Malik Zaka Ullah, Hanif Muhanmmad Shoaib, Tariq Muhammad, Aslam Rizwan, Munir Aslan Javid, Zaidi Hashim, Akmal Muhammad
Department of Orthopaedics, Combined Military Hospital, Quetta.
J Coll Physicians Surg Pak. 2006 Apr;16(4):253-6.
To determine the effectiveness of hospital management, considering triage system, hospital staff response, medical resources availability, and surgical management depending upon the nature and pattern of injuries in a mass casualty incident.
Descriptive.
Combined Military Hospital, Quetta, Pakistan in March 2004.
All injured by gunshot or blast in a terrorist attack and reported to the hospital were included in this study. Patients were triaged by the triage team using "triage sieve" into priority I, II, III, and IV. Priority I patients were further triaged by using "trauma index" to prioritize for surgery. Phase I included life saving, Phase II limb saving surgery and Phase III for debridement. All data was recorded and analyzed.
Hospital received 161 casualties among whom 20 were brought in dead, and 141 patients were admitted to the hospital. Mean age was 26.63 +/- 13.97. The cases were categorized as Priority-I 22.7%, Priority-II 14.72%, Priority-III 50.31% and Priority-IV 12.27%. Maximum casualties reached within the first 2 hours. Eighty-eight patients had pre-dominantly splinter injuries and 53 patients had dominantly gunshot wound injuries. In priority I, the trauma index was 15.55 +/- 5.74. Six patients having trauma index 20 or above could not even be resuscitated. Seventy five percent of staff reported to the hospital within 15 minutes. Only 30% of reserve medical store was consumed. Total management cost to the hospital was Rs. 362,1856/- (British Pounds approx 32,052/-.) calculated by the hospital rates for treatment of non-entitled patients. Death rate in hospital survivors was 4%.
Mass casualty management in a terrorist act requires prompt hospital response, appropriate triage, efficient surgical approach, and dedicated postoperative care. A good response can help to decrease mortality rate in salvageable injuries.
根据大规模伤亡事件中损伤的性质和模式，考虑分诊系统、医院工作人员反应、医疗资源可用性和手术管理等因素，确定医院管理的有效性。
描述性研究。
2004年3月，巴基斯坦奎达联合军事医院。
本研究纳入了在恐怖袭击中受枪伤或爆炸伤并被送往该医院的所有患者。分诊团队使用“分诊筛检法”将患者分为I、II、III和IV级优先。I级优先患者再使用“创伤指数”进行进一步分诊，以确定手术优先级。第一阶段包括挽救生命，第二阶段是保肢手术，第三阶段是清创。所有数据均进行记录和分析。
医院共接收161名伤亡人员，其中20人送达时已死亡，141名患者入院。平均年龄为26.63±13.97岁。病例分类为：I级优先22.7%，II级优先14.72%，III级优先50.31%，IV级优先12.27%。最大伤亡人数在最初2小时内到达。88名患者主要为碎片伤，53名患者主要为枪伤。在I级优先患者中，创伤指数为15.55±5.74。6名创伤指数在20或以上的患者甚至未能复苏。75%的工作人员在15分钟内报到医院。储备医疗用品仅消耗了30%。医院的总管理成本为3621856卢比（约合32052英镑），这是按照医院对无资格患者的治疗收费标准计算得出的。医院幸存者的死亡率为4%。
恐怖袭击中的大规模伤亡管理需要医院迅速反应、适当分诊、高效的手术方法和专门的术后护理。良好的反应有助于降低可挽救损伤的死亡率。
