Maningas P A, Robison M, Mallonee S
Medical Control Board, Emergency Medical Services, Oklahoma City, OK 73103-2616 USA.
Prehosp Disaster Med. 1997 Apr-Jun;12(2):80-5.
This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors. There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion. The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.
这是一项关于紧急医疗服务应对1995年4月19日俄克拉荷马城联邦大楼爆炸事件的描述性研究。爆炸源自一辆停在大楼前的租来的卡车。爆炸的冲击力摧毁了大楼前部四根支撑柱中的三根，导致上层楼板坍塌到下层，形成了“薄饼效应”。医疗应对分为三个不同阶段：1）当地随时可用的急救救护车和工作人员；2）由召回的休班人员配备的额外救护车；3）来自周边社区的互助救护车和人员。爆炸发生时大楼内有361人，其中163人死亡。在爆炸后的第一个小时内，139名患者被送往当地医院。其中，32%处于危急状态。在爆炸当天，有444人因身体受伤接受治疗：其中410人与爆炸有关，14人（包括1名重伤者）在搜救过程中受伤。共有354人（80%）在急诊科接受治疗后出院，90人（20%）被收治入院。6名被运送的受害者在抵达急诊科时已死亡或入院后死亡。在死亡者中，95%的死亡与建筑物坍塌造成的钝器伤有关。爆炸发生后的前五个小时内，只有三人被成功救出。现场涌入了大量志愿者，尽管他们的本意是为伤者提供帮助，但却给事故指挥带来了严重的后勤问题。还吸取了其他一些教训：1）电话线和手机不堪重负，但15家医院中只有3家的医院紧急行政无线电系统能够正常运行；2）志愿者人员应该前往医院而非现场；3）培训对于此类应对行动的成功至关重要。因此，这次行动的成功得益于多机构之间的高强度培训、演练和协调。
