大规模伤亡事件伤员分类的系统评价_《中国循证医学杂志》

作者：

王凌 ,  李静 , 李幼平 , 徐琳

四川大学华西医院循证医学与临床流行病学教研室;

关键词：

大规模伤亡事件伤员分类系统评价地震

DOI：

10.7507/1672-2531.20080107

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

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。

引用本文： 王凌,李静,李幼平,徐琳. 大规模伤亡事件伤员分类的系统评价. 中国循证医学杂志, 2008, 08(7): 469-476. doi: 10.7507/1672-2531.20080107 复制

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 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.	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 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.	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, 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.	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 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, 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 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, 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 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. 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 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. 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, 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. 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 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, 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 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, 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.

《中国循证医学杂志》

大规模伤亡事件伤员分类的系统评价

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《中国循证医学杂志》

大规模伤亡事件伤员分类的系统评价

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