| [Backgroud] Earthquake disaster has been the major issue faced by the public security of our country. Earthquake is the geological disaster occured instantaneously which lasts only a short period within tens of seconds. But the short period of time may cause mass casualties and building collapse, especially property losses. China is known as one of the countries affected with the most serious earthquakes in the world. Especially in the past 10 years, China suffered from Wenchuan earthquake, Yushu earthquake, Lushan earthquake and Ludian earthquake, which all led to nearly 500 thousand casualties and uncalculable economic losses. The first task after the earthquake disaster is to save lives. So the earthquake massive trauma has become the logic starting point of all rescue operations and earthquake rescue operations based on the earthquake mass trauma has been the core content of disaster emergency medical rescue action. Study on disaster emergency medical rescue based on the earthquake mass trauma is an important angle of view which is significant to improve the disaster relief emergency decision making and management.Because the earthquake disasters often happen suddenly and cause the secondary or derivative accident, it also has a serious impact on the local rescue agencies. Aid workers and supplies are seriously deficient. It is usually lack of effort to collect the injury epidemio logical information. And further research is only limited to simple epidemio logical research, but "roots" traced studies of the earthquake mass trauma has been ignored. Earthquake area is not only the source of the earthquake mass trauma, but the "blind spots" of the research of earthquake mass trauma. So much information and data lossed due to no timely, standardization of the collection and the best time to research was also missedThe external environment of the mass trauma caused by earthquake is usually relatively complex, which is typical subject of complex adaptive system (CAS). The impact factors of the earthquake mass trauma can be divided into four categories:the earthquake environmental factors, the demographic factors, the affected environmental factors, and the individual behavior factors, but until now no study focused on these factors together. At present, the modeling of earthquake mass trauma is still a worldwide difficult issue. Even though the domestic and foreign research have focused on the modeling in the past research, most of which used empirical formula, probability analysis method for seismic casualties modeling and evaluation, these models usually limited to a single, or partial influence factors were analyzed, and did not involve multi-factors and the complex environment of system modeling study. An earthquake mass trauma model may provide much reference and help for the future earthquake emergency medical rescue.[Objective] This research focuses on the the area with higher seismic activities in the Western China and sustainability study based on mass trauma occurred in the 2013 Lushan earthquake in Sichuan province. Based on the investigation of 5165 earthquake area residents in 26 villages in 6 towns and the data mining of the mass trauma data, we explored the the the trauma occurrence mechanism and change trend of the earthquake area residents; Through screening the demographic factors, the earthquake factors, building damage factors, as well as individual behavior factors of the massive trauma of the earthquake, we aimed to find earthquake trauma complex causes and the key influencing factors; Based on the medical records of the inpatients wounded in the Lushan earthquake, using AIS trauma score method to evaluate the severity, we analyzed characteristic of earthquake massive trauma;Using the system thinking and the theory of complex adaptive system, we also analyzed the feedback mechanism of main body structure and the external environment of the earthquake mass trauma and treatment system, preliminary established conceptual model and logical model of massive earthquake trauma occurrence and treatment system, which lay the ground for late system dynamics modeling and simulation.[Contents and Methods]According to the research design and methods, the five parts in this research study can be divided into three levels:the first part is the retrospective study, belong to the general part, which conducted an overview of the trend of earthquake frequency and characteristic; The second to fourth part mainly focused on empirical research, according to the traumatic timing. Among them, the second and third part based on investigation of the earthquake disaster area residents; after the further data mining, we also discussed seismic mass trauma complicated causes; the fifth part was the exploratory research, which preliminary built massive earthquake trauma and treatment system conceptual model and logical model for further study.1. Overview of earthquake mass trauma in ChinaThis part is mainly based on the EM-DAT database of the global seismic hazard database and the data of seismic Chinese seismic network catalog. We search the earthquakes in the EM-DAT database during the years 1970-2014 for China earthquake disaster situation and provinces which has earthquakes above magnitude 5 degree occurred during the 2009-2015 years. Through statistics and descriptive analysis methods, this research retrospectively analyzed earthquake occurrence trend and regularity of seismic casualties of China in nearly 100 years and also analyzed the earthquake distribution trend of time and regional.2. Research on earthquake trauma among residents within the seriously hitted areaBased on" the standard questionnaire for the earthquake disaster area residents,", we revised and improved the questionnaire according to the need of study and then conducted a large-scale field survey for the 2013 Lushan earthquake disaster area residents:We invested the seriously hitted area and the original environment, living environment, casualties, the earthquake disaster response. Data was coded by Epi-data software. Through descriptive analysis, this research rebuild earthquake disaster scene and explore the complex causes of large-scale trauma.3. Analysis of complex factors of the earthquake mass traumaBased on previous large-scale investigation of the residents in the hardest hit areas in Lushan earthquake, we got a large number of front-line earthquake trauma related data. By matching the injured and uninjured people, we analysed the relationship between the demographic factors, environmental factors, earthquake factors and the behavior factors by the application of conditional Logistic regression analysis method. Through domestic and international literature review, we analyzed the influence factor of the trauma and provided theoretical help for the earthquake emergency medical research.4. Empirical analysis of massive trauma classification and hospital treatmentThis study retrospectively analyzed complete medical records of 266 injured patients after the Lushan earthquake transported from the quake zone to three military hospitals. The results included every inpatient’s demography information, injury diagnosis, injury part, evacuation mode, causes of injury and other information. We also evaluated all the earthquake injuries with AIS-2005 severity score method. The research mainly adopted descriptive statistical analysis method to construct injury spectrum of earthquake injury.5. Earthquake mass trauma and treatment system logical model structureAcoording the theory of the complex adaptive system, this part analyzed the systematic mechanism and structure of earthquake mass trauma and treatment after the 2013 Lushan earthquake. Based on the previous large-scale investigation of residents and the descriptive analysis, this research used the econometrics and complex system modeling technology to establish the conceptual model and the logic model of earthquake massive trauma and treatment. The study analyzed the impact and interaction mechanism between the mass trauma and deployment of the earthquake rescue force groups, and also provides a theoretical basis for the dynamic system modeling and simulation.[Results and conclusions]1. Earthquake disaster has become the core issue of public security of the mankind. The key point of mass trauma among the global earthquake disasters was China. And the key point of mass trauma among the China earthquake disasters was Western China. In recent years, four major earthquakes had occurred in Western China, where has weak economic foundation and complex mountainous areas. It is very difficult to rescue, and earthquake hazard was especially serious. But at present, information dimension of the domestic and foreign earthquake trauma databases is very small, which have been unable to meet the demand of mass trauma research. Therefore, sustainability research of mass trauma in Western China was particularly urgent and important.2. Questionnaire survey of the Earthquake area residents is an effective method for seismic mass trauma information collection to "scene reappearance", and traced "roots" of earthquake mass trauma to decrease the disaster serverity and the mortality. The topographic and humanistic feature of the Lushan earthquake area was consistent with which of Western China where had high-risk of earthquake disaster. Therefore, it is very important to investigate the earthquake area residents by carrying out the large-scale survey.3. According to the investigation, we found that the Lushan earthquake area was mountainous terrain, and buildings were damaged seriously. Most of the surveyed residents were elderly, and cultural and economic level is generally low. The vast majority experienced earthquakes, but the degree of fear were still high. Collapsed buildings were a prime reason for the massive trauma. It is suggested that newly constructed houses in the earthquake-prone area shall strictly implement the earthquake standards, to strengthen the construction of seismic infrastructure. At the same time, we also should screen the buildings which were under standard of anti-seismic construction, to improve the seismic capacity and reduce the occurrence of the earthquake massive trauma.4. The local rescuers and the residents were the key rescue force in the initial period after the earthquake, but the rescue level and ability is generally low. Earthquake wounded victims were evacuated by the manpower and private cars due to capacity shortages, and most of the wounded were transported to the front-line hospitals. The secondary evacuation is given priority to the rear hospital, and ambulances had been the main method. It was advised to strengthen the local rescue forces and the regional emergency supplies reserve. At the same time, it was so vital to teach the local residents how to escape and emergency measures after the quake, to reduce earthquake casualty rate and death rate from the source.5. The earthquake trauma was classified into four categories:demographic factors, environmental factors, construction factors and individual behavior factors. People matched conditional Logistic regression analysis was applied to analyse the earthquake trauma complicated factors, and to screen high-risk groups, high-risk environment, high-risk construction and high-risk behavior factors by analysing the odds of risk. High-risk groups should be given more attention, and the quality of the buildings in the earthquake-risk area should be improved. The earthquake disaster prevention and the earthquake-escaping education should be strengthened to reduce the earthquake mortality effectively.6. Earthquake medical evacuation started in first day, the admission of the injuries of the three rear military hospitals reached a peak within the first 48 hours, all which to advise hospitals in the earthquake-risk area should improve emergency capability to face and cope with the massive trauma in the future sudden disasters.521 earthquake injury diagnoses were confirmed, injury area was used to establish the trauma matrix with the trauma reason, trauma sorts and trauma severity. We found lower limbs and pelvic fractures were the most frequent, the head and spine trauma was usually the most serious. All the results were applied to the analysis of earthquake trauma occurrence regularity and causes, indicating that the surgery and orthopaedic professional rescuer supplement was very important in the first several days and medical resources should be timely supplied in the initial period.7. Earthquake mass trauma was impacted by the earthquake environmental factors, demographic factors, the structural factors, as well as the individual behavior factors, which were not only restrained and depended by each other, but also influenced by external environment, indicating the characteristics of complex adaptive system. Through the interaction and feedback mechanism between different subjects in system structure, establishing the conceptual model and logical model of the earthquake mass trauma and treatment may be especially helpful for the further system dynamics modeling and intervention. |
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