University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. B15 2TH.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. B15 2TH.
Injury. 2021 May;52(5):1221-1226. doi: 10.1016/j.injury.2020.11.071. Epub 2021 Jan 2.
Terrorist attacks have become more acute, less predictable and frequently involve use of explosives and gunfire to inflict mass casualty to civilians. Resource demand has been reported in Role 3 Medical Facilities but the continued resource required to manage blast and ballistic injuries has not been quantified. This study aimed to assess the resource required for blast and ballistic injuries at the United Kingdom's Role 4 Medical Facility. Military patients admitted to the Queen Elizabeth Hospital (Role 4 Medical Facility) from Afghanistan with blast or ballistic injuries during the 2012 calendar year were retrospectively reviewed. Injury pattern, theatre resource, length of stay and cost analysis were performed. This study included 99 blast and 53 gunshot wound (GSW) patients. Blast patients were more likely to suffer polytrauma than GSW (53% vs 23%), underwent more surgical procedures and utilized double the theatre time. Blast injury patients had a longer length of stay in hospital. The average cost per patient for blast patients was double that of the GSW injury cohort. The Queen Elizabeth experience represents a continuous flow of severely injured military casualties whilst managing concurrent civilian trauma over a long period. This workload has encouraged systematic advancements in managing high numbers of injured patients from point of wounding to rehabilitation. Distribution of resource, theatre planning and multi-disciplinary team working are critical in effectively managing Major Incidents such as terror attacks. Drawing on previous Role 4 Medical Facility experience can aid UK hospitals in terms of strategy and resource distribution.
恐怖袭击变得更加尖锐，更难以预测，并且经常使用爆炸物和枪支对平民造成大规模伤亡。据报道，第 3 类医疗设施需要资源，但管理爆炸和弹道伤所需的持续资源尚未量化。本研究旨在评估英国第 4 类医疗设施中爆炸和弹道伤所需的资源。回顾了 2012 年日历年内从阿富汗因爆炸或弹道伤而入住伊丽莎白女王医院（第 4 类医疗设施）的军事患者。进行了损伤模式、手术室资源、住院时间和成本分析。本研究包括 99 例爆炸伤和 53 例枪伤（GSW）患者。爆炸伤患者比 GSW 更易发生多发伤（53%比 23%），接受的手术更多，手术室时间增加一倍。爆炸伤患者在医院的住院时间更长。每位患者的平均成本是 GSW 损伤组的两倍。伊丽莎白女王的经验代表了在很长一段时间内连续处理大量严重受伤的军事人员伤亡，同时还处理了同时发生的平民创伤。这种工作量鼓励了从受伤点到康复阶段对大量受伤患者进行系统改进。资源分配、手术室规划和多学科团队合作对于有效管理重大事件（如恐怖袭击）至关重要。借鉴以前的第 4 类医疗设施经验，可以为英国医院提供战略和资源分配方面的帮助。
