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
Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victim...Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.展开更多
Objective：To evaluate the technical characteristics and application of mass casualty incident （MCI） primary triage （PT） methods applied in China.Data Sources：Chinese literature was searched by Chinese Academic J...Objective：To evaluate the technical characteristics and application of mass casualty incident （MCI） primary triage （PT） methods applied in China.Data Sources：Chinese literature was searched by Chinese Academic Journal Network Publishing Database （founded in June 2014）.The English literature was searched by PubMed （MEDLINE） （1950 to June 2014）.We also searched Official Websites of Chinese Central Government＇s （http：//www.gov.cn/）,National Health and Family Planning Commission of China （http：//www.nhfpc.gov.cn/）,and China Earthquake Information （http：//www.csi.ac.cn/）.Study Selection：We included studies associated with mass casualty events related to China,the PT applied in China,guidelines and standards,and application and development of the carding PT method in China.Results：From 3976 potentially relevant articles,22 met the inclusion criteria,20 Chinese,and 2 English.These articles included 13 case reports,3 retrospective analyses of MCI,two methods introductions,three national or sectoral criteria,and one simulated field testing and validation.There were a total of 19 kinds ofMCI PT methods that have been reported in China from 1950 to 2014.In addition,there were 15 kinds of PT methods reported in the literature from the instance of the application.Conclusions：The national and sectoral current triage criteria are developed mainly for earthquake relief.Classification is not clear.Vague criteria （especially between moderate and severe injuries） operability are not practical.There are no triage methods and research for children and special populations.There is no data and evidence supported triage method.We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real,practical,and efficient PT method.展开更多
Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and paralle...Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution （ACP） method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine （CBM） databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words：“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident （MCI） were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI.展开更多
Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further...Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further a discussion on upper and lower limb reconstruction following MCIs.Methods: Review of the literature, including our institute's experience with the 2013 Boston Marathon Bombings, the 2015-2016 Terror Attacks in Ankara, and the 2010 earthquake in Haiti, pertaining to extremity reconstruction following MCIs.Results: The three aforementioned case profiles highlight extremity wounds associated with MCIs and the subsequent reconstructive role of plastic surgeons. Surgical intervention or temporization of extremity wounds is a critical responsibility of plastic surgeons in this setting. Limb salvage is possible and often the preferred option following disasters.Conclusion: Intentional or naturally occurring MCIs are a grim reality. Successful response to these events requires prompt mobilization of emergency medical staff and hospital activation. Plastic surgeons play a paramount role in multidisciplinary management of trauma with a particularly important involvement in limb reconstruction.展开更多
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.
文摘Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.
文摘Objective：To evaluate the technical characteristics and application of mass casualty incident （MCI） primary triage （PT） methods applied in China.Data Sources：Chinese literature was searched by Chinese Academic Journal Network Publishing Database （founded in June 2014）.The English literature was searched by PubMed （MEDLINE） （1950 to June 2014）.We also searched Official Websites of Chinese Central Government＇s （http：//www.gov.cn/）,National Health and Family Planning Commission of China （http：//www.nhfpc.gov.cn/）,and China Earthquake Information （http：//www.csi.ac.cn/）.Study Selection：We included studies associated with mass casualty events related to China,the PT applied in China,guidelines and standards,and application and development of the carding PT method in China.Results：From 3976 potentially relevant articles,22 met the inclusion criteria,20 Chinese,and 2 English.These articles included 13 case reports,3 retrospective analyses of MCI,two methods introductions,three national or sectoral criteria,and one simulated field testing and validation.There were a total of 19 kinds ofMCI PT methods that have been reported in China from 1950 to 2014.In addition,there were 15 kinds of PT methods reported in the literature from the instance of the application.Conclusions：The national and sectoral current triage criteria are developed mainly for earthquake relief.Classification is not clear.Vague criteria （especially between moderate and severe injuries） operability are not practical.There are no triage methods and research for children and special populations.There is no data and evidence supported triage method.We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real,practical,and efficient PT method.
文摘Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution （ACP） method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine （CBM） databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words：“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident （MCI） were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI.
文摘Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further a discussion on upper and lower limb reconstruction following MCIs.Methods: Review of the literature, including our institute's experience with the 2013 Boston Marathon Bombings, the 2015-2016 Terror Attacks in Ankara, and the 2010 earthquake in Haiti, pertaining to extremity reconstruction following MCIs.Results: The three aforementioned case profiles highlight extremity wounds associated with MCIs and the subsequent reconstructive role of plastic surgeons. Surgical intervention or temporization of extremity wounds is a critical responsibility of plastic surgeons in this setting. Limb salvage is possible and often the preferred option following disasters.Conclusion: Intentional or naturally occurring MCIs are a grim reality. Successful response to these events requires prompt mobilization of emergency medical staff and hospital activation. Plastic surgeons play a paramount role in multidisciplinary management of trauma with a particularly important involvement in limb reconstruction.
