Lin Chieh-Hung, Chen Wei-Lun, Wu Bor-Hen, Hung Tzu-Yao
Taipei City Hospital, Zhong-Xing branch Department of Emergency Medicine Taipei Taiwan.
National Chiao Tung University Department of Biomedical Science and Technology College of Biological science and Technology.
J Acute Med. 2019 Sep 1;9(3):110-117. doi: 10.6705/j.jacme.201909_9(3).0003.
The Formosa Fun Coast Dust Explosion is one of the major national disasters in Taiwan. The Taipei City Hospital (TCH), a regional hospital without a burn unit, received 33 patients out of 499 casualties in the initial response period. This retrospective study aimed to review the primary response of TCH and the outcome and mortality of the patients who were initially managed at TCH.
Basic profi les, total body surface area (TBSA) with burn injury, facial burn injury, vital signs, laboratory data, intubation rate and clinical outcomes, such as urine output and mortality, were analyzed. Moreover, the emergency department (ED) response faculties, who were involved in the initial response, were interviewed about the critical decision-making processes during the patient surge in the ED.
The average initial estimated TBSA with burn injury in ED was 34.2%, and the average final TBSA assessed in the intensive care unit was 41.0%. The patients with facial burn injury were 38.7%, and the intubation rate was 22.6%. When comparing the result of TCH to the patient group transferred directly to Chang Gung Memorial Hospital (CGMH), and the group received by CGMH from other hospital, the mortality rate was 0.0, 5.7, 9.1%; and the delayed intubation rate was 3.0, 14.3, 27.3%, respectively. The key elements for effi cient initial response were the multidisciplinary response team cooperated as a production line, using the clipboards for orders recordings, and the plastic surgeons ED-operating room (OR) direct transferring.
Regarding airway complications, and mortality, patients who were initially managed in TCH had comparable results with patients directly sent to the burn centers. This study supports the notion that immediate resuscitation in multiple level of hospitals, even without burn units but with adequate recruited response personnel, provided the best chance for the survival of casualties during such national disasters.
八仙尘爆是台湾重大的全国性灾难之一。台北市立联合医院（TCH）是一家没有烧伤科的区域医院，在初期响应阶段接收了499名伤者中的33名患者。这项回顾性研究旨在回顾台北市立联合医院的初期响应情况以及在该院接受初期治疗的患者的结局和死亡率。
分析患者的基本资料、烧伤的总体表面积（TBSA）、面部烧伤情况、生命体征、实验室数据、插管率以及尿量和死亡率等临床结局。此外，还对参与初期响应的急诊科（ED）响应人员就急诊科患者激增期间的关键决策过程进行了访谈。
急诊科最初估计的平均烧伤TBSA为34.2%，重症监护病房评估的最终平均TBSA为41.0%。面部烧伤患者占38.7%，插管率为22.6%。将台北市立联合医院的结果与直接转至长庚纪念医院（CGMH）的患者组以及由其他医院转至长庚纪念医院的患者组进行比较，死亡率分别为0.0%、5.7%、9.1%；延迟插管率分别为3.0%、14.3%、27.3%。高效初期响应的关键要素包括多学科响应团队像生产线一样协同工作、使用写字板记录医嘱以及整形外科医生在急诊科与手术室之间直接转运患者。
在气道并发症和死亡率方面，在台北市立联合医院接受初期治疗的患者与直接送至烧伤中心的患者结果相当。本研究支持这样一种观点，即在多层级医院中，即使没有烧伤科，但有足够的招募响应人员进行即时复苏，能为这类全国性灾难中的伤者提供最佳的生存机会。
