车祸急救“三字经”

我在交通系统医疗部门工作20多年，参加过多次的车祸急救和治疗工作。在被送来急救的交通事故伤者中，有6～7成因出血过多而出现休克、瞳孔放大等症状的。造成这些症状的主要原因就是伤者在受伤后不能在第一时间得到及时、正确地抢救。而这些伤者往往会因耽误了有效抢救时间，受到更大的伤害乃至于死亡。因此说，在车祸抢救中，快捷地报警和正确的急救很是关键。根据多年的工作实践经验和有关急救知识，现将车祸急救概括为通俗易懂的“三字经”供大家参考。     

高速公路车祸伤人院前急救护理

高速公路造成的车祸伤逐年增多，且病员病情重、多发伤、群体伤多，死亡率高，车祸伤的急救成为急救医学的重要课题，良好的院前急救护理对减少车祸伤的致死率及致残率非常重要。绵阳市404医院2004—08／2005-08共急救高速公路车祸伤病员42名。现将高速公路车祸伤入院前急救护理报告如下。     

批量车祸伤病人的急救与护理管理

目的：探讨成批车祸伤病人的急救与护理管理，寻求提高抢救效率和水平，降低死亡率。方法：回顾性分析20起79例车祸伤的救治经验。结果：批量车祸伤病人救治工作有条不紊，保证了抢救的效率。70例抢救脱险，5例现场死亡，4例抢救无效死亡。结论：利用院前院内急救，生命绿色通道，提供高效，快捷的急救是抢救成功的关键，有效的护理管理是提高抢救效率的保证。     

高速公路车祸伤入院前急救护理

高速公路造成的车祸伤逐年增多,且病员病情重、多发伤、群体伤多,死亡率高,车祸伤的急救成为急救医学的重要课题,良好的院前急救护理对减少车祸伤的致死率及致残率非常重要.绵阳市404医院2004-08/2005-08共急救高速公路车祸伤病员42名.现将高速公路车祸伤入院前急救护理报告如下.     

大批量伤员的救治护理

我院是一家年门急诊量达14万人次的综合性三甲医院，毗邻高速公路的人口，是各类交通事故的首选救治医院。创伤急救是急诊医学的重要组成部分，车祸伤的救护成为急救医学的重要课题。我院急救医学科在2007年11月成功救治了2批车祸外伤病员，现就抢救护理经验总结如下：     

郑州市伤害急救的流行病学特征

目的 了解郑州市伤害在急救中的分布，结局情况。方法 采用描述流行病学方法对郑州市急救中心2000年的伤害患者进行研究。结果 郑州市急救中心2000年共收治1816名伤害患者，占总收治患者的26.6%，以青壮年男性为主，伤害主要以车祸伤（67.8%)，跌伤（12.4%)，中毒（5.5%)、压榨伤（4.1%)和砸伤（2.3%)为主；伤情危重病人占16.1%，重病人占76.0%，轻病人占7.9%，在伤害患者中仅有8名患者在伤害发生时采取了自救和互救措施；伤害的总治愈率为53.3%，好转率为42.2%，未愈率2.1%，有34名伤害患者死亡，病死率为1.8%，死者主要是车祸伤，跌伤，分别占死亡人数的67.7%和14.7%。结论 开展伤害急救的研究，降低伤害的死亡率和致残率，同时，应进行全民性急救常识和技术的普及工作。     

车祸的现场急救

随着现代交通的日益发达,车祸也日益频繁,对于出行者,掌握一些必备的车祸现场急救知识,可在危难来临之际急而不乱,赢得抢救生命的最宝贵条件。 当车祸发生后,首先要做的,当然是立即拨通120急救电话,报告出事地点、受伤人员及伤情。同时,应根据具体情况对伤员进行现场急救。 由于车祸所致的伤害大多属于减速伤(如紧急刹车、两车相撞的车内致伤)、撞击伤、碾挫伤、压榨伤及跌扑     

做“镜手术”真是好——5例泌尿腔镜手术侧记

香港《明报》2003年11月19日A24版，以《汕尾逸挥医院申明先救人后谈钱》为题报道了汕尾逸挥基金医院认真履行救死扶伤的职责，成功地救治了许多深汕高速公路上因车祸而受伤的病人。报道中说：“汕尾逸挥基金医院是深汕高速公路“车祸急救”最多的医院之一，每当该路段发生车祸，逸挥医院都是急救主力军。     

十堰市三起重大车祸76名伤员的紧急救援

目的研究突发事件成批伤员院前急救特点,推进城乡"120"急救体系建设和完善紧急医疗救援工作规范。方法对十堰市2009年春运期间紧急救援三起重大车祸76名伤员案例进行总结分析。结果76名伤员急救成功,其中12名重伤员经治疗康复。结论建立城乡"120"急救体系,加强急救站标准化建设,完善紧急救援工作规范,及时、有效的现场救治,是突发事件成批伤员的急救保障。     

成批病人急救应急预案之我见

随着社会的不断发展，突发事件也随之不断增多，如车祸、有害气体中毒、房屋室倒塌等，成批病人来院，能否做好成批病人管理抢救工作直接关系到病人的生命质量，所以说此项工作至关重要。我院2005年1月以来已进行了5起突发事件的抢救，其中2起为房屋倒塌，2起为有害气体中毒，1起为车祸，现将对急救病人应急预案的应用体会汇报如下。     

高速公路医警联合救援系统构建初探

针对荆州市目前交通事故紧急救援体系建设与管理现状,提出在高速公路上设立1个医警联动急救单元、1个一级急救站、4个急救点以及直升机立体救援的＂高速医警联合救援系统＂,用跨系统大格局的救援理念协调各部门之间的合作关系。     

交通创伤及院内急救体系建设

目的以北京市交通创伤为例,调查分析其特点,对建立交通医学急救体系进行探讨。方法收集2007-2009年间北京市120急救数据库中诊断为交通伤的患者资料。结果共收集交通伤患者8251名,以男性患者为主,老年患者约占10%左右,部分患者合并有可疑心肺事件的前驱症状。结论目前交通创伤院内急救模式尚存在不足,应建立新型急救模式,可能有助于降低其危害,提高其救治率。     

Traffic accidents resulting in injuries: underreporting,characteristics, and case fatality rate

In order to describe traffic accidents in a medium-sized Brazilian city and compare the risks of injury and death among different types of vehicles and pedestrians, all traffic accidents identified through police and hospital emergency records were registered for two years Deaths by such accidents were identified and confirmed through the coroner's office. The number of registered vehicles in the municipality was obtained through the State traffic authority. Morbidity and mortality rates were calculated and tests of association between selected variables performed. There was a relevant underreporting of accidents by the police (up to 53%), which varied according to the type of accident and time of occurrence. The highest case fatality rate was observed among bicyclists and pedestrians (around 5%), followed by motorcyclists (3%). Pedestrians formed the highest contingent of deaths. Motorcyclists had an eightfold risk of dying, a fourfold risk of injury, and a twofold risk of running over pedestrians as compared to automobile drivers. We conclude that pedestrians and motorcyclists are priority groups for interventions aimed at reducing injury and death from traffic accidents.     

Traffic accidents in a city in Southern Brazil: an evaluation of coverage and quality of data]

The aim of this study was to analyze police coverage and the validity of data on emergency and hospitalization records as well as on death certificates for traffic casualties in Londrina, Paraná State, Brazil. Victims (3,643) of road accidents during the first semester of 1996 were investigated and followed up after 180 days to confirm whether death was due to the accident. Police data recorded only 32.5% of the casualties, the coverage being higher for car occupants (71.6%) and lower for cyclists (8.1%) and pedestrians (24.8%). Agreement was low between original information and that derived from investigation of death certificates (Kappa coefficient 0.10; 95% CI: 0.02-0.17), fair for hospitalization records (Kappa coefficient 0.33; 95% CI: 0.27-0.40), and substantial for emergency records (Kappa coefficient 0.63; 95% CI: 0.61-0.65). Results suggest that police data underestimate the number of traffic casualties and that it is necessary to improve the validity of medical records.     

交通事故致严重多发伤一体化救治分析

目的探讨急症一体化救治模式在提高交通事故致多发伤救治成功率方面的作用。方法东南大学附属江阴医院2006年1月-2007年10月采用“院前急救-院内急救室-急诊室症监护病房（EICU）”一体化救治严重多发伤病人103例（第1组），和2004年1月-2005年12月未采用新急救模式抢救严重多发伤病人101例（第2组）进行比较。结果第1组死亡20例，救治成功率为80．6％。第2组死亡27例，救治成功率为73．3％。2组患者创伤严重度评分（ISS）差异无统计学意义，第1组患者120平均到达现场的时间、院内绿色通道时间、平均住院时间均低于第2组，救治成功率高于第2组（P〈0．05）。结论多发伤的诊治必须由急救中心医师实施或组织实施，在急救中心实施多发伤一体化救治是提高其成功率的有效途径，也是多发伤救治的发展趋势。     

武警总队医院反恐卫勤保障模式探讨

目的探讨武警总队医院在反恐行动中卫勤应急特点及保障模式。方法根据恐怖活动特点,做到＂四个结合＂,把握＂三快＂原则,细化救治流程,优化力量配置,提高救治效率。结果医院拥有现场处置大批复杂伤情伤员能力、技术和设备,拥有转运后送大批伤员系统和周密保障计划。结论组织纪律严明,装备优良,具有克服困难、勇往直前的精神,便于统一指挥,快速行动,凭着强烈、过硬的职能意识和救治技能,全面提高综合保障能力。     

武警部队国家级医疗救援队模块化编配研究

目的:为进一步提高武警部队国家级救援队执行反恐处突、抢险救灾任务的保障能力,对武警部队医疗救援队力量编配现状进行分析和总结,并针对现状对模块化编配进行研究。方法:根据不同任务需求,按照小型医疗队和大型医疗队编配,将小型装备便携化、大型装备机动化,形成快速、轻便灵活的保障体系。结果:武警部队国家级救援队人员编配科学合理、医疗救治范围广、通讯能力和自身保障能力强。结论:武警部队国家级救援队通过模块化抽组和核心装备的车载化,具有便于机动、便于装卸、便于展开、便于救治的特点,极大提高了救援队独立保障能力。     

Using accident injury data to assess the impact of community first aid training

In a U.K. First Aid Community Training Project from a twon with a population of around 19,000 over 1200 people took a 4-h emergency first aid course. Independent evidence for the effects of the training was obtained from hospital casualty registers and from police road traffic accident data. The data indicated that the first aid training significantly reduced the accident injury rate in the community. Age, sex and accident location effects are discussed with reference to the disaggregated empirical data. It is argued that there are substantial indirect effects from the training, particularly the influence of first aid-trained adults upon children, as well as direct effects upon trained individuals shown by earlier studies.     

武警某部队官兵卫生服务需求调查

目的研究某武警部队官兵卫生服务需求与利用的现况和特点。方法采用多阶段分层整群抽样的方法调查武警部队623名官兵的两周患病及就诊、慢性病患病、住院等情况,并与军队、武警、国家相关调查结果做对比分析。结果被调查的武警部队官兵两周患病率为21．35％,以训练伤最为常见。两周就诊率为9．63％,多数选择部队医疗机构就诊。慢性病患病率为9．63％,多见于腰椎疾病。一年住院率为8．03％,其中90％选择总队医院住院。结论相对偏远地区武警官兵卫生服务需求较高,基层医疗机构卫生服务利用率较低。提示卫生相关部门应结合实际,及时调整和加强各层次卫生医疗机构的配置。     

A Multi-sectoral Approach to Capture Information on Road Traffic Injuries

Background:

Regularly available data is shown to be inadequate for developing, implementing, and evaluating injury prevention and control programs in India. The present study was undertaken in the hospitals of Bangalore and Pune, to examine the feasibility of gathering information on injuries using multiple sources.

Materials and Methods:

Stakeholders meeting and training programs were held for the hospital staff, police personnel, and traffic and transport staff, to identify their roles and responsibilities. Prospective data on morbidity and mortality due to injuries were collected by trained staff from Emergency Departments on a pre-tested questionnaire. The information gathered was cross-checked with the hospital and police records.

Results:

The stakeholders meeting and training programs were able to motivate the departments to provide the correct data. Data on 32188 patients could be extracted from hospital and police records during the study period. Injuries accounted for 16% of the emergency cases. Unintentional injuries were 64%, and 32% were intentional. Road traffic injuries accounted for 44% of all the injuries. One-third of the injured were children and young adults below 25 years. Among the injured, two wheeler riders were 29% and pedestrians were 23%.

Conclusion:

It was possible to improve the data on injuries by adequate training and a data linking mechanism between the Police, Hospital, and Transport Departments. The problem of road traffic injuries could be highlighted and addressed by a good data capture mechanism.