The concept of Initial Casualty Matrix is introduced. Using some probability distribution functions, the initial casualty matrix of masonry is determined. The dynamic method of seismic casualty assessment is establish...The concept of Initial Casualty Matrix is introduced. Using some probability distribution functions, the initial casualty matrix of masonry is determined. The dynamic method of seismic casualty assessment is established and then applied to the Tangshan earthquake data, with some conclusions drawn.展开更多
To determine the individual circumstances that account for a road traffic accident,it is crucial to consider the unplanned connections amongst various factors related to a crash that results in high casualty levels.An...To determine the individual circumstances that account for a road traffic accident,it is crucial to consider the unplanned connections amongst various factors related to a crash that results in high casualty levels.Analysis of the road accident data concentrated mainly on categorizing accidents into different types using individually built classification methods which limit the prediction accuracy and fitness of the model.In this article,we proposed a multi-model hybrid framework of the weighted majority voting(WMV)scheme with parallel structure,which is designed by integrating individually implemented multinomial logistic regression(MLR)and multilayer perceptron(MLP)classifiers using three different accident datasets i.e.,IRTAD,NCDB,and FARS.The proposed WMV hybrid scheme overtook individual classifiers in terms of modern evaluation measures like ROC,RMSE,Kappa rate,classification accuracy,and performs better than state-of-theart approaches for the prediction of casualty severity level.Moreover,the proposed WMV hybrid scheme adds up to accident severity analysis through knowledge representation by revealing the role of different accident-related factors which expand the risk of casualty in a road crash.Critical aspects related to casualty severity recognized by the proposed WMV hybrid approach can surely support the traffic enforcement agencies to develop better road safety plans and ultimately save lives.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
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
Background: Mass Casualty incidents usually overwhelm the capabilities of any centre. It is an event whose nature is undetermined, unexpected and disrupts the normal trauma care in a hospital. Hospitals have establish...Background: Mass Casualty incidents usually overwhelm the capabilities of any centre. It is an event whose nature is undetermined, unexpected and disrupts the normal trauma care in a hospital. Hospitals have established protocols to deal with mass casualty when it arises. Objectives: We sought to profile the presentations of mass casualty incidents and challenges in management in a regional trauma Centre in North-West Nigeria. Methodology: A retrospective look at the records of mass casualty presentations in our centre over a 12-month period (January-December 2011) was done. A mass casualty event in our setting is the presentation to our facility of eight or more patients from the same cause at the same. Results: There were a total of 18 mass casualty presentations with an average of 1.5 per month. There were a total of 236 victims including those brought in dead (BID). Males were 203 (86%) and females 33 (16%) with an M:F ratio of 6:1. Majority of the victims 222 (94%) were above 16 years and all the victims had a common mechanism of injury which was Road traffic crashes. One hundred and forty-three (61%) of the victims sustained lacerations and bruises while 31 (13%) were polytraumatized. Sixty-two (26%) of the victims were BID’S from the scenes of the Road Crashes. The outcome was that 131 (75%) of the victims were treated and discharged while 41 (24%) were admitted for further management. Two (1%) patients died during resuscitation and within 24 hours. Conclusion: Mass casualty presentations are a regular event in our centre hence there is the need for the establishment of a protocol and regular mass casualty drills to cope with future occurrences.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
Extreme precipitation-induced landslide events are projected to increase under climate change,which poses a serious threat to human lives and property.In this study,a global-scale landslide risk assessment model was e...Extreme precipitation-induced landslide events are projected to increase under climate change,which poses a serious threat to human lives and property.In this study,a global-scale landslide risk assessment model was established using global landslide data,by considering landslide hazard,exposure,and vulnerability.The global climate model data were then employed to drive the established global landslide risk model to explore the spatial and temporal variations in future landslide risk across the globe as a result of extreme precipitation changes.The results show that compared to the 30-year period from 1971 to 2000,the average annual frequency of landslides triggered by extreme precipitation is projected to increase by 7%and 10%,respectively,in the future 30-year periods of 2031–2060 and 2066–2095.The global average annual casualty risk of landslides is projected to increase from about 3240 to 7670 and 8380,respectively(with growth rates of 140%and 160%),during the 2031–2060 and 2066–2095 periods under the SSP2-4.5 scenario.The top 10 countries with the highest casualty risk of landslides are China,Afghanistan,India,the Philippines,Indonesia,Rwanda,Turkey,Nepal,Guatemala,and Brazil,60%of which are located in Asia.The frequency and intensity of extreme precipitation will increase under climate change,which will lead to an increase in casualties from landslides in mountainous areas globally,and this risk should be taken seriously.The present study was an attempt to investigate and quantify the impact of global landslide casualty risk under climate change,which still has uncertainty in terms of outcomes,and there remains a need for further understanding in the future of the propagation of uncertainty between the factors that affect the risk.展开更多
This study focuses on the casualty-load distribution problem that arises when a mass casualty incident(MCI)necessitates the engagement of multiple medical facilities.Employing discrete event simulations,the study anal...This study focuses on the casualty-load distribution problem that arises when a mass casualty incident(MCI)necessitates the engagement of multiple medical facilities.Employing discrete event simulations,the study analyzed different MCI response regimes in Lahore,Pakistan,that vary in terms of the level of casualty-load distribution and the required coordination between the incident site and the responding hospitals.Past terrorist attacks in this major metropolitan area were considered to set up experiments for comparing delays in treatment under the modeled regimes.The analysis highlights that the number of casualties that are allowed to queue up at the nearest hospital before diverting the casualty traffic to an alternate hospital can be an important factor in reducing the overall treatment delays.Prematurely diverting the casualty traffic from the incident site to an alternate hospital can increase the travel time,while a delay in diversion can overload the nearest hospital,which can lead to overall longer waiting times in the queue.The casualty distribution mechanisms based only on the responding hospitals’available capacity and current load can perform inefficiently because they overlook the trade-off between the times casualties spend in traveling and in queues.展开更多
Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental...Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.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
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
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
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
There are two weaknesses in current researches into human casualty of ship collision.One is that the range of injuries or fatalities is restricted to the maximum number of casualties in a particular sample,which may n...There are two weaknesses in current researches into human casualty of ship collision.One is that the range of injuries or fatalities is restricted to the maximum number of casualties in a particular sample,which may not cover all the possible numbers of casualties in the future.International Maritime Organization(IMO)employed the injured or dead percentage of all the persons on board to represent casualties,but it only provided several discrete values to quantify human losses in different scenarios.The other is that the assumption that the distributions of the injuries or fatalities follow certain distribution,such as negative binomial and Poisson distributions is left to be statistically tested.Firstly,this study considers casualty rate,including injury and fatality rates,as random variables;the interval of the variables are from 0 to 1.Then,the distributions of the variables are investigated using historical data.From historical data,we can find that there are many zeros.Zeroinflated models are proved to be effective in processing data with inflated zeros.Furthermore,the probability density of the variables decreases rapidly as the casualty rate becomes larger.Thus,zero-inflated exponential distribution is assumed to fit the data.The parameters of zero-inflated exponential distribution are calibrated by maximum likelihood estimation(MLE)method.Finally,the assumption is tested by chi-square test.The zeroinflated exponential distribution can be used to generate human losses as a part of consequences in the simulation of ship collision risk.展开更多
Casualty prediction is meaningful to the emergency management of natural hazards and human-induced disasters.In this study,a two-step machine learning method,including classification step and regression step,is propos...Casualty prediction is meaningful to the emergency management of natural hazards and human-induced disasters.In this study,a two-step machine learning method,including classification step and regression step,is proposed to predict the number of casualties under emergencies.In the classification step,whether there are casualties under an incident is firstly predicted,then in the regression step,samples predicted to have casualties are used to further predict the exact number of the casualties.Using an open-source dataset,this two-step method is validated.The results show that the two-step model performs better than the original regression models.Back propagation(BP)neural network combined with Random Forest performs the best in terms of the death toll and the number of injuries.Among all the two-step models,the lowest mean absolute error(MAE)for the death toll is 1.67 while that for the number of injuries is 4.13,which indicates that this method can accurately predict the number of casualties under emergencies.This study’s results are expected to provide support for decision-making on rapid resource allocation and other emergency responses.展开更多
Background:Changes in platelet concentration are common in severe burn patients. Platelets play a key role in the course of disease. This study aims to explore the significance of platelet concentration during the cou...Background:Changes in platelet concentration are common in severe burn patients. Platelets play a key role in the course of disease. This study aims to explore the significance of platelet concentration during the course of the disease in victims of a mass burn casualty. Methods:A total of 180 patients were involved in the'8.2'Kunshan explosion accident in China. The examined data included age, gender, total burn area (%TBSA), third-degree burn area (%TBSA), and platelet concentration within the first 5 days after the burn injury. The patients were divided into two groups according to four indicators (resuscitation, acute respiratory distress syndrome, acute kidney injury, septic shock). We collected several types of data for the patients and divided the patients into a complication group and non-complication group according to the diagnostic criteria. We analyzed the platelet concentration of the two groups using t tests to determine whether significant differences were present. P values <0.05 were considered statistically significant. Results: The group with successful resuscitation had higher platelet concentration than the failure group on day 3 and day 5. The patients who suffered from acute kidney injury (AKI) and septic shock had a lower platelet concentration than non-sufferers on day 3 and day 5. Conclusions: The platelet concentration of burn patients can dynamical y reflect the pathophysiological changes of the body. It can be used as an early objective indicator of prognosis in mass burn casualty cases.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
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
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
文摘The concept of Initial Casualty Matrix is introduced. Using some probability distribution functions, the initial casualty matrix of masonry is determined. The dynamic method of seismic casualty assessment is established and then applied to the Tangshan earthquake data, with some conclusions drawn.
文摘To determine the individual circumstances that account for a road traffic accident,it is crucial to consider the unplanned connections amongst various factors related to a crash that results in high casualty levels.Analysis of the road accident data concentrated mainly on categorizing accidents into different types using individually built classification methods which limit the prediction accuracy and fitness of the model.In this article,we proposed a multi-model hybrid framework of the weighted majority voting(WMV)scheme with parallel structure,which is designed by integrating individually implemented multinomial logistic regression(MLR)and multilayer perceptron(MLP)classifiers using three different accident datasets i.e.,IRTAD,NCDB,and FARS.The proposed WMV hybrid scheme overtook individual classifiers in terms of modern evaluation measures like ROC,RMSE,Kappa rate,classification accuracy,and performs better than state-of-theart approaches for the prediction of casualty severity level.Moreover,the proposed WMV hybrid scheme adds up to accident severity analysis through knowledge representation by revealing the role of different accident-related factors which expand the risk of casualty in a road crash.Critical aspects related to casualty severity recognized by the proposed WMV hybrid approach can surely support the traffic enforcement agencies to develop better road safety plans and ultimately save lives.
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.
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Background: Mass Casualty incidents usually overwhelm the capabilities of any centre. It is an event whose nature is undetermined, unexpected and disrupts the normal trauma care in a hospital. Hospitals have established protocols to deal with mass casualty when it arises. Objectives: We sought to profile the presentations of mass casualty incidents and challenges in management in a regional trauma Centre in North-West Nigeria. Methodology: A retrospective look at the records of mass casualty presentations in our centre over a 12-month period (January-December 2011) was done. A mass casualty event in our setting is the presentation to our facility of eight or more patients from the same cause at the same. Results: There were a total of 18 mass casualty presentations with an average of 1.5 per month. There were a total of 236 victims including those brought in dead (BID). Males were 203 (86%) and females 33 (16%) with an M:F ratio of 6:1. Majority of the victims 222 (94%) were above 16 years and all the victims had a common mechanism of injury which was Road traffic crashes. One hundred and forty-three (61%) of the victims sustained lacerations and bruises while 31 (13%) were polytraumatized. Sixty-two (26%) of the victims were BID’S from the scenes of the Road Crashes. The outcome was that 131 (75%) of the victims were treated and discharged while 41 (24%) were admitted for further management. Two (1%) patients died during resuscitation and within 24 hours. Conclusion: Mass casualty presentations are a regular event in our centre hence there is the need for the establishment of a protocol and regular mass casualty drills to cope with future occurrences.
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.
基金The Second Tibetan Plateau Scientific Expedition and Research Program(STEP,Grant No.2019QZKK0906)National Key Research and Development Program of China(Grant No.2023YFC3007204)supported this work。
文摘Extreme precipitation-induced landslide events are projected to increase under climate change,which poses a serious threat to human lives and property.In this study,a global-scale landslide risk assessment model was established using global landslide data,by considering landslide hazard,exposure,and vulnerability.The global climate model data were then employed to drive the established global landslide risk model to explore the spatial and temporal variations in future landslide risk across the globe as a result of extreme precipitation changes.The results show that compared to the 30-year period from 1971 to 2000,the average annual frequency of landslides triggered by extreme precipitation is projected to increase by 7%and 10%,respectively,in the future 30-year periods of 2031–2060 and 2066–2095.The global average annual casualty risk of landslides is projected to increase from about 3240 to 7670 and 8380,respectively(with growth rates of 140%and 160%),during the 2031–2060 and 2066–2095 periods under the SSP2-4.5 scenario.The top 10 countries with the highest casualty risk of landslides are China,Afghanistan,India,the Philippines,Indonesia,Rwanda,Turkey,Nepal,Guatemala,and Brazil,60%of which are located in Asia.The frequency and intensity of extreme precipitation will increase under climate change,which will lead to an increase in casualties from landslides in mountainous areas globally,and this risk should be taken seriously.The present study was an attempt to investigate and quantify the impact of global landslide casualty risk under climate change,which still has uncertainty in terms of outcomes,and there remains a need for further understanding in the future of the propagation of uncertainty between the factors that affect the risk.
文摘This study focuses on the casualty-load distribution problem that arises when a mass casualty incident(MCI)necessitates the engagement of multiple medical facilities.Employing discrete event simulations,the study analyzed different MCI response regimes in Lahore,Pakistan,that vary in terms of the level of casualty-load distribution and the required coordination between the incident site and the responding hospitals.Past terrorist attacks in this major metropolitan area were considered to set up experiments for comparing delays in treatment under the modeled regimes.The analysis highlights that the number of casualties that are allowed to queue up at the nearest hospital before diverting the casualty traffic to an alternate hospital can be an important factor in reducing the overall treatment delays.Prematurely diverting the casualty traffic from the incident site to an alternate hospital can increase the travel time,while a delay in diversion can overload the nearest hospital,which can lead to overall longer waiting times in the queue.The casualty distribution mechanisms based only on the responding hospitals’available capacity and current load can perform inefficiently because they overlook the trade-off between the times casualties spend in traveling and in queues.
文摘Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.
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.
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.
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.
基金the Liberal Arts and Social Sciences Foundation of Ministry of Education in China(No.19YJCGJW003)
文摘There are two weaknesses in current researches into human casualty of ship collision.One is that the range of injuries or fatalities is restricted to the maximum number of casualties in a particular sample,which may not cover all the possible numbers of casualties in the future.International Maritime Organization(IMO)employed the injured or dead percentage of all the persons on board to represent casualties,but it only provided several discrete values to quantify human losses in different scenarios.The other is that the assumption that the distributions of the injuries or fatalities follow certain distribution,such as negative binomial and Poisson distributions is left to be statistically tested.Firstly,this study considers casualty rate,including injury and fatality rates,as random variables;the interval of the variables are from 0 to 1.Then,the distributions of the variables are investigated using historical data.From historical data,we can find that there are many zeros.Zeroinflated models are proved to be effective in processing data with inflated zeros.Furthermore,the probability density of the variables decreases rapidly as the casualty rate becomes larger.Thus,zero-inflated exponential distribution is assumed to fit the data.The parameters of zero-inflated exponential distribution are calibrated by maximum likelihood estimation(MLE)method.Finally,the assumption is tested by chi-square test.The zeroinflated exponential distribution can be used to generate human losses as a part of consequences in the simulation of ship collision risk.
基金funded by the National Natural Science Foundation of China(Grant No.72174203).
文摘Casualty prediction is meaningful to the emergency management of natural hazards and human-induced disasters.In this study,a two-step machine learning method,including classification step and regression step,is proposed to predict the number of casualties under emergencies.In the classification step,whether there are casualties under an incident is firstly predicted,then in the regression step,samples predicted to have casualties are used to further predict the exact number of the casualties.Using an open-source dataset,this two-step method is validated.The results show that the two-step model performs better than the original regression models.Back propagation(BP)neural network combined with Random Forest performs the best in terms of the death toll and the number of injuries.Among all the two-step models,the lowest mean absolute error(MAE)for the death toll is 1.67 while that for the number of injuries is 4.13,which indicates that this method can accurately predict the number of casualties under emergencies.This study’s results are expected to provide support for decision-making on rapid resource allocation and other emergency responses.
文摘Background:Changes in platelet concentration are common in severe burn patients. Platelets play a key role in the course of disease. This study aims to explore the significance of platelet concentration during the course of the disease in victims of a mass burn casualty. Methods:A total of 180 patients were involved in the'8.2'Kunshan explosion accident in China. The examined data included age, gender, total burn area (%TBSA), third-degree burn area (%TBSA), and platelet concentration within the first 5 days after the burn injury. The patients were divided into two groups according to four indicators (resuscitation, acute respiratory distress syndrome, acute kidney injury, septic shock). We collected several types of data for the patients and divided the patients into a complication group and non-complication group according to the diagnostic criteria. We analyzed the platelet concentration of the two groups using t tests to determine whether significant differences were present. P values <0.05 were considered statistically significant. Results: The group with successful resuscitation had higher platelet concentration than the failure group on day 3 and day 5. The patients who suffered from acute kidney injury (AKI) and septic shock had a lower platelet concentration than non-sufferers on day 3 and day 5. Conclusions: The platelet concentration of burn patients can dynamical y reflect the pathophysiological changes of the body. It can be used as an early objective indicator of prognosis in mass burn casualty cases.
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.
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.
