Acciones para implementar la recepción masiva de intoxicados en los hospitales durante las emergencias químicas / Actions to implement mass reception of intoxicated people in hospitals during chemical emergencies

Introducción: El sistema de recepción masiva de intoxicados en los hospitales, durante las emergencias químicas, tributa a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres, pero necesita de su implementación en la práctica. Objetivo: Elaborar una secuencia de acciones que permita implementar el sistema de recepción masiva de intoxicados en los hospitales en situaciones de emergencias químicas. Método: Se revisaron y analizaron fuentes bibliográficas entre 2005 y 2017. Se realizaron consultas individuales a personas vinculadas al tema, que permitieron la primera aproximación. Se empleó el criterio de expertos sobre la utilidad y viabilidad para la validación de los resultados. Resultados: Se elaboró una secuencia de acciones para la implementación del sistema de recepción masiva de intoxicados derivados de emergencias químicas en los hospitales, que se corresponden con las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres y con los subsistemas fundamentales del sistema. Esta asumió tres fases: fase 1, de alerta o preparación, que incluye las acciones de preparación hospitalaria; la fase 2, de alarma o ejecución, en las que se ejecutan las acciones de recepción masiva de intoxicados; y la fase 3, o de recuperación, que comprende las acciones de rehabilitación y restablecimiento. Conclusiones: La secuencia de acciones concebida permite implementar en la práctica el sistema de recepción masiva de intoxicados derivados de emergencias químicas en los hospitales; está compuesta por tres fases: preparatoria, ejecutoria y recuperativa; es integral, participativa y reproducible por cualquier institución hospitalaria(AU)

Introduction: The system of mass reception of intoxicated people during chemical emergencies, in hospitals, is linked to the phases of the response stage of the disaster risk reduction cycle, but needs to be implemented in practice. Objective: To elaborate a sequence of actions that allows to implement the system of massive reception of intoxicated people in hospitals, in situations of chemical emergencies. Method: Bibliographical sources were reviewed and analyzed between 2005 and 2017. Individual consultations were made to people linked to the topic, which allowed the first approximation. The criterion of experts on the utility and viability for the validation of the results was used. Results: A sequence of actions was developed for the implementation of the system of mass reception of intoxicates derived from chemical emergencies in hospitals that correspond to the phases of the response phase of the disaster risk reduction cycle and; with the fundamental subsystems of the system. This took three phases: phase 1, alert or preparation, which includes the actions of hospital preparation, phase 2, alarm or execution, in which actions of mass reception of intoxicated are carried out, and phase 3, or recovery, which includes rehabilitation and recovery actions. Conclusions: The sequence of actions conceived allows to implement in practice the system of mass reception of intoxicates derived from chemical emergencies in hospitals. It is composed of three phases: preparatory, executory and recuperative; It is comprehensive, participatory and reproducible by any hospital institution(AU)

Organización del hospital para la recepción masiva de intoxicados por emergencias químicas / Organization of the hospital for the mass reception of poisoned by chemical emergencies

RESUMEN Introducción: La atención a los intoxicados, en las emergencias químicas, tiene un carácter sistémico en las instituciones hospitalarias, por lo que se hace necesario organizar áreas, que permitan la recepción masiva. Objetivo: Determinar la estructura de las áreas para la recepción masiva de intoxicados por emergencias químicas en los hospitales. Método: Se realizó una investigación en sistemas y servicios de salud, en el periodo comprendido de 2005 a 2017. Se revisaron y analizaron fuentes bibliométricas e infométricas y se consultaron informantes claves. Resultados: Bajo principios toxicológicos, en las emergencias químicas, se propone organizar el hospital en doce áreas fundamentales: recepción, tratamiento especial y descontaminación, clasificación, tratamiento de urgencia, hospitalización del intoxicado grave, hospitalización del intoxicado leve, aseguramiento al diagnóstico, aseguramiento médico material, información toxicológica, vigilancia toxicológica, asintomáticos, fallecidos. Conclusiones: La estructura organizacional del hospital en la recepción masiva de intoxicados por emergencias químicas difiere de otros tipos de eventos. Tiene carácter sistémico. Su dinámica depende de principios toxicológicos. El tipo de tóxico y la vía de entrada determinan la presencia o no de un área de tratamiento especial y descontaminación. El área de recepción cumple las funciones de recepción y clasificación, pero, esta última, determina el tipo de descontaminación. En el área de clasificación se define la prioridad de atención médica. Las áreas de tratamiento de urgencia, hospitalización, y, el área de aseguramiento médico material, se crean, en departamentos y servicios dotados de los recursos que permitan su funcionamiento. La propuesta, se caracteriza por ser flexible, participativa, objetiva y reproducible.

ABSTRACT Introduction: Care to poisoned people during chemical emergencies has a systemic nature in hospital institutions, so it is necessary to organize areas that allow mass reception. Objective: To determine the structure of the areas for the mass reception of poisoned people by chemical emergencies in hospitals. Method: A research was carried out in health systems and services in the period from 2005 to 2017. Bibliometric and infometric sources were reviewed and analyzed and key informants consulted. Results: Under toxicological principles, in chemical emergencies, it is proposed to organize the hospital into twelve fundamental areas: reception, special treatment and decontamination, classification, emergency treatment, hospitalization of severe poisoned, hospitalization of mild poisoned, assurance of diagnosis, medical material assurance, toxicological information, toxicological surveillance, asymptomatic patients, and deceased. Conclusions: The organizational structure of the hospital in the mass reception of people poisoned by chemical emergencies differs from other types of events. It has a systemic nature. Its dynamics depends on toxicological principles. The type of toxic substance and the way of entry determine the presence or not of a special area of treatment and decontamination. The reception area fulfills the functions of reception and classification but the latter determines the type of decontamination. In the classification area, the priority of medical attention is defined. The areas of emergency treatment, hospitalization, and the area of material medical assurance are created in departments and services endowed with the resources that allow their operation. The proposal is characterized by being flexible, participative, objective and reproducible.

Concepción teórica de la recepción masiva de intoxicados en los hospitales durante emergencias químicas / Theoretical conception of mass reception of intoxicated people in hospitals during chemical emergencies

Introducción: La recepción masiva de intoxicados en los hospitales, derivados de emergencias químicas, se sustenta en postulados teóricos generales de estas emergencias, los siniestros con víctimas en masa y la teoría de los sistemas. Debe tributar al ciclo de reducción de riesgos de desastres. Objetivo: Diseñar una concepción teórica de la recepción masiva de intoxicados derivados de emergencias químicas, para los hospitales, que tribute a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres. Métodos: Se realizó una investigación en sistemas y servicios de salud, entre los años 2005 y 2017. Se revisaron y analizaron fuentes bibliométricas e infométricas y se consultaron expertos en el proceso de concreción del resultado, por método de consenso para determinar la pertinencia. Resultados: Se concibió la recepción masiva de intoxicados en los hospitales como un sistema, que asumió cuatro subsistemas: el preparativo, ejecutivo y recuperativo como fundamentales, y el de aseguramiento, para garantizar el funcionamiento de estos. Todos están relacionados entre sí, con dependencia significativa entre ellos. Se caracteriza por ser: flexible, objetivo, participativo, oportuno, aceptable, adecuado y selectivo. Conclusiones: El enfoque sistémico de la recepción masiva de intoxicados en los hospitales como consecuencia de las emergencias químicas, constituye un referente de gran valor teórico para su comprensión integral como fenómeno complejo, su estructura está conformada por cuatro subsistemas: el preparativo, ejecutivo, recuperativo y el de aseguramiento, y tributa a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres(AU)

ABSTRACT Introduction: The mass reception of intoxicated people in hospitals, resulting from chemical emergencies, is based on general theoretical postulates of chemical emergencies, mass casualty events and systems theory, which must contribute to the disaster risk reduction. Objective: To design a hospital theoretical conception for mass reception of intoxicated people resulting from chemical emergencies. This conception should contribute to the response phases of the disaster risk reduction. Methods: This is a research on health systems and services conducted from 2005 to 2017. We reviewed and analyzed bibliometric and infometric sources and we consulted experts. To determine the relevance, we focused on the process of result concretion and consensus method. Results: The mass reception of intoxicated patients in hospitals was conceived as a system of four subsystems. The basic are preparatory, executive and recuperative subsystems. The assurance subsystem guarantees the operation. All subsystems relate to each other with significant dependence between them. This system is flexible, objective, participatory, timely, acceptable, adequate and selective. Conclusions: The systemic approach of the mass reception of intoxicated patients in hospitals resulting from chemical emergencies constitutes a valuable theoretical reference for its basic comprehension as a complex phenomenon. Four subsystems structures it: preparatory, executive, recuperative and assurance. It contributes to the response phases of the cycle for disaster risk reduction(AU)

Design of first aid module in tent-form field medical system / 医疗卫生装备

Objective To design a multi-function first-aid module integrating instruments with the box to solve the existing problems in integration, operation, deployment, withdrawal, environmental adaptability and etc, so as to realize integrated storage, transport and operation of the instruments. Methods The module had its structure, modes of deployment and withdrawal, instruments buffering and vibration isolation, ergonomics and etc designed with the technologies of integrating box and instruments, integration, buffering and vibration isolation, centralized oxygen and power supply as well as the methods of system modeling,structure simulation and CAD.Results The first-aid module was gifted with the functions of respiratory and circulatory rehabilitation,vital signs monitoring,emergency treatment of complex and multi injuries, which could be used as a 2 000 mm×800 mm×600 mm emergency treatment platform when deployed. There were 4 angles for adjusting the backboard to form anti-shock positions for the severe casualties.The module had the time for deployment and withdrawal not more than 5 min,and was easy to deploy,withdraw,transport and store.Conclusion The module behaves well in structure,function,layout,operation and military service when used for the treatment of the severe casualties in the tent-form field medical system,which contributes to enhancing the casualty treatment efficiency and prognosis.[Chinese Medi-cal Equipment Journal,2018,39(5):12-16]

Establishment and implementation of the information linkage model between second-line hospital and first- line hospital in Jiuzhaigou earthquake / 中国实用护理杂志

Objective To study establishment and implementation of the information linkage model between second-line hospital and first-line hospital in Jiuzhaigou earthquake. Methods First-line hospital′s work was clearly delineated,and fist-line hospital decided the transport priority according to the wounded′s injuries.And fist-line hospital in disaster area took charge of dispatching ambulances,and kept close touch with the hospital, and used the information linkage platform to return the condition of a disaster,disaster relief work,the information of casualties,emergency convoys and other information to the hospital in time. In order to simplify the process of check, emergency disposal and admission in labor ward, according to the information the second-line hospital′s all departments shared information and worked together to guarantee resources of human, material and money of rational disposal. Results A total of 50 casualties were safely, quickly and orderly finished the process of evacuation, check and admission in labor ward. Conclusion The information linkage between fist-line hospital and second-line hospital can get the disaster relief more efficient and orderly.

Análisis de las defunciones por accidentes de tránsito en los registros oficiales de La Rioja - Argentina. Periodo 2011 - 2013 / Analysis of deaths caused by traffic accidents in the official records of La Rioja - Argentina. Period 2011 - 2013

Los accidentes de tránsito implican la pérdida de 1,3 millones de personas en el mundo cada año, convirtiéndose en una de las principales causas de defunción y la principal causa en la población joven entre 15 y 29 años. En este trabajo, descriptivo y exploratorio, se indagó acerca de la situación de la mortalidad en la provincia de La Rioja- Argentina, entre los años 2011 y 2013 provocada por los accidentes de transporte e intentó identificar si existió subregistro de las defunciones por esta causa en los registros oficiales. Para ello, utilizó como fuentes de datos el registro de defunciones, provisto por el Ministerio de Salud, y una base de datos confeccionada Ad Hoc a partir de los registros periodísticos de los siniestros viales ocurridos en la provincia. A partir de la comparación de estas fuentes se ha identificado un subregistro de muertes por accidentes de transporte del 57% en las estadísticas vitales. Ambos registros coincidieron en que estos eventos afectaron principalmente a los hombres menores de 45 años. La mayoría de los fallecidos conducía motocicleta al momento del siniestro, ocurrido principalmente en zona urbana. Esto últimos datos no se encontraron en los registros oficiales. Este aporte puede servir de base para reforzar ciertas políticas públicas tendientes a reducir estas muertes evitables.

Traffic accidents involve the loss of 1.3 million people in the world each year, becomingone of the main causes of death and the main cause in the young population between 15and 29 years. This descriptive and exploratory research inquires about the mortalitysituation in the province of La Rioja-Argentina between 2011 and 2013 caused by trafficaccidents and tried to identify if there was underreporting of deaths by this cause in officialrecords. We used data from the death registry provided by the Ministry of Health, and an AdHoc database based on the journalistic records of road accidents in the province. From thecomparison of these sources, an underreporting of transport accident deaths of 57% in vitalstatistics has been identified. Both records agreed that these events primarily affect menyounger than 45 years, whose were riding a motorcycle at the time of the incident, mainlyin urban areas. This latest data were not in the official records. This contribution can serveas a basis to reinforce certain public policies aimed at reducing these avoidable deaths.

Cuidado de heridos en el combate táctico / Care of wounded in tactical combat

Introducción: las fuerzas armadas norteamericanas han estado desarrollando un sistema de tratamiento y evacuación médico expedicionario que permite disminuir el número de fallecidos hasta valores muy bajos. Uno de los factores que ha facilitado este resultado es el protocolo de tratamiento de las bajas sanitarias en combates tácticos conocido en inglés como Tactical Combat Casualty Care. Objetivo: brindar información actualizada sobre el origen y conceptos de este. Métodos: se revisó la literatura internacional utilizando combinaciones de palabras claves relacionadas con este tema mediante buscadores (Pubmed, Clinicalkey, Hinari, Ebsco), desde enero del 2001 hasta noviembre del 2016. Desarrollo: en el año 1984 el Coronel Ronald Bellamy del ejército de los EE.UU. en su artículo denominado Causas de muertes en el combate terrestre convencional. Implicaciones en las investigaciones sobre las bajas sanitarias, desafió a la comunidad militar para que enfrentara estas realidades, revisó las causas de muerte en escenarios combativos analizando los datos históricos sobre heridas recogidos por diferentes investigadores que se basaron en la efectividad de las diferentes municiones durante la guerra de Vietnam. Definió que durante las operaciones combativas terrestres convencionales, la mayoría de las muertes resultan por heridas catastróficas. Conclusiones: este protocolo surgió por la necesidad de disminuir las muertes prevenibles en los escenarios combativos y bajo consideraciones tácticas. Debido a su gran repercusión en el tratamiento del lesionado en los escenarios combativos se ha convertido en el documento rector de los servicios médicos de la mayoría de los ejércitos del mundo(AU)

Introduction: The United States Armed Forces have been developing an expeditionary medical treatment and evacuation system that allows to reduce the number of deaths to very low. One of the factors that has facilitated this result is the Tactical Combat Casualty Care protocol. Objective: To provide updated information on the origin and concepts of this. Methods: The international literature was reviewed using combinations of keywords related to this topic through search engines (Pubmed, Clinicalkey, Hinari, Ebsco), from January 2001 to November 2016. Body: In 1984 Colonel Ronald Bellamy of the Army of the USA in his article entitled Causes of deaths in conventional terrestrial combat. Implications of Health Disposal Investigations, challenged the military community to address these realities, reviewed causes of death in combat scenarios by analyzing historical data on injuries collected by different researchers who relied on the effectiveness of different ammunition during the Viet Nam war. He stated that during conventional ground fighting operations, most of the deaths result from catastrophic injuries. Conclusions: This protocol arose because of the need to reduce preventable deaths in combat scenarios and under tactical considerations. Due to its great impact in the treatment of the injured in the combative scenarios has become the guiding document of the medical services of the majority of the armies of the world(AU)

Damage control resuscitation of massive hemorrhage: The key to saving the combat casualties / 解放军医学杂志

Combat casualties can be divided into two types,i.e.,non-survivable (NS) and potentially survivable (PS).According to the data of US army,massive hemorrhage constituted 90.98％ of the potentially survivable casualties,and the most important thing to improve the ability of casualty care is hemorrhage control.In this article,the strategies and techniques of damage control resuscitation like surgical hemorrhage control techniques of non-compressive hemorrhage (NCH) in torso and junctional area,the damage control identification of the injured,field transfusion process and fresh whole blood infusion in tactical level and emergency phase were comprehensively illustrated.

Analysis of the casualties aboard warships attacked by anti-ship missiles / 军事医学

In the future,anti-ship missiles(ASM) will be major weapons in the sea war.It is very important to handle the profile of the casualties aboard warships attacked by ASM for development of naval health service.The statistical result shows there is a greater chance of casualties but less chance of warships being sunken by ASM.Besides,medical staffs should pay more attention to the first aid for victims due to blast,burn,smoke inhalation and penetration while the danger of the sea water immersion should not be ignored.

Status and optimization design of field emergency rescue surgical instruments / 医疗卫生装备

Objective To develop a series of surgical instruments to improve surgical treatment in field conditions with considerations on the characteristics of medical shelter and the requirements of surgical treatment in field conditions.Methods A series of surgical instruments was developed with considerations on the characteristics and requirements of surgical treatment in field conditions.Results The mask strap behaved well in structure,operation and fixation,and prevented the mask from unplanned extubation,dropping off and displacement.The sterilizing rack had high stability and safety and 150 kg bearing capability,and eliminated the needs for additional workload for patient carrying and traction during preoperative sterilization.The prone-position cushion exposed the operative field sufficiently and enhanced the success rate of surgical treatment.Conclusion The series of surgical instruments gains advantages in structure,operation,mobility,cleaning,sterilization,carrying,storage,loading and transport,and thus is applicable for field emergency rescue.

Status and optimization design of field emergency rescue surgical instruments / 医疗卫生装备

Objective To develop a series of surgical instruments to improve surgical treatment in field conditions with considerations on the characteristics of medical shelter and the requirements of surgical treatment in field conditions.Methods A series of surgical instruments was developed with considerations on the characteristics and requirements of surgical treatment in field conditions.Results The mask strap behaved well in structure,operation and fixation,and prevented the mask from unplanned extubation,dropping off and displacement.The sterilizing rack had high stability and safety and 150 kg bearing capability,and eliminated the needs for additional workload for patient carrying and traction during preoperative sterilization.The prone-position cushion exposed the operative field sufficiently and enhanced the success rate of surgical treatment.Conclusion The series of surgical instruments gains advantages in structure,operation,mobility,cleaning,sterilization,carrying,storage,loading and transport,and thus is applicable for field emergency rescue.

Los hospitales de soporte combativo para la práctica quirúrgica contemporánea en escenarios de acciones combativas / Hospitals of combative support for the contemporary surgical practice in scenarios of combative actions

Las demandas de la práctica quirúrgica contemporánea en los escenarios de acciones combativas crecen tanto por la cantidad de las heridas de guerra que ameritan una intervención quirúrgica, como por la calidad y destrucción que los agentes vulnerantes contemporáneos disponibles producen. Eso provoca que los servicios médicos procuren proporcionar buenas prácticas quirúrgicas en los escenarios más hostiles imaginables. Para ello, fue necesario dotar a las instituciones médicas desplegadas de un conjunto de facilidades técnicas -que aunque importadas desde tiempo de paz- fuesen capaces de realizarse sobre una base estructural capaz de poder sustentarlas. Es por ello que en el primer decenio del siglo XXI y atravesando los conflictos de Iraq y Afganistán por sus momentos más sangrientos, se decidió redimensionar las anteriores versiones de los hospitales quirúrgicos en estructura, función y capacitación del personal. El objetivo del artículo es exponer las experiencias en la estructura de bajas sanitarias (incluyendo las pediátricas), los procederes diagnósticos y terapéuticos empleados en los últimos años en los hospitales de soporte o aseguramiento combativo que aparecieron en la literatura médica especializada(AU)

The demands of contemporary surgical practice in the scenarios of combative actions grow both because of the number of war wounds that warrant surgical intervention and because of the quality and destruction available to contemporary vulnerable agents. This causes medical services to strive to provide good surgical practice in the most hostile scenarios imaginable. To do this, it was necessary to equip deployed medical institutions with a set of technical facilities - although imported from peace time - capable of being carried out on a structural basis capable of sustaining them. That is why, in the first decade of the 21st century and through the conflicts in Iraq and Afghanistan because of their bloodiest times, it was decided to resize the previous versions of surgical hospitals in structure, function and staff training. The objective of this article is to describe experiences in the structure of health discharges (including pediatric), the diagnostic and therapeutic procedures used in the last years at support hospitals or combative assurance that appeared in the specialized medical literature(AU)

Determinación de stock de medicamentos y productos médicos para tratamiento inicial en desastres utilizando la tecnica DELPHI en un Hospital del interior de la Provincia de Córdoba (Argentina) / Drugs and medical products stock determination for initial treatment in disaster situations using delphi technique in a hospital in the interior of the province of Cordoba (Argentina) / Determinação do estoque de medicamentos eprodutos médicos para tratamento inicial emdesastres empregando a técnica delphi em umhospital do interior da província de Córdoba (Argentina)

El objetivo de este trabajo fue determinar el stock de medicamentos y productos médicos para el tratamiento inicial de víctimas en masa en un hospital de la provincia de Córdoba (Argentina).Se utilizó la Técnica Delphi como método de consenso. Se solicitó la participación de 13 profesionales entre médicos y enfermeras del Hospital Dr. Arturo U. Illia de la ciudad de Alta Gracia, coordinados por una farmacéutica. Se realizaron 3 cuestionarios por medio de los cuales se arribó a la selección de los insumos necesarios para la atención de víctimas en masa para un plazo de 48 horas.Se determinaron dos listados finales con 25 medicamentos y 25 productos médicos, respectivamente.La utilización de esta técnica en la mencionada selección, agilizó el consenso en la toma de decisiones respecto a la inclusión de los insumos en cuestión.

The objective of this work was to determine the stock of drugs and medical products for the initial treatment of mass casualties at a hospital in the province of Córdoba (Argentina). Delphi Technique was used as the consensus method. Thirteen practitioners including physicians and nurses from Dr. Arturo U. Illia Hospital, in the city of Alta Gracia, were requested to participate, coordinated by a pharmacist. Three questionnaires were produced to come to a selection of the necessary products for mass casualty management during a 48-hour period. Two final lists were made with 25 drugs and 25 medical products, respectively. The use of this technique for the above mentioned selection accelerated consensus in decision making regarding the inclusion of the items in question

Looking back and ahead: some perspectives of military psychiatry

Military psychiatry is a branch of psychiatry that is concerned with the mental health of soldiers and their families in war and peace time. It emerged as a special field of importance after World War I. With changing combat scenarios, peace keeping operations and terrorism modern soldier is obliged to confront and endure wide ranging demands for adjustment; with battle fronts becoming diffuse and coming closer to home unarmed civilians are sucked into war like situations. Military sychiatrists as well as their civilian counter parts need to be aware of the essentials of the mental health consequences of military operations of various kinds and related situations.

Single Center Experiences to Landslides on Woo-myun Mountain: Preparedness, Response, and Lessons Learned

PURPOSE: On July 27, 2011, landslides occurred on Woomyun Mountain, resulting in development of mass casualties. Seoul St. Mary's Hospital was the primary recipient of patients. This experience prompted the drafting of a formal disaster plan. Therefore, we outline the Emergency Management External Disaster Plan of Seoul St. Mary's Hospital and discuss the time course of presentation and medical characteristics of the patients. METHODS: We conducted a retrospective review of medical records of patients who visited Seoul St. Mary's Hospital from Woo-myun Mountain landslides. In addition, we reviewed the time course of hospital disaster response. RESULTS: A total of 33 patients participated in this study. Mean age was 40.2 (+/-21.8) years; eight patients died at the time of admission and cardiopulmonary resuscitation was performed in one patient. Mean Injury Severity Score (ISS) was 9.19 and four patients were ISS above 15. Six patients were admitted to our hospital and two patients underwent an emergency operation. Overall, the emergency disaster management was appropriate due to the formal disaster plan and experiences in conduct of disaster drills. However, there were also several problems. The major problems of our disaster response were as follows: delayed activation of external disaster, difficulties in securing a treatment section, and absence of a decontamination facility. CONCLUSION: We observed several problems from our experience with Woo-myun Mountain landslides. Reassessment of the disaster plan and additional planning for other possibilities are needed.

Atendimento pré-hospitalar à múltiplas vítimas com trauma simulado / Prehospital care to trauma victmis with multiple simulated

OBJETIVO: Analisar a qualidade do atendimento pré-hospitalar realizado pelas agências em Vitória-ES. MÉTODOS: Estudo retrospectivo realizado nos arquivos da Liga Acadêmica de Cirurgia e Atendimento ao Trauma do Espírito Santo (Lacates) dos dados de 40 vítimas de um acidente simulado entre um ônibus e dois automóveis. Os pacientes foram assistidos por quatro equipes: Corpo de Bombeiro Militar do Espírito Santo, Samu 192, Guarda Municipal e Defesa Civil. A atuação dessas equipes foi avaliada pela Lacates, através da análise do check-list com orientações pré-estabelecidas para cada vítima. RESULTADO: O Corpo de Bombeiros Militar do Espírito Santo (CBMES), que desencarcerou as vítimas, delimitou as zonas de perigo e realizou a triagem pelo método START atuou corretamente em 92,5% dos casos. O Samu 192 que atendeu as vítimas pelo método mnemônico (ABCDE) no posto médico avançado agiu corretamente em 92,5% dos casos, no quesito Via Aérea; 97,5%, no Respiração; 92,5%, no Circulação; 90%, no Avaliação Neurológica; e 50%, no Exposição e Controle do Ambiente. A análise conjunta do ABCDE mostrou que o atendimento foi correto em 42,5% dos casos. O transporte dos pacientes foi realizado corretamente em 95% dos casos. A Guarda Municipal garantiu a perviedade das avenidas para transporte dos pacientes, e a Defesa Civil coordenou eficazmente o trabalho das equipes envolvidas no posto de comando. CONCLUSÃO: A triagem e o transporte foram executados satisfatoriamente, entretanto, maior atenção deve ser dada à exposição e proteção contra hipotermia das vítimas, já que esse item comprometeu o tratamento.

OBJECTIVE: To assess the quality of prehospital care agencies conducted in Vitória, capital of Espírito Santo State, Brazil. METHODS: We conducted a retrospective study in the archives of the League of Academic Surgery and Trauma Care of Espírito Santo (Lacates) regarding 40 victims of a simulated crash between a bus and two cars. The patients were treated by four teams: Military Fire Department of Espírito Santo, Samu 192, County Guard and Civil Defense. The performance of these teams was evaluated by Lacates, through analysis of a check-list with pre-established guidelines for each victim. RESULT: The Fire Department of Espírito Santo (CBMES), which extricated victims, outlined the danger zones and carried out the screening by the method START, acted correctly in 92.5% of cases. The Samu 192 victims, which attended victims by the mnemonic method (ABCDE) in medical outposts, acted correctly in 92.5% of cases in the category Airway; 97.5% in breathing, 92.5% in circulation, 90% in Neurological Assessment, and 50% in the Exhibition and Environmental Control. The analysis showed that the ABCDE care was correct in 42.5% of cases. The transport of patients was performed correctly in 95% of cases. The County Guard secured the patency of the avenues for transportation of patients and Civil Defense successfully coordinated the work of teams involved in the command post. CONCLUSION: The triage and transport of victims have been performed satisfactorily. However, more attention should be given to exposure and hypothermia protection of victims, since this item compromised treatment.

"Features of survived casualties and treatment after "" July 23"" EMU railway accident at Wenzhou station" / 中华急诊医学杂志

Objective To analyze the features of EMU survived casualties and the rescue during a head -on- rear collision between two EMU trains on 23 July 2011 ( July 23 train collision accident) at Wenzhou station.Methods The casualties treated in many major hospitals in Wenzhou were surveyed within 24 hours after the accident occurred.The data of age,gender,type of injury and injury severity of the wounded were analyzed.Results A total of 136 casualties were treated within the first 24 hours after the accident occurred,and the male patients and female patients accounted for 55.89％ and 44.11％ respectively,blunt trauma was the main cause of injuries.The percent of multiple injuries in the wounded survivals accounted for 79.41％.The most common injury site of the survived casualties was chest,followed by four limbs and spine.All the wounded were rescued on the spot and were referred to the hospitals with better medical facilities.Conclusions There was no significant difference in gender of the wounded.Blunt trauma was the leading cause of injuries,and the chest,four limbs and spine were the liable parts of body to be traumatized.Saving life,triaging and transferring the wounded as soon as possible were the major algorithm during the initial stage of medical rescue after the accident occurred.

Management of casualties in the assault of Camp Abubakar

The decision to take over Camp Abubakar, the largest camp of the Moro Islamic Liberation Front (MILF), resulted in one of the largest numbers of combat-related casualties in the Philippines. In the delivery of health care, the health service of the AFP in the area encountered various problems. There were difficulties in the retrieval of the casualties, lack of transportation to the collecting points and centers for definitive care, lack of health personnel, and the limited surgical/medical capabilities of the treatment areas near the engagement. In spite of the adaption of new strategies, there was still significant increase in the morbidity and mortality incurred by the battle casualties. During the Abubakar assault, there were 127 wounded military personnel. Twenty percent was due to classified as "killed in action" (KIA). Twenty percent was due to delayed application of emergency care secondary to blood loss from chest and abdominal wounds. This incident brings to fore the need for changes in the current strategy in disaster management.

Triage and transfer of the first batch of casualties in quake-hit center Yingxiu town following the 5·12 Wenchuan Earthquake / 中华急诊医学杂志

Objective To address medical relief algorithm in earthquake center by analyzing triage and transfer of casualties in the quake-hit center Yingxiu town in the wake of the 5·12 Wenchuan earthquake.Method According to the actual hard working conditions and rule of CBASHPLAN,the locale was derided into triage area,minor wounds area,severe wounds area and transfer area.Medical team coming from Soulhwest Hospital,the Third Military Medical University was derided into several groups. Triage, treatment and transfer of casualties well arranged. Results A total of 415 victims was treated by our medical team in early three days.Of these victims,251 were severe injuned,153 were debrided,12 were decompression with cutting open the wound because of their oseofascial canpartment syndrome,and 317 casualties were transferred by helicopters.No victim died during treatment and transfer at quake-stricken region.The whole work was proceeded in good order and efficiently.Conclusions Triage and transfer of casualties scientifically allowing for the capability of medical relief and the sufficiency of medical resources are very important to deal with batches of casualties in quake-stricken region.