Ashkenazi I, Turégano-Fuentes F, Einav S, Kessel B, Alfici R, Olsha O
Surgery Department, Hillel Yaffe Medical Center, P.O.Box 169, 38100, Hadera, Israel.
Emergency Surgery Department, Gregorio Marañon Medical Center, Madrid, Spain.
Eur J Trauma Emerg Surg. 2014 Aug;40(4):445-50. doi: 10.1007/s00068-014-0403-x. Epub 2014 May 1.
The unique patterns of injury following explosions together with the involvement of numerous physicians, most of whom are not experienced in trauma, may create problems in the medical management of mass casualty incidents.
Four hundred patient files admitted in 19 mass casualty events following bombing incidents were reviewed and possible areas which could impact survival were defined.
Forty-nine (9.3 %) patients had an Injury Severity Score ≥16. Of 205 patients in whom triage decisions were available, 5 of 25 severely injured patients were undertriaged by the triage officers at the door of the hospital. Following primary evaluation inside the emergency department critical injuries in two patients were missed due to distracting, less serious injuries. Of 68 (16.1 %) patients who were operated, 28 were in need of either immediate, urgent or high-priority operations. Except for neurosurgical cases which needed to be transferred to other hospitals, there was no delay in surgery. One patient underwent negative laparotomy. There were 15 in-hospital deaths, 6 of which were deemed as either anticipated or unanticipated mortality with possibility for improvement.
Medical management should be evaluated following MCIs as this may illustrate possible problems which many need to be addressed in contingency planning.
爆炸后独特的损伤模式以及众多医生的参与，其中大多数医生没有创伤治疗经验，这可能会给大规模伤亡事件的医疗管理带来问题。
回顾了19起爆炸事件后大规模伤亡事件中收治的400份患者档案，并确定了可能影响生存的潜在领域。
49名（9.3%）患者的损伤严重程度评分≥16。在205名有分诊决策的患者中，25名重伤患者中有5名在医院门口被分诊人员分诊不足。在急诊科进行初步评估后，由于存在分散注意力的不太严重的损伤，两名患者的严重损伤被漏诊。在68名（16.1%）接受手术的患者中，28名需要立即、紧急或优先手术。除了需要转往其他医院的神经外科病例外，手术没有延迟。一名患者接受了阴性剖腹探查术。有15例院内死亡，其中6例被认为是预期或意外死亡，有可能改善。
大规模伤亡事件后应评估医疗管理情况，因为这可能会揭示应急计划中许多需要解决的潜在问题。
