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.
A 7.0 Ms earthquake hit Lushan country at Ya’an city of Sichuan province at 8:02 am, on April 20th, 2013. Rehabilitation medicine department of the West China Hospital, a regional state-level hospital arrived at stricken area, and super early rehabilitation rescue was organized at the second day after Lushan earthquake. On the third day after Lushan earthquake, patients receiving super early rehabilitation intervention were moved forward to orthopedics, neurosurgery, thoracic surgery, pediatric surgery and ICU for super early rehabilitation intervention. Up to 6 pm, 14 days after the earthquake, 69 wounded in total were admitted in early rehabilitation. The experiences of Wenchuan earthquake has been applied, improved and sublimated more rapidly, more appropriately, more effectively in the Lushan earthquake rehabilitation rescue.
Objective To analyze the rationality of emergency medication in the West China Hospital after Lushan earthquake based on the actual drug use of earthquake victims. Methods We applied DDDs and DUI as evaluation index, input data using Excel software, and analyzed if the emergency medication was required for the injury/illness and the rationality of emergency medication. Results Earthquake victims mainly had trauma and wound infection and they were given antibiotics as main treatment one week after the earthquake. Drugs for the respiratory system and digestive system were mainly used in patients who mainly manifested as non-traumatic diseases and internal diseases four weeks after the earthquake. Among 49 kinds of drugs which could be calculated for the value of DUI, injection accounted for a larger proportion than non-injection (59.18% vs. 40.82%). The results showed that, the medication (DUI=1) only accounted for 12.24%; the medication (DUIlt;1, Mean=0.65) accounted for 38.78%, which implied insufficient drug use; the medication (DUIgt;1, Mean=1.77) accounted for 46.94%, which implied drug overuse. Conclusion Medication for every system is basically timely and rational when treating symptoms and causes in the West China Hospital within one month after Lushan earthquake. However, the rationality of emergency medications using DUI=1 under normal conditions still needs to be further verified.
Baoxing airborne medical team of West China Hospital participated in the medical rescue in 2013 “4?20”Lushan earthquake. The medical team excellently fulfilled their rescue task for 1 week in the earthquake-struck areas where there was power and communication failure and lack of water and food supply. We found some experiences and problems in airbornemedical team assembly and member selection, which may provide quotable experiences for future disaster assistance and rescue teams.
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.
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.
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 assess the public health impacts and needs, to evaluate performance of anti-epidemic efforts after Lushan earthquake, so as to provide references for the following anti-epidemic work. Methods The day of earthquake occurrence was defined as the first day after earthquake. We collected information and data from the Sichuan Provincial Government, the National Health and Family Planning Commission of the People’s Republic of China, the Health Department of Sichuan Province, Sichuan Center for Disease Control and Prevention, and then we compared the situations of disaster, public health situation in stricken area, emergency response, resource deployment, etc. with those after Wenchuan earthquake in 2008, in order to evaluate the performance of anti-epidemic response during 2 weeks, clarify current situations and demands, and offer a proposal for the following work. Results Emergency response was conducted immediately after the Lushan earthquake. The counterpart assistance was considered at the beginning of team arrangement. The number and professional structure of rescue participants were planned according to needs. Three days after earthquake, anti-epidemic staff arrived at every involved county, town, and even village, which achieved full rescue coverage of locations and interventions. The staff helped reconstruct disease surveillance system, protect source of drinking water and environmental hygiene, etc., which resulted in progressive achievement. Two weeks after the earthquake there were no outbreak and public health emergency event occurred in stricken area. Conclusion The anti-epidemic efforts after Lushan earthquake inherit and develop the lessons from Wenchuan earthquake in 2008. Emergency response is timely, orderly, scientific, and moderate. The deployment of policies, technologies and resources has already been completed during two weeks. Anti-epidemic efforts achieve preliminary results. We suggest that key issues of further work should be the implementation of policies, strategies and measures, such as health management at relocation sites, water and food hygiene, disease monitoring, prevention and control, mass vaccination, scientific disinfection, and health education, in order to improve long-efficacy mechanism and stabilize work performance.
Objective To analyze the costs of emergency medication in the West China Hospital within one month after Lushan earthquake based on actual medication of the victims’ disease spectrum. Methods We collected emergency medication data as evaluation index in the West China Hospital within one month after Lushan earthquake, including daily cost, cumulative percentage of pharmacology category, average cost per day/person, average cost per day/person when DUI=1, difference between average cost per day /person, and average cost per day/person when DUI=1, etc. Then, we input data using Excel software for statistically analyzing the costs of emergency medication within one month after the earthquake. Results During one month after the earthquake, the costs changed consistently with the number of victims, which implied the change of costs was rational. Injuries were classified into 6 categories and 12 kinds according to ICD-10. The costs of medication accounted for 71% of the total costs. Six kinds of illness accounted for 21%. Medication for injuries was classified into 3 categories and 18 kinds; average cost per day was 186.87 yuan and average cost per person was 1 702.70 yuan. Medication for illness was classified into 5 categories and 28 kinds; average cost per day was 38.96 yuan and average cost per person was 185.13 yuan. The mean value of average cost per day/person of injection was 14.52/5.08 times more than that of non-injection. Meanwhile, the mean value of average cost per day/person of imported medication was 7.10/5.28 times more than that of domestic medication. Conclusion The factors that impact the medication costs include: a) disease burden and traumatic conditions of the sick and wound; b) administration pathway (injection vs. non-injection); c) imported or domestic medication; and d) the rationality of taking DUI as evaluation index. When DUIgt;1, injection through the vein and imported medication take a larger share which increase the costs of medication. Emergency rescue package should mainly prepare for the injury. In order to ensure the timely, safe and effective medication, injection should be given priority to. We also should take into consideration crash-resistance/anti-quake package, reasonable dosage, convenience-to-use of drugs as well as the needs of the illness.
Objective To collect and analyze the data of emergency medicine supply for both Wenchuan and Lushan earthquakes victims in the West China Hospital, so as to provide evidence for scientifically and efficiently carrying out the logistical support for emergency rescue medicines supply, and improving the coping capacity for those similar public health emergencies. Methods Both medicine constituent ratios and DDDs were taken as evaluation indexes, and the data were input by Excel software. Then the following items were analyzed: the use and cost of emergency medicine for victims admitted in the hospital from one day to one month after earthquake, as well as, the acceptance, allocation and use of the donation medicines for both Wenchuan and Lusan earthquakes. Results During the first month after Lushan earthquake, the victims used 26 categories of medicines involving 455 drug specifications in the West China Hospital. The dosage and DDDs of therapeutic medicines were higher than those of ancillary medicines. The donation medicines for Lushan earthquake accepted by the hospital were in 8 categories involving 16 drug specifications, and they were all used to rescue the victims in the hospital. Based on the hospital emergency medicine supply system oriented by the information of victim’s medicine use, the drug specification and total drug cost of the donation medicines for Lushan earthquake decreased by 90.91% and 89.73%, respectively, indicating a more accurate and efficient system compared with those for Wenchuan earthquake. Conclusion The implementation of the hospital emergency medicine supply system oriented by the information of victim’s medicine use is helpful to improve the time efficiency and pertinence of earthquake medical rescue.
