Lu-shan earthquake occurred at 8:02 am, on April 20th, 2013. The epicenter of earthquake was located in Lu-shan county, Ya’an city, Sichuan province, about 100 km from Chengdu along the Longmenshan fault zone in the same province heavily impacted by the 2008 Wenchuan earthquake. The earthquake has resulted in 196 people dead, 24 missing, at least 11,470 injured as of 14:30, April 24th, 2013. After Lu-shan earthquake, medical rescue teams were dispatched from the West China Hospital, Sichuan University to the stricken area. This article written by a member of the rescue team reported the difficult and dangerous rescue work and the performance of rescue members in the stricken area.
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
ObjectiveCurrently, simple triage and rapid transport (START) is widely used as a method to evaluate the severity of mass casualty events in a disaster. Modified physiological triage tool (MPTT) and modified physiological triage tool-24 (MPTT-24) are newly introduced triage methodologies that may offer improvements over START. However, the feasibility and accuracy of these two methods cannot be adequately assessed without sufficient data support, whether in earthquakes or other disasters. Our study aimed to analyze the value of the three triage methodologies in mass casualty events due to earthquakes.MethodsA total of 36 604 injured patients from the West China Hospital database were evaluated using START, MPTT and MPTT-24, respectively. The triage methodologies were then evaluated based on death and ICU acceptance, using the area under the receiver-operator curve (AUC). The sensitivity and specificity of the three methodologies were compared under different standards and correlations with the injury severity score (ISS) were analyzed. ResultsFor deaths, the AUCs for the triage methodologies were 0.711, 0.775 and 0.686 for START, MPTT, and MPTT-24, respectively. For ICU acceptance, the AUCs of the triage methodologies after correction for bias were 0.579, 0.618 and 0.603. The correlation coefficients of the triage methodologies and ISS score were 0.041, 0.087, and 0.115.ConclusionsMPTT is superior to START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.
Objective To explore the impact of quarantine experiences on the public’s perceived infection risk and expectations following the shift in coronavirus disease 2019 (COVID-19) policy. Methods From December 7 to 10, 2022, an online questionnaire survey was conducted to collect data on respondents’ past quarantine experiences and their perceived infection risk and expectations after the relaxation of COVID-19 restrictions. Independent-samples t-tests and multiple linear regression analysis were used to examine the effect of quarantine experience on the public’s perceived infection risk and expectations. Results A total of 570 valid questionnaires were collected. Among the 570 respondents, 377 had quarantine experience. Those who had experienced quarantine reported a significantly higher perceived risk of COVID-19 infection than those who had not (3.07±1.28 vs. 2.77±1.23, P=0.007). Multiple linear regression analysis showed that quarantine experience [unstandardized partial regression coefficient (b)=0.278, 95% confidence interval (CI) (0.069, 0.487), P=0.009] and attitude change [b=0.319, 95%CI (0.251, 0.388), P<0.001] were significant influencing factors of perceived infection risk. Conclusions After the shift in COVID-19 policy, quarantine experience has a significant impact on the public’s perceived infection risk and expectations. Respondents with quarantine experiences have a higher perceived risk of contracting the virus and more pessimistic expectations.
ObjectiveTo evaluate four triage methods including START, Care-Flight, rapid emergency medicinescore (REMS) and Sacco score for the length of hospital stay, length of ICU stay and the severity of injury in Lushan earthquake victims.MethodsA retrospective analysis was performed in 41 cases of critical earthquake victims in the emergency department of West China Hospital from April 20th to April 26th, 2013 in Lushan earthquake. The length of hospital stay and length of ICU stay were compared for four triage methods. The correlation between four triage methods and length of hospital stay, length of ICU stay and injury severity score (ISS) were also analyzed.ResultsThe length of ICU stay for victims whose triage level were red by START triage method or Care-Flight triage method was longer than whose triage levels were yellow. But the length of hospital stay for victims between the two triage levels had no significant difference. In addition, there was a correlation between critical victims and the length of ICU stay in the classification of START triage method and Care-Flight triage method.ConclusionThe length of ICU stay of the victims, whose triage level are red by START triage or Care-Flight triage methods, are longer than whose triage level are yellow. The levels of START and Care-Flight triage are correlated to length of ICU stay.
Objective To explore the influence of two emergency reception and triages workflows between Wenchuan and Lushan earthquakes on the victim’s length of stay in emergency department of the West China Hospital of Sichuan University. Methods A total of 65 victims admitted in the West China Hospital within 12 hours after Lushan earthquake were retrospectively analyzed, and their diagnosis and treatment information and the length of stay in emergency department were collected and compared with those of the victims in Wenchuan earthquake. Then we analyzed the influence of two emergency reception and triage workflows on the length of stay of the batches of earthquake victims. Results For the Lushan earthquake victims, the median length of stay in the emergency reception and triage workflow was 0.51 hour, while that was 2.13 hours for the Wenchuan earthquake victims, with a significant difference (Plt;0.05). Conclusion The emergency reception and triage workflow for Lushan earthquake victims is a summarized experience and improvement based on that for Wenchuan earthquake, which can be used as references for treating batches of victims in the emergency department after a disaster.
Objective To investigate the influencing factors of the hi p functional recovery after Pi pkin fracture surgery. Methods The cl inical data were retrospectively analysed, from 37 patients with Pi pkin fracture between May 2002 and February 2009. There were 32 males and 5 females, aged 26 to 98 years (median, 43 years). The causes of injury were traffic accident in 31 cases, a fall ing in 4 cases, and fall ing from height in 2 cases. The time from injury to operation was 1-28 days (mean, 8.6 days). According to the Pi pkin classification criteria, there were 23 cases of type II, 8 cases of type III, and 6 cases of type IV. Open reduction and internal fixation (ORIF) were performed in 27 cases, total hip arthroplasty (THA) in 10 cases.The relationships between gender, age, time from injury to surgery, type of fracture, treatment way and the hip functionalrecovery were analysed statistically. Results All patients achieved heal ing of incision by first intention, no infection anddeep venous thrombosis occurred. All patients were followed up 10 to 94 months with an average of 40.5 months. Bonefusion was observed at 5-11 months (mean, 8.9 months) in patients undergoing ORIF by X-ray examination; no prostheticloosening or subsidence occurred in patients undergoing THA. At last follow-up, Oxford Hip Score (OHS) was 16-58 points(mean, 37.2 points); the results were excellent in 12 cases, good in 13 cases, fair in 2 cases, and poor in 10 cases. The univarible analysis showed that the type of fracture and treatment way significantly affected the hip functional recovery (P lt; 0.05). The multivarible analysis showed that the type of fracture and treatment way had no significant effect on the hip functional recovery (P gt; 0.05). Conclusion Type and treatment way of Pi pkin fracture may affect postoperative hi p function recovery, so appropriate treatment should be selected based on fracture type to ensure the restoration of joint function.
