| 【Objective】In recent years, earthquakes have been a recurrent global nightmare, whichcause a significant loss of life and assets around the world. Within last century，there had been2.6million of deaths resulting from the global earthquakes, which making up58％of alldeaths caused by other natural disasters. China was one of the countries with seriousearthquake disaster in the world, and from1900，more than550thousands of people havedied from the hit of earthquakes, which making up4％of all deaths caused by other naturaldisasters. A7.1magnitude earthquake struck the Yushu prefecture of China‘s Qinghaiprovince on April14,2010, which was another serious natural disaster in China after the2008Wenchuan earthquake, and finally killed2698and injured12135people including1434severe injuries.Earthquake-related patients not only serve as an important part of the earthquake reliefwork, but play a key role of the success of the whole relief. Compared with other countries,Due to the absence of a scientific evaluation of the earthquake emergency medical aid systemin China, detailed medical records of all hospitalized patients were often incomplete becauseof the initial disorganization, especially during the first few hours after the earthquake. By thelack of policy, manpower and material resources, previous studies only focused on theanalysis of the small size population collected from several hospitals, none of which basedon investigation of the whole earthquake-related patients arising from the earthquake andevaluation of disaster emergency medical aid at the national level. Meanwhile length of stay(LOS) in the hospital, as an important outcome of the inpatients, has been paid great attention.An increasing number of studies on the factors that determine LOS, or a capacity to predict anindividual patient‘s LOS have been performed in various specialty areas, however, there isless information regarding the factors influencing the LOS among patients withearthquake-related injury. Supported by the China National Ministry of Health, this studyperformed the analyses of the overall distributions of the earthquake-related victims, theepidemiological features of injuries and diseases, and factors influencing hospital length of stay among the inpatients based on comprehensive medical data of hospitalized patients inorder to share the experiences and lessons from our emergency medical aid operations so thatfuture disasters, especially those in special geographical environments, can be dealt with moreeffectively.【Methods】1、Analyses of the overall distributions of the earthquake-related victimsTo obtain detailed information about the management of medical relief work, we reviewedpolicy documents, daily records of the casualties, records of meetings, and other documentsabout earthquake relief assembled from China National Ministry of Health and the HealthDepartments of Qinghai.2、The epidemiological analyses of earthquake-related patientsAccording to the records of China National Ministry of Health, a retrospective study ofmedical clinical characteristics of hospitalized patients following the2010Yushu earthquake.We also reviewed the medical records of all newly hospitalized patients evacuated from theYushu earthquake area to a total of62hospitals. Patient demographic data, complaints,diagnoses, injury types, disposition (including admission, discharge, and transfer), prognoses,pregnant (yes/no), rescuer (yes/no), death (yes/no), disabled (yes/no), Injury Severity Scoreand means of transportation were all reviewed individually.3、Factors influencing hospital length of stay among the inpatientsThis is a retrospective study of the demographic variables, injury variables of adult patientswho were transported from the2010Yushu earthquake area and admitted forearthquake-related injury from April14to May14,2010. For comparative purposes, a longerLOS was defined as a hospital stay of over25days, which represents the mean LOS value forall patients. Multivariate regression models were used to identify factors that influence LOSamong patients with earthquake-related injury.【Results】PART Ⅰ: According to the records of casualties，the injury-death ratio was4.50:1, the numberof deaths kept increasing sharply within the first week after the quake, and then stayed stable,while the number of injuries increasing within the first72h. Meanwhile, more than70%ofthe patients were evacuated to the hospitals in Qinghai province, and other were transported tothe province nearby Qinghai province. PART Ⅱ: A total of3255patients were admitted to hospitals, more than80%of which wereearthquake-related injuries. The first3days were the peak period for hospital admission. Bonefractures were most frequently diagnosed but crush syndrome was observed in23(0.89%).Of illnesses,15.37%suffered from pneumonia, most of which were children. Incidence ofacute high altitude sickness was42.34%, most of which were rescuers. The overall mortalityrate was only0.2%.PART Ⅲ: Multivariate regression models show that being elderly, female gender, earlierarrival at the hospital, bone fracture, abdominal injury, injury to the extremities/pelvis injury,higher injury severity score, having undergone surgery, and having developed complicationswere significantly and independently associated with longer LOS.【Conclusion】1、the increasing tendency of the casualties tally with the features of―two phase‖, which wasclassified into the fast increasing phase and the stable phase, all of which illustrated that theeffective organization of the rescue relief. Hospitals in Qinghai province played a key role intreating the injured, while the hospitals in the nearby province were also indispensible torelieve the pressure of treatment.2、The first3days were the peak period for hospital admission. Bone fractures were mostfrequently diagnosed, which proved that peripheral hospitals should been enhanced by addingorthopedist, surgeon, Anesthetist, etc to relieve the treatment pressure of the hospitals. Moreattentions should also be paid to crush syndrome patients to reduce the mortality andmorbidity.3、After a high altitude earthquake, rescue teams locating in the high-altitude regions shouldbe chose and dispatched preferentially to the quake area in order to avoid the large-scaledetachment. Knowledge of prevention of the acute high altitude sickness should be publicizedand popularized among the rescuers and medical staffs. Preventative medicines should betaken properly on the day before entering the plateau4、Strong preventive and therapeutic initiatives should be designed for elderly and femalepatients injured in earthquakes, especially within the initial days. Surgery was the greatest riskfor a longer LOS. The factors identified in this study offer insights into directions for effectivehealth policy to reduce LOS after a devastating earthquake. |
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