大規模傷亡事件傷員分類的系統評價_《中國循證醫學雜志》

作者：

王凌 ,  李靜 , 李幼平 , 徐琳

四川大學華西醫院循證醫學與臨床流行病學教研室;

關鍵詞：

大規模傷亡事件傷員分類系統評價地震

DOI：

10.7507/1672-2531.20080107

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　了解目前全世界范圍內大規模傷亡事件傷員分類方法及應用情況，為今后實施大規模傷員分類和制定統一分類方法提供參考。
方法　借鑒系統評價的原理和方法，系統收集MEDLINE（1950 ～2008），Cochrane圖書館（Issue 2，2008）和CBM（創刊至2008年5月）數據庫的中英文文獻并分大規模傷亡事件傷員分類和地震傷員分類兩類，提取大規模傷員分類方法的名稱、等級次序、分類依據、主要特點及應用情況，提取地震傷員分類實施地點、實施人員、等級次序、方法特點，比較不同分類標記方法的顏色、代碼和標記材料。
結果　最終納入英文文獻38篇，中文文獻6篇。大規模傷員初級分類方法7種，均分4個等級，3種方法有文獻報道應用情況；二次分類方法6種，分3～5個等級，未見文獻報道應用情況。分類結果標記方法4種。地震傷員分類7個實例，2次發生在中國，均為二次分類。
結論　目前缺乏經信度和效度驗證并普遍接受的大規模傷員分類方法，且未明確說明適用于所有大規模傷亡事件。未見專門針對地震傷員的分類方法，地震傷員分類實例與大規模傷亡事件傷員分類有很大差異。有待進一步研究大規模傷員分類方法的信度和效度，提供可靠依據，提高醫學救援能力。

引用本文： 王凌,李靜,李幼平,徐琳. 大規模傷亡事件傷員分類的系統評價. 中國循證醫學雜志, 2008, 08(7): 469-476. doi: 10.7507/1672-2531.20080107 復制

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 of emergency medical care. Annals of Emergency Medicine, 2001, 37(6): 642-646.
4.	Waeckerle JF. Disaster planning and response. New England Journal of Medicine, 1991, 324(12): 815.
5.	Jenkins JL, McCarthy ML, Sauer LM. Mass-casualty triage: time for an 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, Initial Care, and Tactical Considerations in Mass Casualty and Disaster Response. Military Medicine, 2007, 172(3): 232-236.
8.	列本蒂施, 斯托爾茨, 王衍發. 軍事醫學若干問題. 北京: 解放軍出版, 1984, 438-446.
9.	溫世浩, 周亞平, 戴陽. 災害現場救援大批傷員分類的方法. 災害學, 2007, 22(1): 138-140.
10.	Killeen JP, Chan TC, Vilke GM. 223 Wireless Computerized Rapid Triage in the Field: How Well Does Technology Perform During Mass Casualty Incidents and Disaster Events? Annals of Emergency Medicine, 2006, 48(4S): 69-69.
11.	Gao T, Massey T, Selavo L. The Advanced Health and Disaster Aid 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 and Equipment 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 Mass Casualty Emergency Medical Response. Engineering in Medicine and Biology Society, 2006. EMBS’06. 28th Annual International Conference 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 Francis Medical Center’s ED Staff.
15.	Nocera A, Garner A. AN AUSTRALIAN MASS CASUALTY INCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPON TRIAGE MISTAKES OF THE PAST: THE HOMEBUSH TRIAGE STANDARD. Aust NZJ Surg, 1999, 69(8): 603-608.
16.	孫志剛, 李宏立. 地震傷員分類的方法和原則. 災害學, 2001, 16(001): 61-64.
17.	Ramirez M, Peek-Asa C. Epidemiology of Traumatic Injuries from Earthquakes. Epidemiologic Reviews, 2005, 27(1): 47-55.
18.	Baker MS. Creating Order from Chaos: Part II: Tactical Planning for Mass Casualty and Disaster Response at Definitive Care Facilities. Military Medicine, 2007, 172(3): 237-243.
19.	Romig LE. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs.
20.	Hodgetts TJ. Mackway-Jones K., Major Incident Medical Management and Support. The Practical Approach. 1995, BMJ Publishing 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 of multiple-casualty incident triage algorithms. Annals of Emergency Medicine, 2001, 38(5): 541-548.
23.	趙興吉. 院前急救在災難救援中的作用. 中華急診醫學雜志, 2007, 11.
24.	Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake.
25.	Redmond AD, Watson S, Nightingale P. The south Manchester Accident Rescue Team and the earthquake in Iran, June 1990. BMJ, 1991, 302(6791): 1521-1523.
26.	櫻庭和典. 阪神大地震的醫療揀選與倫理研究. 醫學與哲學, 1997, 18(006): 322-324.
27.	Hsu EB, Matthew M, Lin FY, et al. Emergency medical assistance team 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 field hospital in an urban disaster area: Lessons from the August 1999 earthquake in Turkey*. Critical Care Medicine, 2003, 31(5): 1410.
29.	Emami MJ, Tavakoli AR, Alemzadeh H, et al. Strategies in Evaluation 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 arising from the 2005 Kashmir Earthquake: The first 72h. Injury, 2007.
31.	李大江, 張衛東, 劉啟望. 汶川地震醫療救援中的傷員接診處置與轉出管理. 中國循證醫學雜志, 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 in ambulatory medical care. V. Determinants of use of hospital emergency services. American Journal of Public Health and the Nations Health, 1966, 56(7): 1037.
35.	Torbjorn T. Ethical aspects of triage in mass casualty. Current Opinion in Anaesthesiology, 2007, 20(2): 143.
36.	Kennedy K, Aghababian RV, Gans L, et al. Triage: techniques and applications in decision making. Annals of Emergency Medicine, 1996, 28(2): 136-144.
37.	Ueberle HK, Rose TK. Medical policy in the management of a mass casualty situation with special regard to sorting. Med Law, 1985, 4(3): 275-282.
38.	Wallis L. START is not the best triage stategy. British Medical Journal, 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. Academic Emergency Medicine, 2005, 12(8): 759-770.
41.	Wallis LA, Carley S. Comparison of paediatric major incident primary triage tools. British Medical Journal, 2006, 23(6): 475.
42.	Gebhart ME, Pence R. START Triage: Does It Work? Disaster Management & Response, 2007, 5(3): 68-73.
43.	Li WP. 1996~ 2003 年全世界災害地震統計分析. 華北地震科學, 2005, 23(2): 54-64.
44.	Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital & Disaster Medicine, 1996, 11(2): 117-124.
45.	Nufer KE, Richards ME. Different medical needs between hurricane and earthquake victims. Ann Emerg Med, 2004, 44.
46.	Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury, 2005, 36(11): 1298-1305.
47.	Simmons E, Hedges JR, Irwin L, et al. Paramedic Injury Severity Perception Can Aid Trauma Triage. Annals of Emergency Medicine, 1995, 26(4): 461-468.

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 of emergency medical care. Annals of Emergency Medicine, 2001, 37(6): 642-646.
4. Waeckerle JF. Disaster planning and response. New England Journal of Medicine, 1991, 324(12): 815.
5. Jenkins JL, McCarthy ML, Sauer LM. Mass-casualty triage: time for an 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, Initial Care, and Tactical Considerations in Mass Casualty and Disaster Response. Military Medicine, 2007, 172(3): 232-236.
8. 列本蒂施, 斯托爾茨, 王衍發. 軍事醫學若干問題. 北京: 解放軍出版, 1984, 438-446.
9. 溫世浩, 周亞平, 戴陽. 災害現場救援大批傷員分類的方法. 災害學, 2007, 22(1): 138-140.
10. Killeen JP, Chan TC, Vilke GM. 223 Wireless Computerized Rapid Triage in the Field: How Well Does Technology Perform During Mass Casualty Incidents and Disaster Events? Annals of Emergency Medicine, 2006, 48(4S): 69-69.
11. Gao T, Massey T, Selavo L. The Advanced Health and Disaster Aid 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 and Equipment 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 Mass Casualty Emergency Medical Response. Engineering in Medicine and Biology Society, 2006. EMBS’06. 28th Annual International Conference 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 Francis Medical Center’s ED Staff.
15. Nocera A, Garner A. AN AUSTRALIAN MASS CASUALTY INCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPON TRIAGE MISTAKES OF THE PAST: THE HOMEBUSH TRIAGE STANDARD. Aust NZJ Surg, 1999, 69(8): 603-608.
16. 孫志剛, 李宏立. 地震傷員分類的方法和原則. 災害學, 2001, 16(001): 61-64.
17. Ramirez M, Peek-Asa C. Epidemiology of Traumatic Injuries from Earthquakes. Epidemiologic Reviews, 2005, 27(1): 47-55.
18. Baker MS. Creating Order from Chaos: Part II: Tactical Planning for Mass Casualty and Disaster Response at Definitive Care Facilities. Military Medicine, 2007, 172(3): 237-243.
19. Romig LE. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs.
20. Hodgetts TJ. Mackway-Jones K., Major Incident Medical Management and Support. The Practical Approach. 1995, BMJ Publishing 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 of multiple-casualty incident triage algorithms. Annals of Emergency Medicine, 2001, 38(5): 541-548.
23. 趙興吉. 院前急救在災難救援中的作用. 中華急診醫學雜志, 2007, 11.
24. Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake.
25. Redmond AD, Watson S, Nightingale P. The south Manchester Accident Rescue Team and the earthquake in Iran, June 1990. BMJ, 1991, 302(6791): 1521-1523.
26. 櫻庭和典. 阪神大地震的醫療揀選與倫理研究. 醫學與哲學, 1997, 18(006): 322-324.
27. Hsu EB, Matthew M, Lin FY, et al. Emergency medical assistance team 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 field hospital in an urban disaster area: Lessons from the August 1999 earthquake in Turkey*. Critical Care Medicine, 2003, 31(5): 1410.
29. Emami MJ, Tavakoli AR, Alemzadeh H, et al. Strategies in Evaluation 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 arising from the 2005 Kashmir Earthquake: The first 72h. Injury, 2007.
31. 李大江, 張衛東, 劉啟望. 汶川地震醫療救援中的傷員接診處置與轉出管理. 中國循證醫學雜志, 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 in ambulatory medical care. V. Determinants of use of hospital emergency services. American Journal of Public Health and the Nations Health, 1966, 56(7): 1037.
35. Torbjorn T. Ethical aspects of triage in mass casualty. Current Opinion in Anaesthesiology, 2007, 20(2): 143.
36. Kennedy K, Aghababian RV, Gans L, et al. Triage: techniques and applications in decision making. Annals of Emergency Medicine, 1996, 28(2): 136-144.
37. Ueberle HK, Rose TK. Medical policy in the management of a mass casualty situation with special regard to sorting. Med Law, 1985, 4(3): 275-282.
38. Wallis L. START is not the best triage stategy. British Medical Journal, 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. Academic Emergency Medicine, 2005, 12(8): 759-770.
41. Wallis LA, Carley S. Comparison of paediatric major incident primary triage tools. British Medical Journal, 2006, 23(6): 475.
42. Gebhart ME, Pence R. START Triage: Does It Work? Disaster Management & Response, 2007, 5(3): 68-73.
43. Li WP. 1996~ 2003 年全世界災害地震統計分析. 華北地震科學, 2005, 23(2): 54-64.
44. Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital & Disaster Medicine, 1996, 11(2): 117-124.
45. Nufer KE, Richards ME. Different medical needs between hurricane and earthquake victims. Ann Emerg Med, 2004, 44.
46. Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury, 2005, 36(11): 1298-1305.
47. Simmons E, Hedges JR, Irwin L, et al. Paramedic Injury Severity Perception Can Aid Trauma Triage. Annals of Emergency Medicine, 1995, 26(4): 461-468.

《中國循證醫學雜志》

大規模傷亡事件傷員分類的系統評價

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《中國循證醫學雜志》

大規模傷亡事件傷員分類的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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