Similar articles

Abstract: 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 fire, 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.

大规模伤亡事件应对研究范式的发展

系统回顾大规模伤亡事件（MCI）经典研究范式，结合2008年汶川地震和2014年杭州7·5公交车起火事件，优化MCI应对的研究范式。 需求激增理论是MCI应对实时评估的显著进步，结合2008年汶川地震和2014年杭州7·5公交车起火事件，我们发现MCI应对评估中一个非常重要的脆弱性因素被忽略。 采用关键词和医学主题词（大规模伤亡事件、MCI、研究方法、汶川、地震、研究范式、激增科学、激增、激增应对能力和脆弱性等），通过检索数据库PubMed、EMBASE、中国万方及中国生物医学（CBM）的相关研究资料库，进行理论的回顾性分析和结合实际案例的分析。 除需求激增理论中的激增和激增应对能力这二个基本维度外，应引入第三个维度脆弱性，形成更为全面和客观的三个互为关联维度构建MCI的新研究范式，突破MCI传统研究范式的局限性。
大规模伤亡事件；需求激增；脆弱性；地震；火灾

[1] Adini, B., Peleg, K., Cohen, R., 2010. A national system for disseminating information on victims during mass casualty incidents. Disasters, 34(2):542-551. 

[2] Ashkenazi, I., Kessel, B., Olsha, O., 2008. Defining the problem, main objective, and strategies of medical management in mass-casualty incidents caused by terrorist events. Prehosp Disaster Med, 23(1):82-89. 

[3] Aylwin, C.J., Knig, T.C., Brennan, N.W., 2006. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet, 368(9554):2219-2225. 

[4] Blaikie, P., Cannon, T., Davis, I., 1994.  At Risk: Natural Hazards, Peoples Vulnerability and Disasters. Routledge,London :141-156. 

[5] Chen, Z., Shen, J., Kang, J.X., 2012. Emergency medical rescue after major earthquakes: lessons from the Wenchuan earthquake. Chin J Evid-Based Med, (in Chinese),12(4):383-392. 

[6] Cirocchi, R., Abraha, I., Montedori, A., 2010. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev, 20(1):CD007438

[7] Dayton, C., Ibrahim, J., Augenbraun, M., 2008. Integrated plan to augment surge capacity. Prehosp Disaster Med, 23(2):113-119. 

[8] Debacker, M., Hubloue, I., Dhondt, E., 2012. Utstein-style template for uniform data reporting of acute medical response in disasters. PLoS Curr, 4:e4f6cf3e8df15a

[9] de Boer, J., Brismar, B., Eldar, R., 1989. The medical severity index of disasters. J Emerg Med, 7(3):269-273. 

[10] Einav, S., Aharonson-Daniel, L., Weissman, C., 2006. In-hospital resource utilization during multiple casualty incidents. Ann Surg, 243(4):533-540. 

[11] Ferro, G., 2005. Assessment of major and minor events that occurred in Italy during the last century using a Disaster Severity Scale score. Prehosp Disaster Med, 20(5):316-323. 

[12] Goh, S.H., 2009. Bomb blast mass casualty incidents: initial triage and management of injuries. Singap Med J, 50(1):101-106. 

[13] Hamilton, D.R., Gavagan, T.F., Smart, K.T., 2009. Houston’s medical disaster response to Hurricane Katrina: Part 1: the initial medical response from Trauma Service Area Q. Ann Emerg Med, 53(4):505-514. 

[14] Hick, J.L., Hanfling, D., Burstein, J.L., 2004. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med, 44(3):253-261. 

[15] Hick, J.L., Koenig, K.L., Barbisch, D., 2008. Surge capacity concepts for health care facilities: the CO-S-TR model for initial incident assessment. Disaster Med Public Health Prep, 2(S1):S51-S57. 

[16] Hick, J.L., Barbera, J.A., Kelen, G.D., 2009. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep, 3(S1):S59-S67. 

[17] Hirshberg, A., Stein, M., Walden, R., 1999. Surgical resource utilization in urban terrorist bombing: a computer simulation. J Trauma, 47(3):545-550. 

[18] Hupert, N., Hollingsworth, E., Xiong, W., 2007. Is overtriage associated with increased mortality? Insights from a simulation model of mass casualty trauma care. Disaster Med Public Health Prep, 1(S1):S14-S24. 

[19] ISDR, 2004. Living with Risk: a Global Review of Disaster Reduction Initiatives. United Nations International Strategy for Disaster Reduction (ISDR), Geneva, Switzerland :

[20] Jenkins, J.L., O'Connor, R.E., Cone, D.C., 2006. Differentiating large-scale surge versus daily surge. Acad Emerg Med, 13(11):1169-1172. 

[21] Jiang, G.Y., Shen, W.F., Gan, J.X., 2005. Development of the trauma emergency care system based on the three links theory. Chin J Traumatol, (in Chinese),8(5):259-262. 

[22] Jiang, J.X., Wang, Z.G., Fu, X.B., 2008. Experiences and rethinking on medical rescue during Chinese Wenchuan earthquake. Chin J Trauma, (in Chinese),24(8):578-579. 

[23] Kaji, A., Koenig, K.L., Bey, T., 2006. Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med, 13(11):1157-1159. 

[24] Kelen, G.D., McCarthy, M.L., 2006. The science of surge. Acad Emerg Med, 13(11):1089-1094. 

[25] Kelen, G.D., Kraus, C.K., McCarthy, M.L., 2006. Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet, 368(9551):1984-1990. 

[26] Kenneth, H., 1997. Regions of Risk: a Geographical Introduction to Disasters, Longman, Harlow :14-15. 

[27] Koenig, K.L., Dinerman, N., Kuehl, A.E., 1996. Disaster nomenclature—a functional impact approach: the PICE system. Acad Emerg Med, 3(7):723-727. 

[28] Leiba, A., Schwartz, D., Eran, T., 2009. DISAST-CIR: disastrous incidents systematic analysis through components, interactions and results: application to a large-scale train accident. J Emerg Med, 37(1):46-50. 

[29] Lerner, E.B., Schwartz, R.B., Coule, P.L., 2010. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care, 14(1):21-25. 

[30] Marchant, J., Cheng, N.G., Lam, L.T., 2008. Bystander basic life support: an important link in the chain of survival for children suffering a drowning or near-drowning episode. Med J Aust, 188(8):484-485. 

[31] Nagamatsu, S., Maekawa, T., Ujike, Y., 2011. The earthquake and tsunami—observations by Japanese physicians since the 11 March catastrophe. Crit Care, 15(3):167

[32] Newgard, C.D., Schmicker, R.H., Hedges, J.R., 2010. Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort. Ann Emerg Med, 55(3):235-246.e4. 

[33] Nie, V.J., Yang, L.S., Li, H.R., 2012. Macro assessment of seismic population vulnerability in China. Progr Geogr, (in Chinese),31(3):375-382. 

[34] Peleg, K., Kellermann, A.L., 2009. Enhancing hospital surge capacity for mass casualty events. JAMA, 302(5):565-567. 

[35] Rathbun, K.C., Cranmer, H., 2006. Hurricane Katrina and disaster medical care. New Engl J Med, 354(7):772-773. 

[36] Rega, P., Burkholder-Allen, K., Bork, C., 2009. An algorithm for the evaluation and management of red, yellow, and green zone patients during a botulism mass casualty incident. Am J Disaster Med, 4(4):192-198. 

[37] Shen, J., Kang, J., Shi, Y., 2012. Lessons learned from the Wenchuan earthquake. J Evid-Based Med, 5(2):75-88. 

[38] Takahashi, A., Ishii, N., Kawashima, T., 2007. Assessment of medical response capacity in the time of disaster: the estimated formula of Hospital Treatment Capacity (HTC), the maximum receivable number of patients in hospital. Kobe J Med Sci, 53(5):189-198. 

[39] You, W.J., Zhang, Y.L., 2013. Research on index system of social vulnerability for flood hazard. J Catastrophol, (in Chinese),28(3):215-220. 

[40] Zhang, L., Li, H., Carlton, J.R., 2009. The injury profile after the 2008 earthquakes in China. Injury, 40(1):84-86. 

[41] Zhang, L., Liu, X., Li, Y., 2012. Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake. Lancet, 379(9818):853-861. 

[42] Zhou, J.H., Wang, Z.G., Huang, X.D., 2008. Injury characteristics of the earthquake-wounded and medical logistics management of Wenchuan County in “5.12” earthquake. Chin J Trauma, (in Chinese),24(7):488-490.