依托基层医院组建临时创伤团队进行灾难救援

doi:10.19723/j.issn.1671-167X.2025.02.016

摘要/Abstract

摘要：

目的: 探讨依托基层医院在灾难当地迅速组建由创伤专家主导的临时创伤团队进行灾难救援的可行性。方法: 在2021年12月15日山西省孝义市煤矿透水事故中, 在矿难发生后至医务人员被允许进入灾难现场的短暂时间间隔内, 由创伤专家对救援医务人员进行简要的高级创伤生命支持(advanced trauma life support, ATLS)和损伤控制性外科(damage control surgery, DCS)理念和技能培训, 组建由创伤专家、ATLS小组和DCS小组构成的临时创伤团队, 在院前、院内对升井矿工进行早期救治。结果: 矿难发生的第36小时发现井下幸存者, 22名被困矿工均为男性, 其中2人死于井下, 另外20人幸存并在矿难发生后第39~43小时依次升井, 中位年龄48岁(34~57岁)。所有幸存者均遭受失温、脱水和浸渍足等多种损害, 急性吸入性气管支气管炎18例, 电解质酸碱紊乱14例, 躯干顿挫伤6例, 腰大肌血肿1例, 下肢深静脉血栓形成和高凝状态4例。ATLS小组在院前的50~60 min内对患者进行伤情评估、复温、补液、根据预案诊治, 在入院2 h内完成辅助检查明确诊断。DCS小组评估6例躯干机械性钝伤患者并排除紧急手术指征, 创伤专家全程督导和质量控制。所有幸存者入院3 h内足趾毛细血管再充盈实验阳性率较升井即刻显著降低(75.0% vs. 15.0%, P=0.000 3), 均于入院后第4~7天康复出院。结论: 以创伤专家主导尽早在灾难当地依托基层医院迅速组建并培训具备ATLS和DCS能力的临时创伤团队, 参与灾难医疗救援是可行的, 符合当前我国国情。

关键词: 高级创伤生命支持, 灾难, 救援, 基层医院, 临时创伤团队

Abstract:

Objective: To explore the feasibility of establishing a temporary trauma team led by trauma experts in primary hospitals for disaster medical rescue. Methods: In the coal mine flooding accident in Xiaoyi City, Shanxi Province on December 15, 2021, according to the local emergency plan and the characteristics of the accident, the trauma experts trained the medical staff from the local primary hospital on advanced trauma life support (ATLS) and damage control surgery (DCS) in the short time interval between the occurrence of the mine disaster and the admission of medical staff to the disaster scene. A temporary trauma team composed of trauma experts, ATLS team, and DCS team was formed to provide early diagnosis and treatment for survivors before and in the hospital. Results: The miners were found on the 36th hour of the disaster. All 22 miners were male, and 2 died underground. Another 20 people were rescued 39－43 hours after the disaster, with a median age of 48 years (34-57 years). All the survivors suffered from hypothermia, dehydration, maceration of feet and other injuries. There were 18 cases of acute inhalation tracheobronchitis, 14 cases of electrolyte acid-base disturbance, 6 cases of trunk contusion, 1 case of psoas major hematoma, and 1 case of lower extremity hematoma. Deep vein thrombosis was in 4 cases. The ATLS team focused on injury assessment, rewarming and rehydration within 50－60 minutes before admission, and completed auxiliary examinations within 2 hours after admission to clarify the diagnosis. The DCS team evaluated 6 patients with mechanical blunt trunk injury and excluded the indication of emergency surgery. The trauma experts conducted the whole process of supervision and quality control of disaster rescue. The positive rate of capillary refill test in the all survivors at the third hour of admission was significantly lower than that immediately after being rescued (75.0% vs. 15.0%, P=0.000 3), and they were discharged 4－7 days after admission. Conclusion: Under the leadership of trauma experts and relying on the medical staff of primary hospitals, it is feasible to establish and train a temporary trauma team with ATLS and DCS functions to participate in the medical rescue of disasters, which is in line with the current national conditions of China.

Key words: Advanced trauma life support care, Disasters, Rescue work, Primary hospital, Temporary trauma team

中图分类号:

R129

王振洲, 赵秀娟, 郭辅政, 朱凤雪, 王天兵. 依托基层医院组建临时创伤团队进行灾难救援[J]. 北京大学学报（医学版）, 2025, 57(2): 323-327.

Zhenzhou WANG, Xiujuan ZHAO, Fuzheng GUO, Fengxue ZHU, Tianbing WANG. A temporary trauma team established in primary hospital for disaster rescue[J]. Journal of Peking University (Health Sciences), 2025, 57(2): 323-327.

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Composition	Specialty of the staff	Total	Doctors	Nurses
Trauma expert	Trauma	1	1	0
ATLS team^*	Pre-hospital: Emergency	69	23	46
	In-hospital: Emergency, anesthesia, critical care medicine	66	22	44
DCS team	Neurosurgery, thoracic and general surgery, urology, orthopedics, vascular surgery	5	5	0

Injury	Emergency treatment
Drowning	Cardiopulmonary resuscitation for cardiac arrest, oxygen therapy and rapid rewarming for survivors
Hypothermia	Rewarming: remove wet clothes, cover with quilt, air conditioner, warm saline infusion, extracorporeal circulation if necessary
Mechanical trauma	Hemostasis, decompression, debridement and fixation procedures Preparation: tourniquet, pelvic girdle, neck brace, chest and waist circumference, splint, needle for pneumothorax decompression
Hypovolemia	Oral and intravenous fluids guided by thirst, urine output, and hemodynamics. Severe trauma shock with blood transfusion resuscitation, crystalloid＜1 500 mL
Ketosis	Food and rehydration
Acid-base disturbances	Food and rehydration. Adjust according to blood gas test
Airway stimulation	Inhalation of budesonide in patients with pulmonary wheezing
Poisoning (CO, H₂S, etc.)	Oxygen therapy and detection of carboxyhemoglobin in blood
Hypoxia	Manual or oropharyngeal airway in prehospital, endotracheal intubation or surgical airway in hospital, if necessary. Oxygen therapy
Arrhythmia	ECG monitoring. Non malignant arrhythmia, no antiarrhythmic drugs
Cardiac arrest	CPR in hypothermic patients cannot be stopped until the body temperature has recovered CPR not necessary: Irreparable trauma, corpse plaques, other evidence of no hope of survival
Impregnated foot	Cleaning and rewarming
Unconsciousness	Blood sugar measurement, airway management (same as above), blood carboxyhemoglobin detection after admission, and head CT examination if necessary
Chronic disease	Not fatal, not handled

Diagnosis	Data, n(%)
Acute injury
Hypothermia	20 (100)
Acute inhalation tracheobronchitis	18 (90.0)
Dehydration	20 (100)
Electrolyte and acid-base disturbances	14 (70.0)
Ketosis	16 (80.0)
Headache	4 (20.0)
Sinus bradycardia	5 (25.0)
Frequent premature ventricular contractions	2 (10.0)
Ocular foreign bodies and trauma	2 (10.0)
Soft tissue blunt trauma	6 (30.0)
Psoas hematoma	1 (5.0)
Venous thrombosis or hypercoagulability	4 (20.0)
Impregnated foot	20 (100)
Chronic disease
Pneumoconiosis	10 (50.0)
Emphysema	6 (30.0)
Bronchiectasia	1 (5.0)
Old fractures of the spine and extremities	7 (35.0)
Spinal degeneration	4 (20.0)
Hypertension	2 (10.0)
Atherosclerosis	3 (15.0)
Liver and kidney cysts	6 (30.0)
Hepatic hemangioma	2 (10.0)
Urinary calculi	2 (10.0)
Gallstone	2 (10.0)