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Triage of pediatric injuries after the 2008 Wen-Chuan earthquake in China
Bo Xiang1, Wei Cheng, Juxian Liu
1Department of Paediatric Surgery, West China Hospital, Si-Chuan University, Si-Chuan 610041, China. xbljx@hotmail.com
Insights
Modifying triage strategies, particularly involving pediatric surgeons, significantly reduced consultation and operation waiting times after the Wen-Chuan earthquake. This highlights the importance of specialized medical teams in disaster response for orthopedic injuries.
Area of Science:
- Disaster medicine
- Surgical triage
- Pediatric surgery
Background:
- The 2008 Wen-Chuan earthquake presented significant challenges to medical infrastructure and patient care.
- Effective triage strategies are crucial for managing mass casualties during major natural disasters.
- Understanding the impact of modified triage on waiting times is essential for optimizing emergency medical response.
Purpose of the Study:
- To evaluate the effect of modified triage strategies on consultation and operation waiting times.
- To analyze waiting times across different phases of post-earthquake medical management.
- To inform future resource allocation for natural disaster medical responses.
Main Methods:
- Categorization of post-earthquake triage into three distinct phases (0-24 hours, 24-72 hours, 4-19 days).
- Analysis of consultation and operation waiting times for pediatric patients.
- Implementation of specialized protocols, including pediatric surgeon-led triage and gas gangrene screening.
Main Results:
- Phase 1 (initial 24 hours): Triage waiting time 78 minutes, consultation 3.5 hours, operation delay 7.5 hours.
- Phase 2 (24-72 hours): Pediatric surgeon triage reduced consultation time to 31 minutes, operation time to 4.5 hours.
- Phase 3 (4-19 days): Triage and operation times remained significantly shorter than Phase 1 (P < .05); 89% of injuries were orthopedic traumas.
Conclusions:
- Triage by pediatric surgeons in the reception area significantly decreased treatment delays.
- The high prevalence of orthopedic injuries underscores the need for specialized orthopedic resources in earthquake response.
- Optimized triage and resource allocation are critical for improving outcomes in mass casualty events.
Purpose:
The study aimed to review the effect of modifying triage strategies on the consultation and operation waiting times during the Wen-Chuan earthquake in China in 2008.
Method:
The triage during the post-earthquake period was categorized into 3 phases. The consultation and operation waiting times were analyzed.
Results:
Of the 119 admitted children, there were 58 boys and 61 girls. Most of the victims were school-aged. In phase 1 (24 hours after the quake), the triage waiting time was 78 minutes. The waiting time for pediatric subspecialty consultation was 3.5 hours. There was an additional 7.5-hour delay before operation. In phase 2 (24-72 hours after the quake), senior pediatric surgeons carried out the triage and consultation. The consultation waiting time was reduced to 31 minutes. Four rotating teams operated 24 hours a day. The waiting time for operation was reduced to 4.5 hours. In phase 3 (4-19 days after the earthquake), gas gangrene screening was implemented. The triage waiting times for closed and open injuries were 47 and 64 minutes, respectively. Operation waiting times of 4.4 and 4.8 hours were recorded for closed and open injuries, respectively. Compared to that of phase 1, the waiting times for both consultation and operation of phases 2 and 3 were significantly shortened (P < .05). Most of the (89%) of the injuries were orthopedic traumas with lower limb fracture being the most common injury. Intraabdominal and thoracic injuries were relatively uncommon.
Conclusions:
(1) Triage by pediatric surgeons in the reception area greatly reduced the delay of treatment and (2) the predominance of orthopedic injuries resulting from the earthquake indicates the focus of medical resource allocation in natural disasters of this type in the future.
