematically summarize the experience and lessons of emergency medical rescue during the Wenchuan earthquake and to explore the establishment of regional disaster medical rescue system.Methods In this study,various statistical data,information,special reporting,and assessment reports of Wenchuan earthquake were collected and analyzed by descriptive method.Results(1) Health care institutions were hit hardly in Wenchuan earthquake disaster area.(2) Medical teams for emergency rescue rapidly assembled in the disaster area.(3) It was 72 hours after the earthquake that the emergency rescue reached its peak.(4) Totally 91 177 persons were treated in the hospitals.A large cohort of patients was transferred to other provinces for the treatment.The critically wounded were admitted together for the treatment.Conclusion The base for regional disaster medical emergency and ruotine emergency medical operation and management mechanism should be established.The information command and control platform should be improved.Medical resources should be scientifically and rationally allocated.Different types of emergency medical teams and response mechanisms should be established,which can provide professional emergency medical rescue in other areas.
Disaster Medicine
Disaster area
Emergency rescue
Medical record
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To summarize and analyze the medical mission of China National Earthquake Disaster Emergency Search and Rescue Team (CNESAR) in Lushan earthquake, to promote the medical rescue effectiveness incorporated with search and rescue.Retrospective analysis of medical work data by CNESAR from April 21th, 2013 to April 27th during Lushan earthquake rescue, including the medical staff dispatch and the wounded case been treated.The reasonable medical corps was composed by 22 members, including 2 administrators, 11 doctors [covering emergency medicine, orthopedics (joints and limbs, spinal), obstetrics and gynecology, gastroenterology, cardiology, ophthalmology, anesthesiology, medical rescue, health epidemic prevention, clinical laboratory of 11 specialties], 1 ultrasound technician, 5 nurses, 1 pharmacist, 1 medical instrument engineer and 1 office worker for propaganda. There were two members having psychological consultants qualifications. The medical work were carried out in seven aspects, including medical care assurance for the CNESAR members, first aid cooperation with search and rescue on site, clinical work in refugees' camp, medical round service for scattered village people, evacuation for the wounded, mental intervention, and the sanitary and anti-epidemic work. The medical work covered 24 small towns, and medical staff established 3 medical clinics at Taiping Town, Shuangshi Town of Lushan County and Baoxing County. Medical rescue, mental intervention for the old and kids, and sanitary and anti-epidemic were performed at the above sites. The medical corps had successful evacuated 2 severe wounded patients and treated the wounded over thousands. Most of the wounded were soft tissue injuries, external injury, respiratory tract infections, diarrhea, and heat stroke.Compared with the rescue action in 2008 Wenchuan earthquake, the aggregation and departure of rescue team in Lushan earthquake, the traffic control order in disaster area, the self-aid and buddy aid are better, which give rise to the casualties to the lowest. The medical mission incorporated with search and rescue work showed that the medical performance manner altered with stages, the medical staff match changed with the mission, and the focus related with rescue time.
Disaster Medicine
Relief Work
Search and rescue
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During the medical rescue of Wenchuan earthquake, the Nursing Department of West China Hospital of Sichuan University immediately initiated the emergency response plan, reasonably dispatched nurses of the medical teams from West China Hospital, other provinces and foreign countries. Meanwhile, the Nursing Department set up the medical team for emergency treatment, provided the basic information of the wounded, established the flow of rapid registration and rapid preview, formulated and optimized the flow of the admission of the wounded, and improved the flow of information-collecting. What’s more, the nursing department adjusted the current work according to the situation of hospitalization of the wounded in different stages to ensure the efficient running of medical rescue. Moreover, the routine nursing practice was also maintained and none of the inpatients other than those from the disaster area got involved in any unexpected accident.
Work flow
Emergency rescue
Nursing management
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Objective To report 5 grave disaster events in Henan Province and the management of emergency medical rescue. Methods Reported to supervises and emergency medical rescue center immediately when disaster events happened. Policemen,firefighters and docters cooperated,preserved information and road unobstructed,first aid at scene and transferred the wounded to the hospitals promptly. Emergency medical specialists of Henan Public Health went to the hospitals speedly and gave guidelines for the emergency operation and intensive care for the patients. Results 259 persons died,181 wounded were sent to the hospitals,including 26 serious wounded,in 5 grave disaster events. 2 cases died of multiple organ failure,the other discharged with recovered. Conclusion Policemen,firefighters,docters and others need cooperation during emergency rescue for grave disaster event. Emergency medical specialist gives guidelines for the emergency operation and intensive care may increase successful rescue rate.
Disaster Medicine
Emergency rescue
First aid
Medical care
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Twenty-eight hours after the Wenchuan earthquake, the first disaster medical assistant team organized by the Ministry of Health arrived at the disastrous area of Mianyang, as the first medical assistant team from outside Provinces that reached the most severe disaster area. After visiting Beichuan and Anxian counties, it was decided that an emergency medical rescue command center be set up in Mianyang to coordinate the work of different relevant medical institutions, and an emergency medical assistance system was rapidly established. The health risks were identified. Operating rooms in hospitals were recovered to perform the major operations on cranial trauma, multiple fractures of extremities, sever thoracic inquiry, multiple organ injuries, severe crush injuries, etc. The objectives of good somatic and mental health of the disaster victims and no epidemic after the disaster were set. Attention was paid to the quality of life, quality of well being, and quality of work-life should be raised. Identification and classification of trauma was conducted 3 times, thus guaranteeing the quality of treatment, life safety, and effective allocation of medical resources, and management. Part of the sick and wounded was transferred to other cities in China via different vehicles. Due to timely and strong measures tetanus and gas gangrene were controlled.
Christian ministry
Disaster area
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Objective To approach the management of organization of urgent rescue to wounded personnel in front line hospital in great disaster.Methods The date of wounded personnel after earthquake disaster in Central Hospital of Mianyang was analyzed.Results The task of emergency treatment to wounded personnel in Wenchuan earthquake was progressed successfully by switch on the project of stringency and utilization all kinds of resources.Conclusion It was important to ensure wounded personnel remedied in Makro-disaster by switch on the project of stringency,effective management of organization and coordinate of society and government.
Front line
Disaster area
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Objective To analyse the emergency medical evacuation for critically wounded and sick people after major natural disasters,raise evacuation capacity and reduce mortality and morbidity.Methods The information of emergency medical evacuation of critical casualty during Yushu earthquake and Zhouqu debris flow disaster in Lanzhou General Hospital of Lanzhou Military Area Command was analysed in order to learn lessons.Results All the wounded were taken to their destinations safely to ensure the effective treatment.Conclusion The tight organization,the complete preparation of evacuation equipment and strict management are the key to ensure emergency medical evacuations to success.
Medical evacuation
Emergency Evacuation
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Many years ago,a wartime emergency air transfer medical team had been established in the PLA No 425 Hospital. This team played an important role during Wenchuan earthquake since all the roads leading to the earthquake-stricken areas were broken off. The composition of personnel of the team,35 persons,aged 23～45,all with the educational level of or over college education,was rational with the physician/ nurses ratio of 1.5:1. Two helicopters transported 3 medical rescue teams ,medicaments,and medical equipments o Yingxiu Town,the epicenter and a seriously affected place,and carried out 283 wounded persons. Rapid triage was conducted in the first time. Each helicopter transferred 5～8 wounded persons in one time with the ratio of patient/medical worker of 2:1 and the physician/nurse ratio of 1:1. Military telephone,maritime satellite telephone service,and airdropping of personnel remedied the deficit of communication. Military helicopters transport a great amount of necessary materials. However,the experience in this disaster relief action shows that emergency disaster relief plan lacks. Only after the earthquake a temporary disaster relief forward command post of Chengdu Military Area was established. The military and local did things in their own ways. It is necessary to establish a comprehensive emergency management system+systems of emergency management systems of different specialties. Both the military and local departments should develop their disaster relief emergency plans and strengthen training for specialized rescue personnel.
Triage
Action plan
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