单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,伤情评估和战场伤员分类,江 雷,卫生勤务学教研室,Mass casualties,Any large number of casualties produced in a relatively short period of time, usually as the result of a single incident such as a military aircraft accident, hurricane, flood, earthquake, or armed attack, that exceeds local logistical support capabilities.,The term mass casualties means that a large number of casualties has been produced simultaneously or within a relatively short period of time.,It also means that the number of patients requiring medical care exceeds the medical capability to provide treatment in a timely manner.,An absolute disparity exists between the number of patients, the available medical resources and timely treatment.,Mass casualty situation,A mass casualty situation is present when one combat medic is confronted with two critically injured patients at the same time.,With a large number of casualties, the disparity may be multiplied many times; this greatly disrupts the doctrinal approach to treatment and evacuation.,In addition to the treatment and evacuation of a large number of military and civilian casualties, problems may occur from disruptions in the supply, communication, and transportation systems.,“在包扎所内最重要的是伤员优先分类，然后对所有伤员合理配置医疗救护工作，比起仓促慌忙上手术好得多，后者仅只能救活不多的伤员。,”,俄,皮洛果夫,N.A.,叶菲缅科主编（涂通今主译）：野战外科学，,P5.,人民军医出版社，,2005,年,10,月,什么是伤情评估？,伤情,评估是指在战场上运用,简明的应急诊断技术,，迅速地对伤员情况进行初步判断，进而以,量化标准,来判定伤员损伤的严重程度，从而指导战场伤员分类救治，预测战伤结局以及评估救治质量。,一、伤情评估方法,院前评分,院内救治和创伤研究评分,伤 情 损伤程度 治愈时间 预后 比例,轻 伤 软组织伤,30,天内 良好,40%,中等伤,广泛软组织伤、,60,天内,部分伤员机能,35%,上肢骨折、一般脏器伤 障碍，影响归队,重 伤 伤情严重、,60,天以上 严重残废,25%,有生命危险 或后遗症,伤势分度与百分比,院前指数（,Pre-hospital index,，,PHI,）,指标,0,1,2,3,4,5,SBP(KPa,),13.3,11.5-13.3,10-11.4,0-9.9,脉搏,(,次,/,分,),51-119,=120,=50,呼吸,(,次,/,分,),正常,浅费力,100 mmHg,毛细血管充盈迟,sBP,85,99 mmHg,毛细血管无充盈,sBP, 85 mmHg,呼吸,R,正常,35,次,/,分钟,无自主呼吸,胸腹,A,均无压痛,胸或腹压痛,连枷胸、板状腹或深穿刺伤,运动,M,遵嘱动作,只有疼痛反应,无反应,言语,S,回答切题,错乱、无伦次,发音听不懂或不能发音,轻度：,9-10,分，重度：,7-8,分，极重度：,0-6,分,参数,0,1,2,3,4,5,呼吸,次数,0, 35,25,35,10,24,幅度,浅或困难,正常,循环,SBP,0, 90,毛细血管充盈,无充盈,充盈迟缓,正常,意识状态,GCS,3,4,5,7,8,10,11,13,14,15,创伤计分（,Trauma score,）,1-16,分， ,12,分为重伤,Glasgow Coma Scale,，,GCS,Best Motor Response,Eye Opening,Best Verbal Response,Obeys,6,Localizes Pain,5,Oriented, Conversing,5,Withdraws,4,Spontaneous,4,Disoriented, Conversing,4,Abnormal Flexion,3,To Verbal Command,3,Inappropriate Words,3,Extension,2,To Pain,2,Incomprehensive Sounds,2,None,1,No Response,1,No Response,1,Add the scores for each category.,A total score of 7 or less indicates a severe injury.,The most common patterns of comatose patients are M=5 of less, V=1, E=1.,校正的创伤积分,( Revised Trauma Score,，,RTS ),编码值,cv,4,3,2,1,校正,值,w,GCS,13,15,9,12,6,8,4,5,0.9368,SBP, 89,76,-89,50,75,1,49,0.7326,RR,10,29, 29,6,9,1,5,0.2908,简易战伤评分方法,A.,呼吸次数（,/,分）,B.,收缩压（,mmHg,）,C.,神志昏迷状况,等级,积分,等级,积分,等级,积分,1029,4,89,4,1315,4,29,3,7689,3,912,3,69,2,5075,2,68,2,15,1,149,1,45,1,0,0,30,3,6-9,2,1-5,1,0,0,Systolic blood pressure,90,4,89-76,3,75-50,2,49,1,0,0,Glasgow coma scale,15-13,4,12-9,3,8-6,2,5-4,1,3,0,Priorities are assigned as:,P1(T1),1-10,P2(T2),11,P3(T3),12,P1 Hold(T4),1-3,Dead,0,The overlap in scores allows for the seriously injured to be placed in either category,depending on number of casualties and resources available of evacuation.,Evacuation will be delayed when the number of casualties outstrips available transport.,In this situation,，,the greater time spent with the casualty will allow additional anatomical assessment of injuries.,Where the primary determined by physiology does not match the anatomical severity of injuries, the priority can be upgraded,Example:,A soldier loses his left leg in a landmine incident.Immediate first aid is effective in stopping hemorrhage.He is transported to the division aid station.,He cannot walk, his respiratory rate is 22 and his pulse is 110/minute.,He is triaged ? for treatment(Triage Sieve).,He then receives intravenous fluids and analgesia. His systolic BP is 115 mmHg, his respiratory rate is 20,he is fully alert,with a GCS of 15. He scores 12 on his Triage Sort, which is P3 for evacuation.,Clearly, he requires early surgical treatment and the surgeon upgrades his priority to P2 for evacuation to the field hospital.,Chinese triage :wound marker,Sign of sorting,advanced triage systems,In advanced triage systems, secondary triage is typically implemented by paramedics, battlefield medical personnel, or by skilled nurses in the emergency departments of hospitals during disasters, injured people are sorted into five categories.,Blue / Expectant,They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock); they should be taken to a holding area and given painkillers to ease their passing.,Red / Immediate,They require immediate surgery or other life-saving intervention, first priority for surgical teams or transport to advanced facilities, cannot wait but are likely to survive with immediate treatment.,Yellow / Observation,Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under normal circumstances).,Green / Wait,They will require a doctors care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).,White / Dismiss,They have minor injuries; first aid and home care are sufficient, a doctors care is not required.,根据以下描述给出伤员创伤计分，并判断相应的急救优先等级。,某部队战士赵晓明,5,小时前，被炮弹弹片炸伤右颞部。当即昏迷，战友包扎救下，到营救护所时清醒,15,分钟，曾呕吐二次，团救护所注射,T.A.T1500,单位，庆大霉素,8,万单位。目前伤员仍呈昏迷状态，伤侧瞳孔散大，对光反射消失，左下肢瘫痪，呼吸困难，脉搏,55,次分，血压,147,96mmHg,。,