The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three fact...The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three factors: the initial injury degree, the trap surroundings and the physique of the cornered, a function SFC (State-Function of Casualties) can be naturally constructed. Through parameter analysis from eight pieces of figures, it can be found that the trapped with weaker physique and worse initial injury degree and in more adverse trap surroundings deserves sooner rescue.展开更多
Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit...Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit information during battlefield treatment and medical evacuation. This equipment consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.展开更多
1 Geography Location At 16：30 on August 3rd, 2014, Ludian County, Zhaotong City, Yunnan Province （27.1°N, 103.3°E） was hit by Ms 6.5 earthquake, with the maximum intensity is 9 and epicenter depth is aro...1 Geography Location At 16：30 on August 3rd, 2014, Ludian County, Zhaotong City, Yunnan Province （27.1°N, 103.3°E） was hit by Ms 6.5 earthquake, with the maximum intensity is 9 and epicenter depth is around 12 km （Figs. 1 and 2）.展开更多
The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta Nation...The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject’s inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including;assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.展开更多
Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences ...Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.展开更多
Objective： To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods： Data were extracted from the Army Staff Headquarters based on dai...Objective： To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods： Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results： During 52 days, Tehran was stroked by 118 A1-Hussein missiles （a modified version of Scud missile）. Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured （4.9 deaths and 18.3 injuries per missile）. During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons （24%） were excluded due to the lack of information. Among the remainders, 179 （55.8%） were maleand 142 （44.2%） were female. The mean age of the victims was 25.3 years＋19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. Conclusion： The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile at- tacks are necessary.展开更多
Currently,the number of lightning casualties and casualty rates have significantly reduced in developed countries,but there has been no significant reduction in developing countries.On the one hand,this is due to the ...Currently,the number of lightning casualties and casualty rates have significantly reduced in developed countries,but there has been no significant reduction in developing countries.On the one hand,this is due to the high frequency of lightning;on the other hand,the vulnerability of people in developing countries is also an influencing factor.Through case analysis and summary,this paper expounds on lightning injury s mechanism and clinical manifestations.It points out that lightning injury is mainly related to heart problems and the impact on the nervous system,rather than burns,which usually cause fewer consequences.Medical treatment needs to pay attention to the order and principles of treatment.Implementing CPR and auxiliary AED is the most effective way to save lives.Attention should be paid to the practical and effective treatment and nursing of lightning stroke sequelae.Finally,combined with the situation of lightning casualties in China,the existing problems are put forward during the process of early treatment,post-hospital treatment,and nursing observation,which provides an objective basis for the cognition of the scientific nature of the lightning injury.展开更多
In this study, we swiftly determined the focal parameters(focal mechanism, seismic imaging process, magnitude)of the Jishishan earthquake, leveraging a solved fault model to assess the intensity field and casualties p...In this study, we swiftly determined the focal parameters(focal mechanism, seismic imaging process, magnitude)of the Jishishan earthquake, leveraging a solved fault model to assess the intensity field and casualties promptly.The investigation began by retrieving the source mechanism through the P-wave initial motion and W-phase method. This enabled us to chart the spatial and temporal distribution of energy release in the source area via the back-projection technique. Following this, we estimated the earthquake's intensity field by merging the source inversion findings with the ground motion prediction equation. This analysis facilitated the evaluation of earthquake casualties, utilizing the theoretical intensity field and a casualty assessment model. Our findings indicate that the fault type is a thrust fault, characterized by a unilateral rupture in the direction of NW, with a rupture length spanning approximately 10–15 km and a duration ranging between 8 and 10 s. The earthquake's magnitude varied from M 5.9 to M 6.2. The demarcated high-intensity areas, as per our intensity assessment, align closely with the actual survey results. Furthermore, the predicted total casualties and identified critical rescue zones closely match the real-world casualty figures. These insights offer crucial technical support for governmental emergency command and rescue operations.展开更多
Most of the current studies on drunk driving accidents focus on law making and public education. However, especially in China, there is less statistical analysis on the severity of drunk driving accidents between driv...Most of the current studies on drunk driving accidents focus on law making and public education. However, especially in China, there is less statistical analysis on the severity of drunk driving accidents between driving under the influence of alcohol (DUI) and driving while intoxicated (DWI). 3368 drunk driving related crashes were collected from the blood-alcohol test report in a city of China at 2012 and 2013. After data pre-processing, Chi-square tests were used to analyze the association between different variables and the type of drunk driving. The logistic regression model is conducted to estimate the effect of the variables under DUI and DWI. The results show that Hour of the day, Driver’s age, Driver’s casualties and Accident area have significant correlation with drunk driving. There was a slightly decrease by 0.995 per year with age and a slightly increase by 1.014 with time in the possibility of DWI. DWI is more likely to cause death in traffic accidents (OR = 1.316) than DUI. Driver’s deaths (OR = 2.346) is more likely to happen than the injuries (OR = 1.910) under DWI cases. These findings show that more attention should be paid to strengthen controls on the DWI. It also can provide important basis for accident prevent, traffic law enforcement and traffic management.展开更多
The Second Lebanon War between Hezbollah and Israel broke out on July 12, 2006, and lasted until August 14, 2006. Out of the wounded Israeli soldiers, 128 were treated at the orthopedic departments of the Rambam Medic...The Second Lebanon War between Hezbollah and Israel broke out on July 12, 2006, and lasted until August 14, 2006. Out of the wounded Israeli soldiers, 128 were treated at the orthopedic departments of the Rambam Medical Center, Haifa, Israel. Aretrospective study was carried out on these 128 combatants. The objective of the study was to characterize musculoskeletal combat wounds with regard to age, type, location, mechanism, side and intensity. The average age of an injured soldier was 25.7 years. Most injuries (63.9%) were caused by shrapnel. The prevalence of injury to the lower limb was much higher compared with upper limb (43.4% vs. 28.3%). There was no side preference. A considerable number of soldiers had more than one injury (60%). The majority of wounds that occurred in the Second Lebanon War were orthopedic-related, particularly involving the upper and lower extremities. Fragmenting weapons were responsible for most injuries.展开更多
Accidental radiation exposure and the threat of deliberate radiation exposure have been in the news and are a public health concern. Experience with acute radiation sickness has been gathered from atomic blast survivo...Accidental radiation exposure and the threat of deliberate radiation exposure have been in the news and are a public health concern. Experience with acute radiation sickness has been gathered from atomic blast survivors of Hiroshima and Nagasaki and from civilian nuclear accidents as well as experience gained during the development of radiation therapy for cancer. This paper reviews the medical treatment reports relevant to acute radiation sickness among the survivors of atomic weapons at Hiroshima and Nagasaki, among the victims of Chernobyl, and the two cases described so far from the Fukushima Dai-Ichi disaster. The data supporting the use of hematopoietic stem cell transplantation and the new efforts to expand stem cell populations ex vivo for infusion to treat bone marrow failure are reviewed. Hematopoietic stem cells derived from bone marrow or blood have a broad ability to repair and replace radiation induced damaged blood and immune cell production and may promote blood vessel formation and tissue repair. Additionally, a constituent of bone marrow-derived, adult pluripotent stem cells, very small embryonic like stem cells, are highly resistant to ioniz-ing radiation and appear capable of regenerating radiation damaged tissue including skin, gut and lung.展开更多
Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number...Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics;emergency plans;equipment and infrastructure;collaborative agreements;personnel trainings;emergency communications;laboratory facilities;treatment protocols;security;and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.展开更多
Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia ind...Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia induced suspended animation for delayed resuscitation(SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest(CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.Methods: Sixteen male BAMA minipigs were randomized into two groups: CA90 group(90 min, n =8) and CA120 group(120 min, n =8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution(OPS), cardioplegia and profound hypothermia(15℃) were induced. After CA, cardiopumonary bypass(CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase(ALT), aspartate aminotransferase(AST), creatinine(CR), lactic dehydrogenase(LDH) and troponin T(TnT)] and survival were observed from pre-operation to 7 days post-operation.Results: Fifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation(ALT 84.43±18.65 U/L; AST 88.99±23.19 U/L; Cr 87.90±24.49μmol/L; LDH 1894.13±322.26 U/L; TnT 0.849±0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation(ALT 52.48±9.04 U/L; AST 75.23±21.46 U/L; Cr 82.69±18.41μmol/L; LDH 944.67±834.32 U/L; TnT 0.336±0.076 ng/ml).Conclusion: Profound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min(at 15℃) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15℃ is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15℃ can lead to safe recovery.展开更多
Cities ability reducing earthquake disasters is a complex system involving numerous factors, moreover the re-search on evaluating cities ability reducing earthquake disasters relates to multi-subject, such as earthqua...Cities ability reducing earthquake disasters is a complex system involving numerous factors, moreover the re-search on evaluating cities ability reducing earthquake disasters relates to multi-subject, such as earthquake sci-ence, social science, economical science and so on. In this paper, firstly, the conception of cities ability reducing earthquake disasters is presented, and the ability could be evaluated with three basic elements the possible seis-mic casualty and economic loss during the future earthquakes that are likely to occur in the city and its surround-ings and time required for recovery after earthquake; based upon these three basic elements, a framework, which consists of six main components, for evaluating citys ability reducing earthquake disasters is proposed; then the statistical relations between the index system and the ratio of seismic casualty, the ratio of economic loss and re-covery time are gained utilizing the cities prediction results of earthquake disasters which were made during the ninth five-year plan; at last, the method defining the comprehensive index of cities ability reducing earthquake disasters is presented. Thus the relatively comprehensive theory frame is set up. The frame can evaluate cities ability reducing earthquake disasters absolutely and quantitatively and consequently instruct the decision-making on reducing cities earthquake disasters loss.展开更多
Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the Wor...Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11 th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.展开更多
BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage ...BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental health.However,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental burden.AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds.Active and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological status.RESULTS Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control group.In addition,the color,thickness,vascular distribution and softness score of the scars improved(P<0.01),and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair,limb functional exercise,anti-scar and psychological rehabilitation.展开更多
Analysis of casualties due to landslides from 2000 to 2012 revealed that their spa- tial pattern was affected by terrain and other natural environmental factors, which resulted in a higher distribution of landslide ca...Analysis of casualties due to landslides from 2000 to 2012 revealed that their spa- tial pattern was affected by terrain and other natural environmental factors, which resulted in a higher distribution of landslide casualty events in southern China than in northern China. Hotspots of landslide-generated casualties were in the western Sichuan mountainous area and Yunnan-Guizhou Plateau region, southeast hilly area, northern part of the loess hilly area and Tianshan and Qilian Mountains. However, local distribution patterns indicated that land- slide casualty events were also influenced by economic activity factors. To quantitatively analyse the influence of natural environment and human-economic activity factors, the Probability Model for Landslide Casualty Events in China （LCEC） was built based on logistic regression analysis. The results showed that relative relief, GDP growth rate, mean annual precipitation, fault zones, and population density were positively correlated with casualties caused by landslides. Notably, GDP growth rate ranked only second to relative relief as the primary factors in the probability of casualties due to landslides. The occurrence probability of a landslide casualty event increased 2.706 times with a GDP growth rate increase of 2.72%. In contrast, vegetation coverage was negatively correlated with casualties caused by land- slides. The LCEC model was then applied to calculate the occurrence probability of landslide casualty events for each county in China. The results showed that there are 27 counties with high occurrence probability but zero casualty events. The 27 counties were divided into three categories： poverty-stricken counties, mineral-rich counties, and real-estate overexploited counties; these are key areas that should be emphasized in reducing landslide risk.展开更多
The role of point-of-care ultrasound in mass casualty incidents(MCIs)is still evolving.Occasionally,hospitals can be destroyed by disasters resulting in large number of trauma patients.CAVEAT and FASTER ultrasound pro...The role of point-of-care ultrasound in mass casualty incidents(MCIs)is still evolving.Occasionally,hospitals can be destroyed by disasters resulting in large number of trauma patients.CAVEAT and FASTER ultrasound protocols,which are used in MCIs,included extremity ultrasound examination as part of them.The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs.The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively.Nevertheless,majority of these studies were in children and they had very high heterogeneity.The portability,safety,repeatability,and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs.Its potential in managing fractures in MCIs needs to be further defined.The operator should master the technique,understand its limitations,and most importantly correlate the sonographic findings with the clinical ones to be useful.This editorial critically reviews the literature on this topic,describes its principles and techniques,and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.展开更多
Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in ord...Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in order to outline and develop an improved research paradigm for MCI management. Methods： We searched PubMed, EMBASE China Wanfang, and China Biology Medicine （CBM） databases for relevant studies. The following key words and medical subject headings were used： ＇mass casualty incident＇, ＇MCI＇, ＇research method＇, ＇Wenchuan＇, ＇earthquake＇, ＇research paradigm＇, ＇science of surge＇, ＇surge＇, ＇surge capacity＇, and ＇vulnerability＇. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results： The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods （medical severity index （MSI）, potential injury creating event （PICE） classification, and disaster severity scale （DSS））, which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored--vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions： This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.展开更多
Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,an...Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care settings.The increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be developed.Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute triage.The protocol is two-tiered,based on the urgency and technical difficulty of the sonographic examination.In addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone fractures.Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.展开更多
文摘The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three factors: the initial injury degree, the trap surroundings and the physique of the cornered, a function SFC (State-Function of Casualties) can be naturally constructed. Through parameter analysis from eight pieces of figures, it can be found that the trapped with weaker physique and worse initial injury degree and in more adverse trap surroundings deserves sooner rescue.
基金the funding from the Military Program during the 12th Five-year Plan Period,Proposal No.2011YY027
文摘Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit information during battlefield treatment and medical evacuation. This equipment consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.
文摘1 Geography Location At 16：30 on August 3rd, 2014, Ludian County, Zhaotong City, Yunnan Province （27.1°N, 103.3°E） was hit by Ms 6.5 earthquake, with the maximum intensity is 9 and epicenter depth is around 12 km （Figs. 1 and 2）.
文摘The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject’s inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including;assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.
文摘Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.
文摘Objective： To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods： Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results： During 52 days, Tehran was stroked by 118 A1-Hussein missiles （a modified version of Scud missile）. Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured （4.9 deaths and 18.3 injuries per missile）. During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons （24%） were excluded due to the lack of information. Among the remainders, 179 （55.8%） were maleand 142 （44.2%） were female. The mean age of the victims was 25.3 years＋19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. Conclusion： The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile at- tacks are necessary.
文摘Currently,the number of lightning casualties and casualty rates have significantly reduced in developed countries,but there has been no significant reduction in developing countries.On the one hand,this is due to the high frequency of lightning;on the other hand,the vulnerability of people in developing countries is also an influencing factor.Through case analysis and summary,this paper expounds on lightning injury s mechanism and clinical manifestations.It points out that lightning injury is mainly related to heart problems and the impact on the nervous system,rather than burns,which usually cause fewer consequences.Medical treatment needs to pay attention to the order and principles of treatment.Implementing CPR and auxiliary AED is the most effective way to save lives.Attention should be paid to the practical and effective treatment and nursing of lightning stroke sequelae.Finally,combined with the situation of lightning casualties in China,the existing problems are put forward during the process of early treatment,post-hospital treatment,and nursing observation,which provides an objective basis for the cognition of the scientific nature of the lightning injury.
基金supported by the Fundamental Research Funds of the Institute of Earthquake Predic-tion, China Earthquake Administration (2023IESLZ04)the Gansu Provincial Key Talent Project。
文摘In this study, we swiftly determined the focal parameters(focal mechanism, seismic imaging process, magnitude)of the Jishishan earthquake, leveraging a solved fault model to assess the intensity field and casualties promptly.The investigation began by retrieving the source mechanism through the P-wave initial motion and W-phase method. This enabled us to chart the spatial and temporal distribution of energy release in the source area via the back-projection technique. Following this, we estimated the earthquake's intensity field by merging the source inversion findings with the ground motion prediction equation. This analysis facilitated the evaluation of earthquake casualties, utilizing the theoretical intensity field and a casualty assessment model. Our findings indicate that the fault type is a thrust fault, characterized by a unilateral rupture in the direction of NW, with a rupture length spanning approximately 10–15 km and a duration ranging between 8 and 10 s. The earthquake's magnitude varied from M 5.9 to M 6.2. The demarcated high-intensity areas, as per our intensity assessment, align closely with the actual survey results. Furthermore, the predicted total casualties and identified critical rescue zones closely match the real-world casualty figures. These insights offer crucial technical support for governmental emergency command and rescue operations.
文摘Most of the current studies on drunk driving accidents focus on law making and public education. However, especially in China, there is less statistical analysis on the severity of drunk driving accidents between driving under the influence of alcohol (DUI) and driving while intoxicated (DWI). 3368 drunk driving related crashes were collected from the blood-alcohol test report in a city of China at 2012 and 2013. After data pre-processing, Chi-square tests were used to analyze the association between different variables and the type of drunk driving. The logistic regression model is conducted to estimate the effect of the variables under DUI and DWI. The results show that Hour of the day, Driver’s age, Driver’s casualties and Accident area have significant correlation with drunk driving. There was a slightly decrease by 0.995 per year with age and a slightly increase by 1.014 with time in the possibility of DWI. DWI is more likely to cause death in traffic accidents (OR = 1.316) than DUI. Driver’s deaths (OR = 2.346) is more likely to happen than the injuries (OR = 1.910) under DWI cases. These findings show that more attention should be paid to strengthen controls on the DWI. It also can provide important basis for accident prevent, traffic law enforcement and traffic management.
文摘The Second Lebanon War between Hezbollah and Israel broke out on July 12, 2006, and lasted until August 14, 2006. Out of the wounded Israeli soldiers, 128 were treated at the orthopedic departments of the Rambam Medical Center, Haifa, Israel. Aretrospective study was carried out on these 128 combatants. The objective of the study was to characterize musculoskeletal combat wounds with regard to age, type, location, mechanism, side and intensity. The average age of an injured soldier was 25.7 years. Most injuries (63.9%) were caused by shrapnel. The prevalence of injury to the lower limb was much higher compared with upper limb (43.4% vs. 28.3%). There was no side preference. A considerable number of soldiers had more than one injury (60%). The majority of wounds that occurred in the Second Lebanon War were orthopedic-related, particularly involving the upper and lower extremities. Fragmenting weapons were responsible for most injuries.
文摘Accidental radiation exposure and the threat of deliberate radiation exposure have been in the news and are a public health concern. Experience with acute radiation sickness has been gathered from atomic blast survivors of Hiroshima and Nagasaki and from civilian nuclear accidents as well as experience gained during the development of radiation therapy for cancer. This paper reviews the medical treatment reports relevant to acute radiation sickness among the survivors of atomic weapons at Hiroshima and Nagasaki, among the victims of Chernobyl, and the two cases described so far from the Fukushima Dai-Ichi disaster. The data supporting the use of hematopoietic stem cell transplantation and the new efforts to expand stem cell populations ex vivo for infusion to treat bone marrow failure are reviewed. Hematopoietic stem cells derived from bone marrow or blood have a broad ability to repair and replace radiation induced damaged blood and immune cell production and may promote blood vessel formation and tissue repair. Additionally, a constituent of bone marrow-derived, adult pluripotent stem cells, very small embryonic like stem cells, are highly resistant to ioniz-ing radiation and appear capable of regenerating radiation damaged tissue including skin, gut and lung.
文摘Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics;emergency plans;equipment and infrastructure;collaborative agreements;personnel trainings;emergency communications;laboratory facilities;treatment protocols;security;and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.
基金supported by the Major Project for Equipment Development of PLA in 2013(ASY135001)the National High Technology Research and Development Program of China(2015AA020312)
文摘Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia induced suspended animation for delayed resuscitation(SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest(CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.Methods: Sixteen male BAMA minipigs were randomized into two groups: CA90 group(90 min, n =8) and CA120 group(120 min, n =8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution(OPS), cardioplegia and profound hypothermia(15℃) were induced. After CA, cardiopumonary bypass(CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase(ALT), aspartate aminotransferase(AST), creatinine(CR), lactic dehydrogenase(LDH) and troponin T(TnT)] and survival were observed from pre-operation to 7 days post-operation.Results: Fifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation(ALT 84.43±18.65 U/L; AST 88.99±23.19 U/L; Cr 87.90±24.49μmol/L; LDH 1894.13±322.26 U/L; TnT 0.849±0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation(ALT 52.48±9.04 U/L; AST 75.23±21.46 U/L; Cr 82.69±18.41μmol/L; LDH 944.67±834.32 U/L; TnT 0.336±0.076 ng/ml).Conclusion: Profound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min(at 15℃) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15℃ is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15℃ can lead to safe recovery.
文摘Cities ability reducing earthquake disasters is a complex system involving numerous factors, moreover the re-search on evaluating cities ability reducing earthquake disasters relates to multi-subject, such as earthquake sci-ence, social science, economical science and so on. In this paper, firstly, the conception of cities ability reducing earthquake disasters is presented, and the ability could be evaluated with three basic elements the possible seis-mic casualty and economic loss during the future earthquakes that are likely to occur in the city and its surround-ings and time required for recovery after earthquake; based upon these three basic elements, a framework, which consists of six main components, for evaluating citys ability reducing earthquake disasters is proposed; then the statistical relations between the index system and the ratio of seismic casualty, the ratio of economic loss and re-covery time are gained utilizing the cities prediction results of earthquake disasters which were made during the ninth five-year plan; at last, the method defining the comprehensive index of cities ability reducing earthquake disasters is presented. Thus the relatively comprehensive theory frame is set up. The frame can evaluate cities ability reducing earthquake disasters absolutely and quantitatively and consequently instruct the decision-making on reducing cities earthquake disasters loss.
文摘Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11 th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.
基金Supported by Key Research and Development Project of Jiangsu Province,No.BE2018626。
文摘BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental health.However,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental burden.AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds.Active and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological status.RESULTS Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control group.In addition,the color,thickness,vascular distribution and softness score of the scars improved(P<0.01),and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair,limb functional exercise,anti-scar and psychological rehabilitation.
基金National Key Research and Development Program Project,No.2017YFC1502505,No.2016YFA0602403National Natural Science Foundation of China,No.41271544
文摘Analysis of casualties due to landslides from 2000 to 2012 revealed that their spa- tial pattern was affected by terrain and other natural environmental factors, which resulted in a higher distribution of landslide casualty events in southern China than in northern China. Hotspots of landslide-generated casualties were in the western Sichuan mountainous area and Yunnan-Guizhou Plateau region, southeast hilly area, northern part of the loess hilly area and Tianshan and Qilian Mountains. However, local distribution patterns indicated that land- slide casualty events were also influenced by economic activity factors. To quantitatively analyse the influence of natural environment and human-economic activity factors, the Probability Model for Landslide Casualty Events in China （LCEC） was built based on logistic regression analysis. The results showed that relative relief, GDP growth rate, mean annual precipitation, fault zones, and population density were positively correlated with casualties caused by landslides. Notably, GDP growth rate ranked only second to relative relief as the primary factors in the probability of casualties due to landslides. The occurrence probability of a landslide casualty event increased 2.706 times with a GDP growth rate increase of 2.72%. In contrast, vegetation coverage was negatively correlated with casualties caused by land- slides. The LCEC model was then applied to calculate the occurrence probability of landslide casualty events for each county in China. The results showed that there are 27 counties with high occurrence probability but zero casualty events. The 27 counties were divided into three categories： poverty-stricken counties, mineral-rich counties, and real-estate overexploited counties; these are key areas that should be emphasized in reducing landslide risk.
文摘The role of point-of-care ultrasound in mass casualty incidents(MCIs)is still evolving.Occasionally,hospitals can be destroyed by disasters resulting in large number of trauma patients.CAVEAT and FASTER ultrasound protocols,which are used in MCIs,included extremity ultrasound examination as part of them.The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs.The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively.Nevertheless,majority of these studies were in children and they had very high heterogeneity.The portability,safety,repeatability,and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs.Its potential in managing fractures in MCIs needs to be further defined.The operator should master the technique,understand its limitations,and most importantly correlate the sonographic findings with the clinical ones to be useful.This editorial critically reviews the literature on this topic,describes its principles and techniques,and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.
基金Project supported by the Research Fund of Ministry of Health of China(No.N20080022)the Major Science and Technology Project of Zhejiang Province(No.2009C03010-3)+1 种基金the Medical Scientific Research Foundation of Zhejiang Province(No.200921012)the Educational Commission of Zhejiang Province(No.Y200908921),China
文摘Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in order to outline and develop an improved research paradigm for MCI management. Methods： We searched PubMed, EMBASE China Wanfang, and China Biology Medicine （CBM） databases for relevant studies. The following key words and medical subject headings were used： ＇mass casualty incident＇, ＇MCI＇, ＇research method＇, ＇Wenchuan＇, ＇earthquake＇, ＇research paradigm＇, ＇science of surge＇, ＇surge＇, ＇surge capacity＇, and ＇vulnerability＇. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results： The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods （medical severity index （MSI）, potential injury creating event （PICE） classification, and disaster severity scale （DSS））, which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored--vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions： This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.
文摘Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care settings.The increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be developed.Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute triage.The protocol is two-tiered,based on the urgency and technical difficulty of the sonographic examination.In addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone fractures.Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.
