Hogan D E, Waeckerle J F, Dire D J, Lillibridge S R
Section of Emergency Medicine, Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA.
Ann Emerg Med. 1999 Aug;34(2):160-7. doi: 10.1016/s0196-0644(99)70224-6.
To collect descriptive epidemiologic injury data on patients who suffered acute injuries after the April 19, 1995, Oklahoma City bombing and to describe the effect on metropolitan emergency departments.
A retrospective review of the medical records of victims seen for injury or illness related to the bombing at 1 of the 13 study hospitals from 9:02 AM to midnight April 19, 1995. Rescue workers and nontransported fatalities were excluded.
Three hundred eighty-eight patients met inclusion criteria; 72 (18.6%) were admitted, 312 (80.4%) were treated and released, 3 (.7%) were dead on arrival, and 1 had undocumented disposition. Patients requiring admission took longer to arrive to EDs than patients treated and released (P =.0065). The EDs geographically closest to the blast site (1.5 radial miles) received significantly more victims than more distant EDs (P <.0001). Among the 90 patients with documented prehospital care, the most common interventions were spinal immobilization (964/90, 71.1%), field dressings (40/90, 44.4%), and intravenous fluids (32/90, 35.5%). No patients requiring prehospital CPR survived. Patients transported by EMS had higher admission rates than those arriving by any other mode (P <.0001). The most common procedures performed were wound care and intravenous infusion lines. The most common diagnoses were lacerations/contusion, fractures, strains, head injury, abrasions, and soft tissue foreign bodies. Tetanus toxoid, antibiotics, and analgesics were the most common pharmaceutical agents used. Plain radiology, computed tomographic radiology, and the hospital laboratory were the most significantly utilized ancillary services.
EMS providers tended to transport the more seriously injured patients, who tended to arrive in a second wave at EDs. The closest hospitals received the greatest number of victims by all transport methods. The effects on pharmaceutical use and ancillary service were consistent with the care of penetrating and blunt trauma. The diagnoses in the ED support previous reports of the complex but often nonlethal nature of bombing injuries.
收集1995年4月19日俄克拉何马城爆炸案后遭受急性损伤患者的描述性流行病学损伤数据，并描述对大都市急诊科的影响。
对1995年4月19日上午9:02至午夜在13家研究医院之一因与爆炸相关的损伤或疾病就诊的受害者病历进行回顾性研究。救援人员和未转运的死亡者被排除在外。
388名患者符合纳入标准；72人（18.6%）入院，312人（80.4%）接受治疗后出院，3人（0.7%）到达时死亡，1人处置情况未记录。需要入院的患者比接受治疗后出院的患者到达急诊科的时间更长（P = 0.0065）。地理上最靠近爆炸现场（半径1.5英里）的急诊科接收的受害者明显多于距离较远的急诊科（P < 0.0001）。在90名有院前护理记录的患者中，最常见的干预措施是脊柱固定（964/90，71.1%）、现场包扎（40/90，44.4%）和静脉输液（32/90，35.5%）。没有需要院前心肺复苏的患者存活。由紧急医疗服务（EMS）转运的患者入院率高于通过任何其他方式到达的患者（P < 0.0001）。最常进行的操作是伤口护理和静脉输液。最常见的诊断是撕裂伤/挫伤、骨折、拉伤、头部损伤、擦伤和软组织异物。破伤风类毒素、抗生素和镇痛药是最常用的药剂。普通放射学、计算机断层放射学和医院实验室是使用最频繁的辅助服务。
EMS提供者倾向于转运伤势较重的患者，这些患者往往会在第二波到达急诊科。所有运输方式中，距离最近的医院接收的受害者数量最多。对药物使用和辅助服务的影响与穿透性和钝性创伤的护理一致。急诊科的诊断支持了先前关于爆炸伤复杂但通常非致命性质的报道。
