农村救援系统对降低地雷受害者死亡率的影响：伊朗伊拉姆省的一项前瞻性研究。

Effect of the rural rescue system on reducing the mortality rate of landmine victims: a prospective study in Ilam Province, Iran.

作者信息

Saghafinia Masoud, Nafissi Nahid, Asadollahi Reza

机构信息

Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

出版信息

Prehosp Disaster Med. 2009 Mar-Apr;24(2):126-9. doi: 10.1017/s1049023x00006671.

DOI:10.1017/s1049023x00006671

PMID:19591306

Abstract

BACKGROUND

In several Iranian provinces, there are large numbers of landmines that threaten the lives of many civilians. Ilam is one of the most polluted areas with 1,086 injuries from landmines between 1989 to 1999, with an overall mortality rate of 36.4%. A remarkable number of deaths occurred before the injured were conveyed to the hospital. In this survey, the effects of on trauma outcome of the use of prehospital trauma life support provided by trained paramedics and rural health workers as first responders were examined.

METHODS

In an interventional, prospective study, 4,834 persons (general physicians, nurses, rural health workers, and emergency technicians, high- and low-educated people, layperson villagers, and nomads) were trained in one level of advanced (for general physicians and nurses) and four levels of basic life support courses during two years (2000-2001). Following the training, the data from 288 landmine victims who were referred to the main hospital in Ilam (trauma center) were registered prospectively (2001-2005). The effects of prehospital trauma life support training were assessed by using the Injury Severity Scale (ISS) score and prehospital physiologic severity (PSS) score.

RESULTS

There were 288 injuries from landmines in the Mehran region between 2002 and 2005. The mean ISS score was 20.3 with a median of 13. Forty percent were severely injured with an ISS score >15. Of the injured who received prehospital care at the Mehran Emergency Center, the mean value of the PSS scores was 6.40, which improved to 7.43 in the hospital (p = 0.01; 95% CI for difference -0.72 to -0.45), in comparison with 5.97 in the injured who were conveyed to Ilam Hospital directly (mean of ISS was approximately equal in both groups). The total mortality rate was 27% between 2001 and 2005.

CONCLUSIONS

Prehospital educations and training help improve PSS scores and reduce the death toll of landmine accidents in the remote areas.

摘要

背景

在伊朗的几个省份，存在大量威胁众多平民生命的地雷。伊拉姆是受污染最严重的地区之一，1989年至1999年间有1086人因地雷受伤，总死亡率为36.4%。相当数量的死亡发生在伤者被送往医院之前。在这项调查中，研究了由经过培训的护理人员和农村卫生工作者作为第一响应者提供的院前创伤生命支持对创伤结局的影响。

方法

在一项干预性前瞻性研究中，在两年（2000 - 2001年）内，对4834人（普通医生、护士、农村卫生工作者、急救技术人员、受过高等和低等教育的人、外行人村民以及游牧民）进行了一个高级水平（针对普通医生和护士）和四个基础生命支持课程水平的培训。培训后，对转诊至伊拉姆主要医院（创伤中心）的288名地雷受害者的数据进行了前瞻性记录（2001 - 2005年）。通过使用损伤严重程度评分（ISS）和院前生理严重程度（PSS）评分来评估院前创伤生命支持培训的效果。

结果

2002年至2005年间，梅赫兰地区有288人因地雷受伤。平均ISS评分为20.3，中位数为13。40%的人受重伤，ISS评分>15。在梅赫兰急救中心接受院前护理的伤者中，PSS评分的平均值为6.40，在医院时提高到7.43（p = 0.01；差异的95%置信区间为 - 0.72至 - 0.45），而直接被送往伊拉姆医院的伤者该评分为5.97（两组的平均ISS大致相等）。2001年至2005年间的总死亡率为27%。