大规模伤亡事件伤员分类的系统评价
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摘要
目的了解目前全世界范围内大规模伤亡事件伤员分类方法及应用情况,为今后实施大规模伤员分类和制定统一分类方法提供参考。方法借鉴系统评价的原理和方法,系统收集MEDLINE(1950～2008),Cochrane图书馆(Issue 2,2008)和CBM(创刊至2008年5月)数据库的中英文文献并分大规模伤亡事件伤员分类和地震伤员分类两类,提取大规模伤员分类方法的名称、等级次序、分类依据、主要特点及应用情况,提取地震伤员分类实施地点、实施人员、等级次序、方法特点,比较不同分类标记方法的颜色、代码和标记材料。结果最终纳入英文文献38篇,中文文献6篇。大规模伤员初级分类方法7种,均分4个等级,3种方法有文献报道应用情况;二次分类方法6种,分3～5个等级,未见文献报道应用情况。分类结果标记方法4种。地震伤员分类7个实例,2次发生在中国,均为二次分类。结论目前缺乏经信度和效度验证并普遍接受的大规模伤员分类方法,且未明确说明适用于所有大规模伤亡事件。未见专门针对地震伤员的分类方法,地震伤员分类实例与大规模伤亡事件伤员分类有很大差异。有待进一步研究大规模伤员分类方法的信度和效度,提供可靠依据,提高医学救援能力。
Objective To investigate the mass casualty triage system and its application, to provide evidence and advice for its future standardized use. Method Based on the principles and methods of systematic reviews, we searched MEDLINE (1950 to 2008), The Cochrane library (Issue 2, 2008) and CBM (from establishment to May 2008) to identify papers written in English of Chinese which described mass casualty triage systems or triage systems specific to the aftermath of earthquakes. We extracted information on name, grades, criteria, main characteristics and application of each triage system from the papers involving mass casualty triage systems. We also extracted information on setting, personnel performing the triage, grades, and characteristics from those papers describing any specific triage system for earthquake. We compared the colour of tags, codes and other materials used in different triage systems. Result We included 38 English and 6 Chinese papers. For mass casualty triage systems, we identified 7 primary triage methods with 4 grades.Three of these had relevant application reports. There were 6 secondary triage methods with 3-5 grades, and none had relevant application reports. Four tag methods were identified. Seven papers, 2 of which were published in China, reported specific secondary triage methods for earthquakes. Conclusion Based on the current evidence, there is no universally accepted mass casualty triage system with documented reliability and validity. No triage system has been developed specifically for the wounded in earthquakes. There are large differences between the triage methods for earthquake and other mass casualty incidents. Future research should focus on the development of a reliable and valid mass casualty triage system, aimed at maximizing the capacity for medical rescue.
Objective To investigate the mass casualty triage system and its application, to provide evidence and advice for its future standardized use. Method Based on the principles and methods of systematic reviews, we searched MEDLINE (1950 to 2008), The Cochrane library (Issue 2, 2008) and CBM (from establishment to May 2008) to identify papers written in English of Chinese which described mass casualty triage systems or triage systems specific to the aftermath of earthquakes. We extracted information on name, grades, criteria, main characteristics and application of each triage system from the papers involving mass casualty triage systems. We also extracted information on setting, personnel performing the triage, grades, and characteristics from those papers describing any specific triage system for earthquake. We compared the colour of tags, codes and other materials used in different triage systems. Result We included 38 English and 6 Chinese papers. For mass casualty triage systems, we identified 7 primary triage methods with 4 grades.Three of these had relevant application reports. There were 6 secondary triage methods with 3-5 grades, and none had relevant application reports. Four tag methods were identified. Seven papers, 2 of which were published in China, reported specific secondary triage methods for earthquakes. Conclusion Based on the current evidence, there is no universally accepted mass casualty triage system with documented reliability and validity. No triage system has been developed specifically for the wounded in earthquakes. There are large differences between the triage methods for earthquake and other mass casualty incidents. Future research should focus on the development of a reliable and valid mass casualty triage system, aimed at maximizing the capacity for medical rescue.
引文
1 Slater MS,Trunkey DD.Terrorism in America.An evolving threat.Archives of Surgery,1997,132(10):1059-1066.
2 Iserson KV,Moskop JC.Triage in Medicine,Part I:Concept,History,and Types.Annals of Emergency Medicine,2007,49(3):275-281.
3 Pesik N,Keim ME,Iserson KV.Terrorism and the ethics ofemergency medical care.Annals of Emergency Medicine,2001,37(6):642-646.
4 Waeckerle JF.Disaster planning and response.New England Journalof Medicine,1991,324(12):815.
5 Jenkins JL,McCarthy ML,Sauer LM.Mass-casualty triage:time foran evidence-based approach.2008.
6 Sacco WJ,Nvain M,Fiedler EA.Precise formulation and evidence-based application of resource-constrained triage.Acad Emerg Med,2005,12(8):759.
7 Baker MS.Creating Order from Chaos:Part I:Triage,InitialCare,and Tactical Considerations in Mass Casualty and DisasterResponse.Military Medicine,2007,172(3):232-236.
8列本蒂施,斯托尔茨,王衍发.军事医学若干问题.北京:解放军出版,1984,438-446.
9温世浩,周亚平,戴阳.灾害现场救援大批伤员分类的方法.灾害学,2007,22(1):138-140.
10 Killeen JP,Chan TC,Vilke GM.223 Wireless Computerized RapidTriage in the Field:How Well Does Technology Perform DuringMass Casualty Incidents and Disaster Events?Annals of EmergencyMedicine,2006,48(4S):69-69.
11 Gao T,Massey T,Selavo L.The Advanced Health and DisasterAid Network:A Light-Weight Wireless Medical System for Triage.Biomedical Circuits and Systems,IEEE Transactions on,2007,1(3):203-216.
12 Fry EA,Lenert LA.MASCAL:RFID Tracking of Patients,Staff andEquipment to Enhance Hospital Response to Mass Casualty Events.AMIA Annual Symposium Proceedings,2005,2005:261.
13 Gao T,White D.A Next Generation Electronic Triage to Aid MassCasualty Emergency Medical Response.Engineering in Medicineand Biology Society,2006.EMBS'06.28th Annual InternationalConference of the IEEE,2006.
14 On-Line CEU.Simple Triage and Rapid Transport(START)On-Line CEU for the Peoria Area EMS System and OSF Saint FrancisMedical Center’s ED Sta.
15 Nocera A,Garner A.AN AUSTRALIAN MASS CASUALTYINCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPONTRIAGE MISTAKES OF THE PAST:THE HOMEBUSH TRIAGESTANDARD.Aust NZJ Surg,1999,69(8):603-608.
16孙志刚,李宏立.地震伤员分类的方法和原则.灾害学,2001,16(001):61-64.
17 Ramirez M,Peek-Asa C.Epidemiology of Traumatic Injuries fromEarthquakes.Epidemiologic Reviews,2005,27(1):47-55.
18 Baker MS.Creating Order from Chaos:Part II:Tactical Planning forMass Casualty and Disaster Response at De nitive Care Facilities.Military Medicine,2007,172(3):237-243.
19 Romig LE.Pediatric triage.A system to JumpSTART your triage ofyoung patients at MCIs.
20 Hodgetts TJ.Mackway-Jones K.,Major Incident MedicalManagement and Support.The Practical Approach.1995,BMJPublishing Group,London.
21 Hodgetts TJ,Hedges,JR,Irwin L,et al.Paediatric triage tape.Pre-hospital Immediate Care,1998,2:155-159.
22 Garner A,Lee A,Harrison K,et al.Comparative analysis ofmultiple-casualty incident triage algorithms.Annals of EmergencyMedicine,2001,38(5):541-548.
23赵兴吉.院前急救在灾难救援中的作用.中华急诊医学杂志,2007,11.
24 Benson M,Koenig KL,Schultz CH.Disaster triage:START,thenSAVE--a new method of dynamic triage for victims of a catastrophicearthquake.
25 Redmond AD,Watson S,Nightingale P.The south ManchesterAccident Rescue Team and the earthquake in Iran,June 1990.BMJ,1991,302(6791):1521-1523.
26樱庭和典.阪神大地震的医疗拣选与伦理研究.医学与哲学,1997,18(006):322-324.
27 Hsu EB,Matthew M,Lin FY,et al.Emergency medical assistanceteam response following Taiwan Chi-Chi earthquake.Prehospital&Disaster Medicine,2002,17(1):17-22.
28 Halpern P,Rosen B,Carasso S,et al.Intensive care in a eld hospitalin an urban disaster area:Lessons from the August 1999 earthquakein Turkey*.Critical Care Medicine,2003,31(5):1410.
29 Emami MJ,Tavakoli AR,Alemzadeh H,et al.Strategies inEvaluation and Management of Bam Earthquake Victims.Prehospital Disaster Med,2005,20(5):327-330.
30 Mulvey JM,Awan SU,Qadri AA,et al.Profile of injuries arisingfrom the 2005 Kashmir Earthquake:The rst 72h.Injury,2007.
31李大江,张卫东,刘启望.汶川地震医疗救援中的伤员接诊处置与转出管理.中国循证医学杂志,2008,8(6):4.
32 Larrey RR.Surgeon to Napoleon’s Imperial Guard.1974,London:John Murray.
33 Welch CE.War wounds of the abdomen.N Engl J Med,1947,237:156-162.
34 Weinerman,ER,Ratner RS,Robbins A,et al.Yale studies inambulatory medical care.V.Determinants of use of hospitalemergency services.American Journal of Public Health and theNations Health,1966,56(7):1037.
35 Torbjorn T.Ethical aspects of triage in mass casualty.CurrentOpinion in Anaesthesiology,2007,20(2):143.
36 Kennedy K,Aghababian RV,Gans L,et al.Triage:techniques andapplications in decision making.Annals of Emergency Medicine,1996,28(2):136-144.
37 Ueberle HK,Rose TK.Medical policy in the management of a masscasualty situation with special regard to sorting.Med Law,1985,4(3):275-282.
38 Wallis L.START is not the best triage stategy.British MedicalJournal,2002,36(6):473.
39 Wesson DE,Scorpio R.Field triage--help or hindrance?Can J Surg,1992,35(1):19-21.
40 Sacco WJ,Navin M,Fiedler EA.Precise Formulation and Evidence-based Application of Resource-constrained Triage.AcademicEmergency Medicine,2005,12(8):759-770.
41 Wallis LA,Carley S.Comparison of paediatric major incidentprimary triage tools.British Medical Journal,2006,23(6):475.
42 Gebhart ME,Pence R.START Triage:Does It Work?DisasterManagement&Response,2007,5(3):68-73.
43 Li WP.1996~2003年全世界灾害地震统计分析.華北地震科學,2005,23(2):54-64.
44 Benson M,Koenig KL,Schultz CH.Disaster triage:START,thenSAVE--a new method of dynamic triage for victims of a catastrophicearthquake.Prehospital&Disaster Medicine,1996,11(2):117-124.
45 Nufer KE,Richards ME.Di erent medical needs between hurricaneand earthquake victims.Ann Emerg Med,2004,44.
46 Mulholland SA,Gabbe BJ,Cameron P.Is paramedic judgementuseful in prehospital trauma triage?Injury,2005,36(11):1298-1305.
47 Simmons E,Hedges JR,Irwin L,et al.Paramedic Injury SeverityPerception Can Aid Trauma Triage.Annals of Emergency Medicine,1995,26(4):461-468.
2 Iserson KV,Moskop JC.Triage in Medicine,Part I:Concept,History,and Types.Annals of Emergency Medicine,2007,49(3):275-281.
3 Pesik N,Keim ME,Iserson KV.Terrorism and the ethics ofemergency medical care.Annals of Emergency Medicine,2001,37(6):642-646.
4 Waeckerle JF.Disaster planning and response.New England Journalof Medicine,1991,324(12):815.
5 Jenkins JL,McCarthy ML,Sauer LM.Mass-casualty triage:time foran evidence-based approach.2008.
6 Sacco WJ,Nvain M,Fiedler EA.Precise formulation and evidence-based application of resource-constrained triage.Acad Emerg Med,2005,12(8):759.
7 Baker MS.Creating Order from Chaos:Part I:Triage,InitialCare,and Tactical Considerations in Mass Casualty and DisasterResponse.Military Medicine,2007,172(3):232-236.
8列本蒂施,斯托尔茨,王衍发.军事医学若干问题.北京:解放军出版,1984,438-446.
9温世浩,周亚平,戴阳.灾害现场救援大批伤员分类的方法.灾害学,2007,22(1):138-140.
10 Killeen JP,Chan TC,Vilke GM.223 Wireless Computerized RapidTriage in the Field:How Well Does Technology Perform DuringMass Casualty Incidents and Disaster Events?Annals of EmergencyMedicine,2006,48(4S):69-69.
11 Gao T,Massey T,Selavo L.The Advanced Health and DisasterAid Network:A Light-Weight Wireless Medical System for Triage.Biomedical Circuits and Systems,IEEE Transactions on,2007,1(3):203-216.
12 Fry EA,Lenert LA.MASCAL:RFID Tracking of Patients,Staff andEquipment to Enhance Hospital Response to Mass Casualty Events.AMIA Annual Symposium Proceedings,2005,2005:261.
13 Gao T,White D.A Next Generation Electronic Triage to Aid MassCasualty Emergency Medical Response.Engineering in Medicineand Biology Society,2006.EMBS'06.28th Annual InternationalConference of the IEEE,2006.
14 On-Line CEU.Simple Triage and Rapid Transport(START)On-Line CEU for the Peoria Area EMS System and OSF Saint FrancisMedical Center’s ED Sta.
15 Nocera A,Garner A.AN AUSTRALIAN MASS CASUALTYINCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPONTRIAGE MISTAKES OF THE PAST:THE HOMEBUSH TRIAGESTANDARD.Aust NZJ Surg,1999,69(8):603-608.
16孙志刚,李宏立.地震伤员分类的方法和原则.灾害学,2001,16(001):61-64.
17 Ramirez M,Peek-Asa C.Epidemiology of Traumatic Injuries fromEarthquakes.Epidemiologic Reviews,2005,27(1):47-55.
18 Baker MS.Creating Order from Chaos:Part II:Tactical Planning forMass Casualty and Disaster Response at De nitive Care Facilities.Military Medicine,2007,172(3):237-243.
19 Romig LE.Pediatric triage.A system to JumpSTART your triage ofyoung patients at MCIs.
20 Hodgetts TJ.Mackway-Jones K.,Major Incident MedicalManagement and Support.The Practical Approach.1995,BMJPublishing Group,London.
21 Hodgetts TJ,Hedges,JR,Irwin L,et al.Paediatric triage tape.Pre-hospital Immediate Care,1998,2:155-159.
22 Garner A,Lee A,Harrison K,et al.Comparative analysis ofmultiple-casualty incident triage algorithms.Annals of EmergencyMedicine,2001,38(5):541-548.
23赵兴吉.院前急救在灾难救援中的作用.中华急诊医学杂志,2007,11.
24 Benson M,Koenig KL,Schultz CH.Disaster triage:START,thenSAVE--a new method of dynamic triage for victims of a catastrophicearthquake.
25 Redmond AD,Watson S,Nightingale P.The south ManchesterAccident Rescue Team and the earthquake in Iran,June 1990.BMJ,1991,302(6791):1521-1523.
26樱庭和典.阪神大地震的医疗拣选与伦理研究.医学与哲学,1997,18(006):322-324.
27 Hsu EB,Matthew M,Lin FY,et al.Emergency medical assistanceteam response following Taiwan Chi-Chi earthquake.Prehospital&Disaster Medicine,2002,17(1):17-22.
28 Halpern P,Rosen B,Carasso S,et al.Intensive care in a eld hospitalin an urban disaster area:Lessons from the August 1999 earthquakein Turkey*.Critical Care Medicine,2003,31(5):1410.
29 Emami MJ,Tavakoli AR,Alemzadeh H,et al.Strategies inEvaluation and Management of Bam Earthquake Victims.Prehospital Disaster Med,2005,20(5):327-330.
30 Mulvey JM,Awan SU,Qadri AA,et al.Profile of injuries arisingfrom the 2005 Kashmir Earthquake:The rst 72h.Injury,2007.
31李大江,张卫东,刘启望.汶川地震医疗救援中的伤员接诊处置与转出管理.中国循证医学杂志,2008,8(6):4.
32 Larrey RR.Surgeon to Napoleon’s Imperial Guard.1974,London:John Murray.
33 Welch CE.War wounds of the abdomen.N Engl J Med,1947,237:156-162.
34 Weinerman,ER,Ratner RS,Robbins A,et al.Yale studies inambulatory medical care.V.Determinants of use of hospitalemergency services.American Journal of Public Health and theNations Health,1966,56(7):1037.
35 Torbjorn T.Ethical aspects of triage in mass casualty.CurrentOpinion in Anaesthesiology,2007,20(2):143.
36 Kennedy K,Aghababian RV,Gans L,et al.Triage:techniques andapplications in decision making.Annals of Emergency Medicine,1996,28(2):136-144.
37 Ueberle HK,Rose TK.Medical policy in the management of a masscasualty situation with special regard to sorting.Med Law,1985,4(3):275-282.
38 Wallis L.START is not the best triage stategy.British MedicalJournal,2002,36(6):473.
39 Wesson DE,Scorpio R.Field triage--help or hindrance?Can J Surg,1992,35(1):19-21.
40 Sacco WJ,Navin M,Fiedler EA.Precise Formulation and Evidence-based Application of Resource-constrained Triage.AcademicEmergency Medicine,2005,12(8):759-770.
41 Wallis LA,Carley S.Comparison of paediatric major incidentprimary triage tools.British Medical Journal,2006,23(6):475.
42 Gebhart ME,Pence R.START Triage:Does It Work?DisasterManagement&Response,2007,5(3):68-73.
43 Li WP.1996~2003年全世界灾害地震统计分析.華北地震科學,2005,23(2):54-64.
44 Benson M,Koenig KL,Schultz CH.Disaster triage:START,thenSAVE--a new method of dynamic triage for victims of a catastrophicearthquake.Prehospital&Disaster Medicine,1996,11(2):117-124.
45 Nufer KE,Richards ME.Di erent medical needs between hurricaneand earthquake victims.Ann Emerg Med,2004,44.
46 Mulholland SA,Gabbe BJ,Cameron P.Is paramedic judgementuseful in prehospital trauma triage?Injury,2005,36(11):1298-1305.
47 Simmons E,Hedges JR,Irwin L,et al.Paramedic Injury SeverityPerception Can Aid Trauma Triage.Annals of Emergency Medicine,1995,26(4):461-468.
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