傷情評估和戰(zhàn)場傷員分類(江)

1、傷情評估和戰(zhàn)場傷員分類傷情評估和戰(zhàn)場傷員分類江江 雷雷衛(wèi)生勤務(wù)學(xué)教研室衛(wèi)生勤務(wù)學(xué)教研室Mass casualties Any large number of casualties produced in a relatively short period of time, usually as the result of a single incident such as a military aircraft accident, hurricane, flood, earthquake, or armed attack, that exceeds local logistical suppo

2、rt capabilities. The term mass casualties means that a large number of casualties has been produced simultaneously or within a relatively short period of time. It also means that the number of patients requiring medical care exceeds the medical capability to provide treatment in a timely manner. An

3、absolute disparity exists between the number of patients, the available medical resources and timely treatment. Mass casualty situation A mass casualty situation is present when one combat medic is confronted with two critically injured patients at the same time. With a large number of casualties, t

4、he disparity may be multiplied many times; this greatly disrupts the doctrinal approach to treatment and evacuation. In addition to the treatment and evacuation of a large number of military and civilian casualties, problems may occur from disruptions in the supply, communication, and transportation

5、 systems. N.A.葉菲緬科主編（涂通今主譯）：野戰(zhàn)外科學(xué)，葉菲緬科主編（涂通今主譯）：野戰(zhàn)外科學(xué)，P5.人民軍醫(yī)人民軍醫(yī)出版社，出版社，2005年年10月月什么是傷情評估？ 傷情評估是指在戰(zhàn)場上運用簡明的應(yīng)急診斷技術(shù)，迅速地對傷員情況進行初步判斷，進而以量化標(biāo)準(zhǔn)來判定傷員損傷的嚴(yán)重程度，從而指導(dǎo)戰(zhàn)場傷員分類救治，預(yù)測戰(zhàn)傷結(jié)局以及評估救治質(zhì)量。一、傷情評估方法院前評分院前評分院內(nèi)救治和創(chuàng)傷研究評分傷傷 情情 損傷程度損傷程度 治愈時間治愈時間 預(yù)后預(yù)后 比例比例輕輕 傷傷 軟組織傷軟組織傷 30天內(nèi)天內(nèi) 良好良好 40%中等傷中等傷 廣泛軟組織傷、廣泛軟組織傷、 60天內(nèi)天內(nèi) 部分傷員

6、機能部分傷員機能 35% 上肢骨折、一般臟器傷上肢骨折、一般臟器傷 障礙，影響歸隊障礙，影響歸隊重重 傷傷 傷情嚴(yán)重、傷情嚴(yán)重、 60天以上天以上 嚴(yán)重殘廢嚴(yán)重殘廢 25% 有生命危險有生命危險 或后遺癥或后遺癥傷勢分度與百分比傷勢分度與百分比院前指數(shù)（Pre-hospital index，PHI）指標(biāo)指標(biāo)012345SBP(KPa)13.311.5-13.310-11.40-9.9脈搏脈搏(次次/分分)51-119=120=50呼吸呼吸(次次/分分)正常正常淺費力淺費力100 mmHg 毛細(xì)血管充盈遲毛細(xì)血管充盈遲sBP 85 99 mmHg 毛細(xì)血管無充盈毛細(xì)血管無充盈sBP 85 mmH

7、g 呼吸呼吸R 正常正常 35 次次/分鐘分鐘 無自主呼吸無自主呼吸 胸腹胸腹A 均無壓痛均無壓痛 胸或腹壓痛胸或腹壓痛 連枷胸、板狀腹或連枷胸、板狀腹或深穿刺傷深穿刺傷 運動運動M 遵囑動作遵囑動作 只有疼痛反應(yīng)只有疼痛反應(yīng) 無反應(yīng)無反應(yīng) 言語言語S 回答切題回答切題 錯亂、無倫次錯亂、無倫次 發(fā)音聽不懂或不能發(fā)音聽不懂或不能發(fā)音發(fā)音輕度：輕度：9-10分，重度：分，重度：7-8分，極重度：分，極重度：0-6分分參數(shù)參數(shù)012345呼吸呼吸 次數(shù)次數(shù)0 3525351024幅度幅度淺或困難淺或困難正常正常循環(huán)循環(huán) SBP0 90毛細(xì)血管充毛細(xì)血管充盈盈無充盈無充盈充盈遲緩充盈遲緩正常正常意識

8、狀態(tài)意識狀態(tài)GCS345781011131415創(chuàng)傷計分（Trauma score）1-16分，分， 12分為重傷分為重傷Glasgow Coma Scale，GCSBest Motor ResponseEye OpeningBest Verbal ResponseObeys6Localizes Pain5Oriented, Conversing5Withdraws4Spontaneous4 Disoriented, Conversing4Abnormal Flexion3To Verbal Command3 Inappropriate Words3Extension2To Pain2 Inc

9、omprehensive Sounds2None1No Response1 No Response1Add the scores for each category.A total score of 7 or less indicates a severe injury.The most common patterns of comatose patients are M=5 of less, V=1, E=1.校正的創(chuàng)傷積分 ( Revised Trauma Score，RTS ) 編碼值編碼值cv 4 3 2 1 校正校正值值w GCS 1315 912 68 45 0.9368 SBP

10、89 76-89 5075 149 0.7326 RR 1029 29 69 15 0.2908 簡易戰(zhàn)傷評分方法 A.呼吸次數(shù)（呼吸次數(shù)（/分）分）B.收縮壓（收縮壓（mmHg）C.神志昏迷狀況神志昏迷狀況等級等級積分積分等級等級積分積分等級等級積分積分102948941315429376893912369250752682151149145100303 6-92 1-51 00Systolic blood pressure904 89-763 75-502 491 00Glasgow coma scale15-134 12-93 8-62 5-41 30Priorities are ass

11、igned as:P1(T1)1-10P2(T2)11P3(T3)12P1 Hold(T4)1-3Dead0The overlap in scores allows for the seriously injured to be placed in either category,depending on number of casualties and resources available of evacuation.Evacuation will be delayed when the number of casualties outstrips available transport.

12、 In this situation，the greater time spent with the casualty will allow additional anatomical assessment of injuries. Where the primary determined by physiology does not match the anatomical severity of injuries, the priority can be upgraded Example:A soldier loses his left leg in a landmine incident

13、.Immediate first aid is effective in stopping hemorrhage.He is transported to the division aid station.He cannot walk, his respiratory rate is 22 and his pulse is 110/minute.He is triaged ? for treatment(Triage Sieve).He then receives intravenous fluids and analgesia. His systolic BP is 115 mmHg, hi

14、s respiratory rate is 20,he is fully alert,with a GCS of 15. He scores 12 on his Triage Sort, which is P3 for evacuation.Clearly, he requires early surgical treatment and the surgeon upgrades his priority to P2 for evacuation to the field hospital.Chinese triage :wound markerSign of sortingadvanced

15、triage systems In advanced triage systems, secondary triage is typically implemented by paramedics, battlefield medical personnel, or by skilled nurses in the emergency departments of hospitals during disasters, injured people are sorted into five categories.Blue / Expectant They are so severely inj

16、ured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock); they should be taken to a holding area and g

17、iven painkillers to ease their passing. Red / Immediate They require immediate surgery or other life-saving intervention, first priority for surgical teams or transport to advanced facilities, cannot wait but are likely to survive with immediate treatment. Yellow / Observation Their condition is sta

18、ble for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under normal circumstances). Green / Wait They will require a doctors care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue i