Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire

作     者：Wei-feng SHEN Li-bing JIANG Guan-yu JIANG Mao ZHANG Yue-feng MA Xiao-jun HE 

作者机构：Department of Emergency Medicine the Second Affiliated Hospital School of Medicine Zhejiang University 

出 版 物：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 (浙江大学学报（英文版）B辑（生物医学与生物技术）)

年 卷 期：2014年第15卷第12期

页      面：1072-1080页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 100402[医学-劳动卫生与环境卫生学] 10[医学] 

基　　金：Project supported by the Research Fund of Ministry of Health of China(No.N20080022) the Major Science and Technology Project of Zhejiang Province(No.2009C03010-3) the Medical Scientific Research Foundation of Zhejiang Province(No.200921012) the Educational Commission of Zhejiang Province(No.Y200908921),China 

主　　题：Mass casualty incident Surge Vulnerability Earthquake Fire incident 

摘      要：Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in order to outline and develop an improved research paradigm for MCI management. Methods： We searched PubMed, EMBASE China Wanfang, and China Biology Medicine （CBM） databases for relevant studies. The following key words and medical subject headings were used： ＇mass casualty incident＇, ＇MCI＇, ＇research method＇, ＇Wenchuan＇, ＇earthquake＇, ＇research paradigm＇, ＇science of surge＇, ＇surge＇, ＇surge capacity＇, and ＇vulnerability＇. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results： The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods （medical severity index （MSI）, potential injury creating event （PICE） classification, and disaster severity scale （DSS））, which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored--vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions： This new paradigm breaks through the limitation of traditional research paradigm