爆炸恐怖袭击与应急医学救援

在各种恐怖活动中,爆炸恐怖最为多见。本文介绍了当今国际爆炸恐怖袭击的现状及我国面临的现实威胁,系统阐述了爆炸恐怖袭击的种类、所致损伤的伤类伤情特点、爆炸现场伤员的紧急救治原则与内容、掩埋伤员的搜寻与挖掘、伤员的搬运与医学后送及其特殊要求。     

恐怖袭击与应急医学救援对策

近年来,恐怖袭击活动在世界范围内蔓延,已成为人类社会的公害。中提出了恐怖袭击的界定及其类型,按恐怖袭击手段可分为核、化、生、爆炸和劫持5种类型;按实施的意识形态可分为极端宗教型、极端民族型、极端邪教型、极端黑社会型、极右型和极左型等6种;按实施的范围可分为集团型、国家型和跨国型3种。恐怖袭击特点在于手段的残忍性、行动的诡秘性、恐怖袭击效果的惨烈性、发生时间和地点的不确定性和突发性,以及伤类伤情的复杂性和危重性。提出的应急医学救援对策包括：建立高效的医疗救援指挥机构;完善各种医疗救援应急预案;建立救援体系和救援基地;加强反恐训练,重视心理灾害的预防;建立反恐医学,“以人为本”搜救善后。     

Forensic answers to the 14th of July 2016 terrorist attack in Nice

International Journal of Legal Medicine - The terrorist attack of July 14, 2016 in Nice (France) was a devastating event. A man voluntarily drove a truck into a crowd gathered for the fireworks...     

An autopsy case related to a terrorist attack using a ball-bearing bomb

We encountered an autopsy case related to a terrorist attack using a ball-bearing bomb. The decedent was a 51-year-old male without significant medical histories. During dinner in a restaurant, the perpetrator suddenly exploded a ball-bearing bomb, the blast from which blew the victim off his chair. The victim was found to be unresponsive, and pronounced dead. X-ray photographs taken before autopsy revealed six spherical shadows. Three penetrating wounds in the head, one in the neck and chest, and two in the left upper arm were observed in vivo. Six projectiles recovered from the body were identified as ball-bearings, one of which traveled through the midbrain, diencephalon, and left temporal lobe. Although blast injuries and penetrating wounds are often combined in bomb attack victims, penetrating brain injury would be the cause of death in this case. Lethal injuries to major organs can thus occur even though the destructive force of a ball-bearing bomb is weak. X-ray films were informative for detecting the ball-bearings in this case, suggesting that autopsy imaging is essential in cases of terrorism victims.     

Critical care delivery: the experience of a civilian terrorist attack

It has been recognised for some time that a terrorist incident was threatened in the U.K. and it has been noted previously in the JRAMC that the locations for terrorist atrocities are likely to be more diverse than previously experienced. July 7th 2005 witnessed the first terrorist suicide bombing on the U.K. mainland, targeting the public transport system in London. These attacks were unprecedented in both scale and intensity but they were anticipated in London. However there were clear difficulties, relating to multiple sites, their location underground and early problems with communication (2). This article highlights some of the experiences and learning points of the Intensive Care Medicine Service at the Royal London Hospital (RLH) in the wake of the July 7th bombings. The RLH was the single biggest receiver of casualties (195); seven of whom were admitted to the Intensive Care Unit. The Defence Medical Services have tri-service representation (both regular and reserve) at the RLH in Emergency Medicine and Pre-hospital Care, Surgical Services and Intensive Care Medicine.     

Food for thought: the use of hazard and critical control point analysis to assess vulnerability of food to terrorist attack in deployment locations

As part of a screening study, a literature review, personal interviews, and field work at several deployment locations, we examined the historical use of biological warfare agents and the vulnerability of food at military deployment locations to bioterrorist attack. The results of our experience suggest the following: historically, food has occasionally been used as a weapon by individuals; a benchmark procedure already exists to evaluate and ensure the safety of foods procured and used by the U.S. federal government; and food sources at the deployment locations examined are vulnerable to terrorist attack as determined by a critical control point analysis. Recommendations to potentially decrease the vulnerability of the U.S. military food supply to intentional contamination are also provided.     

Expression of paraoxonase isoform did not confer protection from acute sarin poisoning in the Tokyo subway terrorist attack

We previously reported the polymorphism of the high density lipoprotein-associated enzyme paraoxonase (PON1), in the 10 sarin poisoning victims in the Tokyo subway terrorist attack. Arg₁₉₂ PON1, which has low sarin hydrolysing activity, was found to be more common in the Japanese population than in people of other races. However, from our analyses seven of the victims expressed the PON1 phenotype with high sarin hydrolysing activity and three with low sarin hydrolysing activity. These results indicate that the main factor contributing to the tragedy of the Tokyo subway terrorist attack was the high toxicity of sarin rather than the race-dependent genetic difference in the Arg₁₉₂ PON1 polymorphism. Received: 29 August 2000 / Accepted: 7 March 2001     

美国空中急救概况

美军大规模使用直升飞机转运伤员开始于朝鲜战争及后来的越南战争。根据已取得的成功经验,空中急救(air medicine)现已成为美国平时完整创伤急救系统不可分割的重要组成部分。笔者重点介绍美国空中急救的方法与经验,以供国内创伤急救医学有关人员在决策或开展中国的空中急救项目．时参考。     

The effect of a chemical protective ensemble on intravenous line insertion by emergency medical technicians.

Protective gear is mandatory for medical personnel treating casualties in a contaminated environment. In the present study, we assessed the ability of emergency medical technicians to insert an intravenous line in this situation. Sixty emergency medical technicians were randomized to a control group, wearing fatigues, and a study group, wearing full protective gear. The ability to insert an intravenous line in healthy volunteers was assessed 1, 2, 4, and 8 hours after randomization. We found no effect of protective gear (p = 0.543) or time in protective gear (p = 0.8869) on success rate or on time needed for successful task completion (p = 0.4005 and p = 0.9021, respectively). The overall success rate was 58.6%, 65% in the unprotected state and 56% in the protected state, and the time was 303 +/- 115 and 351 +/- 113 seconds, respectively. These findings suggest that introduction of an intravenous line is possible but time consuming even after a prolonged stay in full protective gear. Alternative methods for antidotal treatment, such as the use of automatic autoinjectors for intramuscular administration, might be suggested.     

商业航空飞行中的紧急医学事件

目的对国内外商业航空飞行中紧急医学事件进行综述。资料来源与选择该领域的相关研究论文和综述。资料引用国内外公开发表的论文和综述43篇。资料综合对国内外商业航空飞行中的紧急医学事件的基本情况和应对措施进行分析和总结。结论虽然飞行中紧急医学事件发生率低，但可能会导致严重后果。我国的商业航空公司应借鉴国外航空公司先进的做法和有价值的经验，为旅客提供优质服务，为飞行安全提供更好的保障。