The injuries caused by earthquake were characterized as complicated injuries, multiple injuries, crush injury, commonly accompanied by the impairment of the organs, open wound with susceptibility to contamination, difficulties in the implementation of in-time treatment, and resource-limited settings. Considering the specialty of early treatment of earthquake victims and existing misconduct, we propose recommendations according to general principles of early rationale use of antibiotics, in order to treat the earthquake victims safely, effectively and feasibly, and to decrease wound infection rates after surgery.
ObjectiveTo investigate the effects of early rehabilitation on function of patients undergoing complex lower limb amputation caused by injuring in "4·20" Lushan earthquake.
MethodsFrom April 20th to June 30th, 2013, we carried out comprehensive rehabilitation intervention for two patients who had undergone complex lower limb amputation, including physical treatment, exercise treatment, psychological treatment, wound dressing, rehabilitation program, and multiple rehabilitation nursing care.
ResultsThrough early comprehensive rehabilitation intervention, patients' pain was relieved, and their muscle strength, activities of daily living (ADL), and balance function had been improved greatly, achieving the goal of installing artificial limb.
ConclusionEarly rehabilitation intervention treatment is effective in relieving pain in patients undergoing lower extremities amputation, and improving their muscle strength, ability of ADL and balance function, which can make the patients return to society much better and faster.
Objective To explore the traumatic situation and transfer methods of the in-patients injured in Lushan Earthquake, and to provide evidence for treating injured mass in future. Methods The information of the patients injured in Lushan Earthquake who were admitted in Chengdu Military General Hospital were collected by “No. 1 Military Medical Project” hospital information system and a self-edited “Questionnaire for Hospitalized Patients Injured in 4.20 Lushan Earthquake”. Results A total of 65 patients were admitted in this hospital: 63 (96.92%) patients were injured in the main shock; 28 (43.08%) patients were injured by building collapse; 23 (35.38%) patients got injured due to falls or got bruised when escaping; and 14 (21.54%) patients were accidentally injured. Rescue methods: 32 (49.23%) patients were saved by themselves; 23 (35.38%) patients were mutually helped; 10 (15.38%) patients were rescued by local non-military rescue team; 34 (52.31%) patients were rescued by military rescue teams; and 26 (44.83%) patients were transferred by air transport. Conclusion In order to cope with emergencies and major disasters (e.g. earthquake) and to treat injured mass scientifically in the future, we should set up emergency wards scientifically and reasonably, carry out education on earthquake prevention and disaster mitigation widely, reinforce self-care and mutual aid in the stricken area, quickly send rescue and medical teams, and organize training for air transportation of patients.
Objective To analyze drug use for 23 sick and wounded hospitalized in the departments of gynaecology, obstetrics and paediatrics in the West China Second University Hospital, during one month after Lushan earthquake, so as to provide references for the drug use for the sick and wounded women and children. Methods Medication information was retrospectively investigated in the departments of gynaecology, obstetrics and paediatrics in the West China Second University Hospital during one month after Lushan earthquake. We extracted data including hospitalization duration, medication prescriptions, types and costs of essential medicines, types and costs of antibiotic medicines using the HIS system. Discharge diagnosis was standardized and classified according to ICD-10. Indicators of rational drug use included defined daily dose (DDD), defined daily dose statistic (DDDs), drug utilization index (DUI), children defined daily dose (cDDD), children drug utilization index (cDUI), proportion of essential medicines, proportion of antibiotic medicines, mismatch of medicine and diagnosis, repeated drug use, improper combination of drug, incorrect usage and dosage, and frequently drug change. Medication information was evaluated and discussed by the prescription working group. Discrepency was resolved by consulting with the panel. Results A total of 23 sick and wounded women and children were assessed during one month after Lushan Earthquake. There were 13 sick and wounded children in the department of pediatrics (mainly manifested as bronchial pneumonia) and 10 sick and wounded women in the department of gynaecology and obstetrics (mainly involved in cesarean delivery). Proportions of essential medicines were 13/13 in the department of pediatrics and 9/10 in the department of gynaecology and obstetrics. Proportions of antibiotic medicines were 10/13 in the department of pediatrics and 8/10 in the department of gynaecology and obstetrics. Irrational drug use was mainly caused by improper use of antibiotics. Conclusion The drug use for 23 hospitalized sick and wounded is rational in the departments of gynaecology, obstetrics and paediatrics in the West China Second University Hospital during one month after Lushan earthquake. Evaluation methods of rational drug use in high-risk population are urgently needed. Using cDDD and cDUI is an active exploration for the evaluation of pediatric drug use, which needs more practice to test and improve.
Objective We evaluated effectiveness and performance of medical rescue after Lushan earthquake during 2 weeks, and enriched Wenchuan lessons to provide useful references for emergency medical rescue (EMR) after similar earthquake worldwide. Methods We collected and analyzed official information, public documents, news release, and relevant information from websites, and then we systematically reviewed and descriptively analyzed all included literature of EMR after earthquake (domestic and foreign). Results Learned from Wenchuan earthquake, EMR for Lushan earthquake were characterized as: a) Assess the situations of quake damage and injuries were scientifically assessed; human resources, funds and materials were reasonably distributed; and the EMR relied mainly on regional rescue power of Sichuan province. b) Patients’ with critical injuries were treated using “Four concentration treatment principles”, which resulted in a new medical record of zero death, 14 days after the earthquake. c) The experience of EMR after Lushan earthquake verified, enriched and improved lessons from Wenchuan, Yushu and Yiliang earthquake, which provided first-hand references of evidence-based decision making for earthquake EMR worldwide.
ObjectiveTo analyze the cases of surgical wounded characteristics after Lushan county 7.0 earthquake for government departments to formulate relevant policies to provide references for future decision-making.
MethodsThe data of surgical wounded were collected from various hospitals in Sichuan province. Origin, operation time and the injured area were counted according to gender and operation time was counted according to origin. In the descriptive statistics the frequencies and proportions were used to describe categorical data and x±SD was used to describe quantitative data. SPSS 13.0 software was used to analyze the data.
ResultsA total of 975 cases of surgical wounded included 586 cases of male (accounting for 60.10%) and 389 cases of female (accounting for 39.90%). The average age of the surgical wounded was 40.42±20.06 years. Ya'an city had completed the largest number of surgical cases. Medical institutions completed 53.85 percent of the surgery in the first three days, 41.03 percent of the surgery from four days to seven days after the earthquake. They completed 94.88 percent of surgery in one week after the earthquake. Ya'an city was the largest city in the number of surgical cases within 3 days after the earthquake. Medical institutions directly under the province and the Ministry of Health medical institutions in Sichuan were the largest medical institutions in number of surgical cases from four days to seven days after the earthquake. The largest number of cases was wounded ankle and foot injuries, followed by the abdomen, lower back, lumbar spine and pelvis injuries, once again the knee and calf injuries, and finally the head injury.
ConclusionIn the face of natural disasters like earthquakes, the health care system should establish a reasonable and effective medical emergency response mechanisms and plans, and establish a scientific and rational triage mechanism. Multi-disciplines such as orthopedics and surgery should be ready ahead of first aid equipment and emergency medicine, so as to rationalize the allocation of medical resources, achieve maximum utilization of medical resources, reduce morbidity and mortality, and save surgical treatment time for more wounded.
Objective To analyze the injury and dysfunction as well as the rehabilitation status and demand of the 188 Lushan earthquake victims admitted in the hospitals in and around Ya’an city and the West China Hospital of Sichuan University, so as to provide guidance for the rehabilitation work in the following step. Methods By means of the onsite investigation, 122 victims admitted in 7 hospitals and 2 health centers in and around Ya’an city within 1-9 days after Lushan earthquake, and the other 66 victims treated in the West China Hospital of Sichuan University were analyzed. Results The injury categorization of 122 victims in and around Ya’an city was as follows: upper limb fracture (12.30%), lower limb fracture (42.62%), spine fracture (16.39%) (25.00% treated by surgery and 75.00% treated by non-surgery treatment), pelvis fracture (1.64%), rib fracture (4.10%), traumatic brain injury (10.66%), soft tissue contusion (8.20%), and others (4.09%). At the corresponding period, the injury categorization of 66 victims treated in the department of rehabilitation medicine of the West China Hospital of Sichuan University was as follows: fracture (77.27%), traumatic brain injury (3.03%), spinal cord injury (4.55%), and others, including soft tissue injury (15.15%). At the ninth day after earthquake, among the 122 victims in and around Ya’an city, 8 victims (6.56%) were recovered with self-care ability of daily living, and the other 144 (93.44%) still needed the strengthened rehabilitation treatment. At the corresponding period, among the 66 victims in the West China Hospital, one victim (1.52%) was recovered with self-care ability of daily living, and the other 65 (98.48%) still needed the strengthened rehabilitation treatment. Conclusion Early rehabilitation treatment such as active exercise, elevating injured limbs, physical therapy, turning over at regular time, and psychological intervention can help the earthquake victims to return to home and society early.
Objective To collect the clinical data of victims with traumatic brain injury (TBI) admitted in the West China Hospital of Sichuan University within 2 weeks after 4.20 Lushan earthquake, and to analyze their clinical characteristics and effects of early rehabilitation, so as to provide baseline data for rescue TBI victims with the early rehabilitation treatment during emergency medical rescue. Methods A total of 392 victims admitted in the hospital from April 20th, 2013 to May 3rd, 2013 were screened, of which the TBI victims were clinically assessed and treated with early rehabilitation. Then both the activities of daily living (ADL) and the Rancho Los Amigos Cognitive Recovery Scale (RLA) before and after the treatment were analyzed. The data were input by Excel software, and the statistical analysis was performed by SPSS softwar. Results A total of 51 TBI victims at age from 3 to 84 years old were included finally. The categories of TBI included subarachnoid hemorrhage (41.2%), intracranial hematoma (33.3%) and mixed type (33.3%), and the severity were associated with the type of TBI. The GCS score of cerebral concussion was higher (13.25 ± 0.62) while that of the diffuse axonal injury was lower (4.50 ± 0.71). All victims (100%) had limited ADL, 74.51% had cognitive dysfunction, 9.80% had speech disorder, and 7.84% had dysphagia. After the early rehabilitation treatment, both ADL (before treatment: 34.82 ± 58.29, after treatment: 69.63 ± 22.29) and RLA (pre-treatment: 4.16 ± 1.24, treatment: 7.20 ± 1.69) were obviously higher than those before treatment, with statistical differences (both P lt;0.05). Conclusion The TBI categories of Lushan earthquake victims are various and mixed, and the severity associated with the type of TBI. All TBI victims are accompanied with more clinical problems and functional limitation. Early rehabilitation treatment is safe and effective to improve ADL and RLA as well.
Objective
To comparatively analyze the rationality of emergency medication after Wenchuan earthquake with that after Lushan earthquake in West China Hospital of Sichuan University, based on the use of medicine of the victim’s disease spectrum.
Method
By using Excel, defined daily dose system (DDDs) and drug utilization index (DUI) were used as the evaluation indexes to analyze the rationality of emergency medication in West China Hospital of Sichuan University within one month after Wenchuan earthquake and Lushan earthquake.
Results
Within one month after Wenchuan and Lushan earthquake, there were 1 839 and 488 victims treated in the hospital, respectively. Within one month after the two earthquakes, the variation tendency of DDDs of drugs and number of victims was consistent, and the consistency was better in Lushan earthquake than that in Wenchuan earthquake. Among the 60 drugs which DDDs were ranked top five in their pharmacological class (top ten for antimicrobials) in Wenchuan earthquake, the majority of them were injections (injections vs. non-injections: 70.0% vs. 30.0%); the results showed that the medication (DUI=1) only accounted for 10.0%, the medication (DUI<1) accounted for 28.3%, which implied that the use of drugs was insufficient, the medication (DUI>1) accounted for 61.7%, which implied that drugs were overused; the average of DUI was 1.61. And in Lushan earthquake, injections also accounted for a larger proportion than non-injections (63.3%vs. 36.7%); the results showed that the medication (DUI=1) accounted for 15.0%, the medication (DUI<1) accounted for 38.3%, the medication (DUI>1) accounted for 46.7%; the average of DUI was 1.30.
Conclusions
Base on the DUI, we draw the conclusion that the rationality of emergency drug use and the timeliness of emergency drug supply were better in Lushan earthquake than those in Wenchuan earthquake. But the rationality of using the DUI, which is an evaluation index for normal conditions, to evaluate the emergency conditions still needs to be further verified.
Objective To assess the impact of earthquake magnitude scale on injury characteristics of patients admitted to an earthquake rescue hospital，and provide references for rescue strategy formulation and medical resourceallocation. Methods We retrospectively analyzed clinical data of patients injured in 2008 “5 ? 12” Wenchuan earthquakeand 2013 “4 ? 20” Lushan earthquake who were admitted to West China Hospital of Sichuan University. Patient gender，age，time of admission，mechanisms，types and severity of injury and their prognosis were compared between the 2 groups.Results A total of 1 856 patients who were injured in Wenchuan earthquake，including 974 male and 882 female patients with their age of 45.8±22.7 years，and 316 patients who were injured in Lushan earthquake，including 174 male and 142 female patients with their age of 43.0±23.1 years，were enrolled in our study. No significant difference was found in genderor age between these 2 groups （P＞0.05）. Peak time of admission of Wenchuan earthquake patients was significantlylater than that of Lushan earthquake patients，and transfer duration of Wenchuan earthquake patients was significantly longerthan that of Lushan earthquake patients. The percentage of patients with crash injury of heavy objects or buried trauma ofWenchuan earthquake patients was significantly higher than that of Lushan earthquake patients. Injury severity and in-hospitalmortality of Wenchuan earthquake patients were significantly higher than those of Lushan earthquake patients. The proportionof patients with chest or cerebral injury of Lushan earthquake patients was significantly higher than that of Wenchuanearthquake patients. Conclusions Earthquake magnitude scale has a significant influence on mechanisms，types andseverity of injury of patients injured in earthquakes，as well as their timely transfer，management and prognosis. In earthquakeswith a comparatively lower magnitude scale，more thoracic surgeons and neurosurgeons are needed to ensure timelymanagement for patients with chest or cerebral injury.
