Earthquake disaster is a special kind of injury factor, the number of injured is large, the types of injuries are complex, the treatment force is limited, the treatment time is urgent, thus creating a contradiction between the need for treatment and the possibility of treatment, the contradiction between the treatment of the seriously injured and the less seriously injured, the contradiction between some of the injured and the whole of the injured. It is definitely not feasible to solve the problems according to the usual mode of treatment, and in fact, for inexperienced hospitals, it is very difficult for them to provide better treatment to the wounded in this situation. In order to solve these contradictions, the hospital must first of all quickly classify the wounded, distinguish between priority, the need for emergency rescue of the wounded out, especially shock and bleeding wounded; the need for immediate surgery out of the wounded; to determine the measures for the treatment of the wounded, the classification of the work done to ensure that in the conditions of the wounded in the multitude of conditions, the rational use of hospital manpower and material resources, and orderly treatment work, so as to Improve the efficiency and quality of work. In the face of this situation, our medical team firstly applied the method of classification of the wounded in the field situation to the treatment of the earthquake wounded, and put the experienced field surgery expert medical personnel into the classification of the wounded, and carried out the rapid and reasonable treatment of the wounded, and used the wound label of the classification of the wartime wounded for the classification of the earthquake wounded.
2 Implementation of graded treatment casualty evacuation is necessary
The evacuation of casualties is an important means of accomplishing graded treatment. The evacuation of the injured who are not in life-threatening danger but still need continued treatment is to reduce the pressure on the front so that the injured waiting for treatment can get better treatment, and secondly, to free up more beds for the front hospitals so that they can deal with more patients. The transfer of the injured after the earthquake is three-dimensional, using a variety of possible use of the transfer tool, such as cars, trains, airplanes, etc., however, the evacuation of the injured for the specific hospitals, the transfer of their own hands to treat the injured out of the hospital is not so easy to understand at the beginning, is the need to ideological conceptual change, to establish a big-picture concept before it is possible to achieve. In the Wenchuan earthquake, the treatment of the injured embodied the principle of graded treatment. On-site rescue, in the search for the injured and excavation of the scene there are waiting to administer medical personnel, many of the injured once rescued to get emergency medical treatment, keep the airway open, infusion, bleeding, bandaging, fixation, and even in the pressurized to be rescued before the patient has been given oxygen and fluids, to give the most timely support for life.
First-line treatment: in the earthquake-stricken areas of the existing troops in field conditions of the tent hospitals, so that the patient to get a more standardized emergency treatment, vital signs support, wound debridement, fracture immobilization, including surgical fixation, closed drainage of the thoracic cavity, and even carry out the conditions of the cervical spine and lumbar spine decompression and internal fixation surgery.
Second-line treatment: local and military hospitals in less-affected cities were used as the basis for definitive specialized treatment, and nationally renowned expert treatment teams carried out treatment guidance and inspections to ensure the quality of patient treatment. Rear treatment and rehabilitation: a large number of injured people were transferred to different parts of the motherland through airplanes, trains and buses to get better treatment and rehabilitation, especially for some injured people who were difficult to deal with, timely rescue by air was carried out, which achieved good results and basically formed a three-dimensional treatment network. However, how to be able to rescue in the 72 hours after the earthquake within the golden time of the rescue, the scene can start the rescue is still a topic worthy of study. Wenchuan earthquake environment of special circumstances, this time in many areas can only self-help mutual aid. The biggest lesson of the Tangshan earthquake is the lack of first aid knowledge and rescue equipment, in the heat of the moment, there are many survivors were dragged out, many of the injured caused paraplegia. In this rescue, the phenomenon of rescuers not using scientific rescue tools such as neck braces and spinal boards is still visible. Medical rescue is scientific rescue, safety rescue, both to protect the injured, but also to protect themselves, to establish a three-dimensional, socialization of the concept of big rescue is very important. The establishment of a three-stage ladder rescue system is to improve the success rate and quality of treatment is an important guarantee, the establishment of the county and city medical institutions and personnel involved in the first and second level of the rescue system, can be in the shortest possible time to save a large number of casualties, effectively reduce the mortality rate in the early stage.
The third level of treatment system should be borne by the provincial hospitals, focusing on the protection of critical, complex and serious infections complicating the rescue mission of the injured, and overall improve the cure rate of the earthquake victims.
3 Adhere to the principle of life first, limb second treatment
Earthquake on-site treatment should be strictly to save the life of the first after the treatment of injuries, the first serious injuries after the first light injuries, the first after the rescue, for the later treatment to win time. Earthquake occurs when the most crush injuries, the rate of emergence of crush syndrome is quite high, often endangering the lives of the injured, the pursuit of zero amputation rate, it is possible to lose the lives of more injured. To scientific treatment, when the limb of the extrusion injury caused by extrusion syndrome life-threatening to be decisive amputation. Limb prolonged extrusion, limb survival hope is very little casualty, very easy to occur renal failure, after lifting the heavy pressure, to avoid elevation of the affected limb, in the injured limb on the proximal side of the tourniquet, as soon as possible amputation. The mortality rate of renal failure occurring in crush syndrome can be up to 90%. Continuous renal replacement therapy (CRRT) can effectively treat renal failure caused by crush syndrome and significantly reduce the mortality rate, which was confirmed in the treatment of Wenchuan earthquake casualties, but we have to be vigilant about the late complications. There were two cases of delayed renal failure from crush injuries in the casualties arriving at our hospital, one occurred 5 days after amputation, one after re-clearance and amputation, and was cured after continuous renal replacement therapy, which should be paid enough attention to this relatively rare condition. Special attention should also be paid to crush injuries of the thoracic and abdominal cavities, which can have fatal consequences if missed or untimely treated.
4 External fixation frame - the best way to deal with open fractures of the limbs
The Wenchuan earthquake casualties have the most closed and open fractures of the limbs, accounting for about 80% of the total number of casualties. As a result, the orthopedics and traumatology departments have the heaviest treatment task. What methods can be used to dispose of the injured as quickly and effectively as possible? In the application of various methods, it is realized that the treatment of open fractures of the limbs with external fixation frames has its special advantages; (1) external fixation frames can provide good fixation for the fractures without the need for incision and reduction;
(2) percutaneous external fixation with pins and needles, with less trauma and less loss of blood, without the need to rely on X-ray at the initial stage, and the possibility of adjusting the fracture at a later stage;
(3) the surgical conditions and the requirements for asepsis are not very high The fracture can be fixed quickly and easily, and the operation time is short, and the fixation of one case of tibiofibular fracture of the lower leg can be completed in about half an hour;
(4) the application of the treatment of multiple injuries is even more important, and it also facilitates the treatment of wounds without interfering with the reduction and fixation of the fracture and allows for the pressurization of the fracture or prolonged treatment of defects caused by the fracture. In fact, in the earthquake-stricken areas of the hospitals and medical teams external fixation frame configuration is very limited, and has not been very widely used. The earliest in the war in Bosnia and Herzegovina in the treatment of extremity firearms injuries in the treatment of external fixation frame is widely used, has shown the good effect of this technology, in the trauma treatment of the medical team should be a large number of configurations.
5 Early prevention of infection, alert to the occurrence of special infections
To effectively prevent earthquake-induced wound infections, it is necessary to eliminate the various factors that may cause infection. In the whole process of treatment of the injured, all medical personnel must have a strict concept of asepsis, and embodied in each specific treatment operation. Never use the difficult conditions in the disaster area as an excuse to neglect the aseptic technical operation, but should pay equal attention to the aseptic requirements as usual, and prevent the formation of infection in all the treatment links. A good sterile dressing at the scene of first aid is the first measure to reduce wound contamination, reducing wound bleeding can reduce the conditions for bacterial growth and reproduction, the early use of antimicrobials after injury can delay the onset of infection, so that debridement surgery under the control of antimicrobials can reduce the incidence of infection, because of the limitations of knowledge and conditions, early use of antimicrobials in the disaster area casualties is not widespread. The single biggest step in preventing infection is early debridement of the casualty, a fundamental treatment that cannot be replaced by drugs. Infections occur less frequently in hospitals in the disaster area, but the rate of infection is very high in tents, especially in sutured wounds and closed amputations, where most of them become infected, and some of them undergo a second amputation. In the first line of tent operating room equipment conditions and sterile conditions are relatively poor, emergency treatment of patients, experience tells us that we should be in accordance with the principles of wartime field surgical treatment of wounds, complex injuries, serious contamination of wounds after wound debridement should be strictly prohibited a period of suture wounds, the need for emergency surgical amputation of casualties should be carried out open amputation, only in this way can effectively reduce the incidence of infection. Be especially alert to the occurrence of special infections, according to the current report of gas gangrene occurs in more than 40 cases, once the occurrence of isolation treatment immediately.
6 Establishment of a constant medical emergency response team
The health emergency rescue of emergencies is very strong scientifically, only by the passion is far from enough, how to jump out of the "passionate rescue", Wenchuan earthquake relief experience tells us that the hospital to establish a constant medical emergency response team is very necessary. The hospital to establish a permanent and unremitting medical emergency detachment is very necessary. This detachment should have a variety of disasters when the rescue plan, to be uninterrupted strict training, encountered a disaster rescue not only can quickly and independently, skillful treatment of the injured, life but also to be able to self-sufficiency, not to increase the burden of the people in the disaster area. Emergency response teams should conduct rigorous training in a variety of difficult simulated environments, so that there will be no X-ray machine, ultrasound, CT can not diagnose, no imported equipment, imported instruments can not be operated on the embarrassing phenomenon. Everything should be from the actual treatment of the disaster area, everything should be from the wartime treatment, high standards, strict requirements, in order to cope with a variety of disasters caused by the complexity of the difficult treatment situation.