Medical mountain rescue in the Yushu Earthquake: Have lessons been learned?

On April 14,2010,an earthquake reaching Richter scale 7.1 struck Jiegu Town of Yushu,a mountain rescue operation promptly launched. All injurers had a direct assess to take medical care,and were immediately rescued and rapidly evacuated by air to Xining and Golmud at lower altitudes and admitted to advanced hospitals. Almost all of the injurers have been completely recovered. Yushu Earthquake was one of the highest earthquakes in the world,with a high incidence of acute altitude illness,which was observed in about 80 % of the lowland rescuers at an altitude of 4 000 m."Rescue the rescuers"became the major task of Qinghai-Tibetan rescue teams,all the severe patients were rapidly descended to Xining and treated promptly and effectively. The outcome was excellent,all patients survived. After the earthquake,it is a long and arduous task to reconstruct what has been destroyed. Medical teams continue to work in the Yushu Earthquake area because about 30 000 workers and carders are now here for rebuilding the earthquake center. Thus the prevention and treatment of altitude illness are still critical tasks for medical teams. Although all the fights are successful,there are more experiences and lessons we have learned from the medical mountain rescue during the earthquake and the reconstruction,and reports here are to sum up our experiences from the medical mountain rescue operation in Yushu Earthquake and draw the lessons that we should learn. With the increasing of earthquake probability occurring in the Qinghai-Tibetan Plateau,we also should prepare against earthquake disasters and for further rescue training in the high mountains.

Ataxia,acute mountain sickness,and high altitude cerebral edema

Previous investigations suggest that ataxia is common and often one of the most reliable warning signs of high altitude cerebral edema(HACE). The aim of this study was to investigate the diagnostic role of ataxia in acute mountain sickness(AMS)and HACE among mountain rescuers on the quake areas,and in approaching the relation between AMS and HACE. After the earthquake on April 14,2010,approximately 24 080 lowland rescuers were rapidly transported from sea level or lowlands to the mountainous rescue sites at 3 750 ~ 4 568 m,and extremely hardly worked for an emergency treatment after arrival. Assessments of acute altitude illness on the quake areas were using the Lake Louise Scoring System. 73 % of the rescuers were found to be developed AMS. The incidence of high altitude pulmonary edema(HAPE)and HACE was 0.73 % and 0.26 %,respectively,on the second to third day at altitude. Ataxia sign was measured by simple tests of coordination including a modified Romberg test. The clinical features of 62 patients with HACE were analyzed. It was found that the most frequent,serious neurological symptoms and signs were altered mental status(50/62,80.6 %)and truncal ataxia(47/62,75.8 %). Mental status change was rated slightly higher than ataxia,but ataxia occurred earlier than mental status change and other symptoms. The earliest sign of ataxia was a vague unsteadiness of gait,which may be present alone in association with or without AMS. Advanced ataxia was correlated with the AMS scores,but mild ataxia did not correlate with AMS scores at altitudes of 3 750~4 568 m. Of them,14 patients were further examined by computerized tomographic scanning of the brain and cerebral magnetic resonance imagines were examined in another 15 cases. These imaging studies indicated that the presence of the cerebral edema was in 97 % of cases who were clinically diagnosed as HACE(28/29). Ataxia seems to be a reliable sign of advanced AMS or HACE,so does altered mental status.

A successful mountain rescue operation in Yushu Earthquake

On April 14, 2010, an earthquake reaching 7.1 Richter scale struck Jiegu Town of Yushu. More than 2 698 people were confirmed dead, and 12 135 were injured, of which 1 434 were severely injured. Rescue operation was carried out soon after the disaster; however, the rescue teams face great challenges of altitude hypoxia, freezing temperature and very bad weather. Thus, 1 434 severe injuries were rapidly transported airlifted to hospitals in Xining and neighboring provinces for effective treatment. The extremity trauma （49.9 % ） was the most common patteru of injuries. Asphyxia （40.8 % ） was by far the most important reason for death. A high incidence of acute altitude illness in the lowland rescuers was a special medical problem during the highest earthquake in Yushu. We have learned more lessons from Yushu Earthquake.

Psychological reaction in members of medicine rescue team for Wenchuan earthquake in 2008 and its management

This paper reviews the rescue experience of our medical rescue team during the relief of Wenchuan earthquake in 2008 in Sichuan province, China, and analyzes the psychological reaction of team members. Based on the rescuers' distinctive psychological reaction in different phases of the rescue operation, we aims to propose measures for administration of the team in order to better fulfill the rescue duties and provide references for future medical service in non-war operations such as an earthquake relief.

Lifeline system network reliability calculation based on GIS and FTA

Lifelines, such as pipeline, transportation, communication, electric transmission and medical rescue systems, are complicated networks that always distribute spatially over large geological and geographic units. The quantification of their reliability under an earthquake occurrence should be highly regarded, because the performance of these systems during a destructive earthquake is vital in order to estimate direct and indirect economic losses from lifeline failures, and is also related to laying out a rescue plan. The research in this paper aims to develop a new earthquake reliability calculation methodology for lifeline systems. The methodology of the network reliability for lifeline systems is based on fault tree analysis （FTA） and geological information system （GIS）. The interactions existing in a lifeline system ale considered herein. The lifeline systems are idealized as equivalent networks, consisting of nodes and links, and are described by network analysis in GIS. Firstly, the node is divided into two types： simple node and complicated node, where the reliability of the complicated node is calculated by FTA and interaction is regarded as one factor to affect performance of the nodes. The reliability of simple node and link is evaluated by code. Then, the reliability of the entilre network is assessed based on GIS and FTA. Lastly, an illustration is given to show the methodology.

A necklace of pearl in high altitude medicine and hypoxic physiology in Yushu Earthquake

During Yushu Earthquake,a large number of rescuers flocked to the mountainous quake areas. Under such a very specific circumstance,a high incidence of acute altitude illness was observed in rescuers who rapidly traveled from near sea level to an altitude of 4 000 m. It is evident that acute altitude illness leads to a significant human and economic toll,and also seriously influences the mountain rescue operation. So what does this teach us about mountain rescue in Yushu? Professor Wu Tianyi and many other authors collected shining points of the experiences and drew the lessons from the Yushu Earthquake into this special issue in Engineering Sciences which is like to thread pearl beads for a necklace. What readers learn from this special issue will have implications for the health and well-being of all high altitude populations all over the world.

World Focus on the Moment

Chinese people would never for- get the moment-14:28,on May 12,2008,as the 8.0-magnitude earthquake shook the whole of Sichuan;at that moment the world's at- tention was focused on the southwest of China-the homeland of the Giant Panda.

MORE FINANCIAL Aids Needed

Weeks have past since the out- break of May 12 Earthquake in southwest China's Sich- uan province.With the pos- sibility for the missing to survive becom- ing increasingly remote,more importance should be attached to the resettlement

Protective equipment for emergency rescue in alpine-cold region

Alpine-cold regions are characterized as hypoxia,strong wind,heavy rain,cold climate,huge temperature difference between day and night,and vertical climate. All these make it difficult for an emergency rescue when a natural disaster such as earthquake happens. Based on the characteristics of emergency rescue in alpinecold region,several multifunctional protective equipments have been developed by the Quartermaster Equipment Institute of General Logistics Departmen(tGLD)of the Chinese People's Liberation Army(CPLA). These equipments are lightweight,durable and environment adaptable.

三教图像所见明代三教观

佛教传入中国之初,先是依附于中国传统的思想文化。传播者不断地援儒家、道家思想入佛教,并论证三教的一致性,藉此发展佛学。魏晋以后宣传三教合一思想的人物渐多。隋唐时期,儒、释、道形成了鼎足之势。唐中期开始出现三教融合趋势。宋元时期'三教合一'呈现出发展态势。明代特别是明晚期三教融合完全成熟,'三教合一'已经成为中国文化发展的基本趋势,被社会各阶层人士按照自己的理解所接受。

Management of limb fractures in a teaching hospital： comparison between Wenchuan and Yushu earthquakes

Objective： To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods： We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital （WCH） of Sichuan University. Results： In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day （PED） 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals out- side the Sichuan Province. In Yushu earthquake, the maxi- mum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 （396/942, 42.0%） open limb fractures, includ- ing 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower （6/61, 9.8%）. The percent of patients with acute complications in Wenchuan earthquake （167/891,18.7%） was much higher than that in Yushu earthquake （5/53, 3.8%）. In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and sur- vived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion： Provision of suitable and sufficient medi- cal care in a catastrophe can only be achieved by construc- tion of sophisticated national disaster medical system, pre- diction of the injury types and number of injuries, and con- flrmation of participating hospitals＇ exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.

A contrast study of the traumatic condition between the wounded in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake

Purpose： 5.12 Wenchuan earthquake and 4.25 Nepal earthquake are of the similar magnitude, but the climate and geographic environment are totally different. Our team carried out medical rescue in both disasters, so we would like to compare the different traumatic conditions of the wounded in two earthquakes. Methods： The clinical data of the wounded respectively in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake rescued by Chengdu Military General Hospital were retrospectively analyzed. Then a contrast study between the wounded was conducted in terms of age, sex, injury mechanisms, traumatic conditions, complications and prognosis. Results： Three clays after 5.12 Wenchuan earthquake, 465 cases of the wounded were hospitalized in Chengdu Military General Hospital, including 245 males （52.7%） and 220 females （47.3%） with the average age of （47.6 ±22.7） years. Our team carried out humanitarian relief in Ratmandu after 4.25 Nepal earthquake. Three days after this disaster, 71 cases were treated in our field hospital, including 37 males （52.1%） and 34 females （47.9%） with the mean age of （44.8 ± 22.9） years. There was no obvious difference in sex and mean age between two groups, but the age distribution was a little different： there were more wounded people at the age over 60 years in 4.25 Nepal earthquake （p 〈 0.01） while more wounded people at the age between 21 and 60 years in 5.12 Wenchuan earthquake （p 〈 0.05）. The main cause of injury in both disasters was bruise by heavy drops but 5.12 Wenchuan earthquake had a higher rate of bruise injury and crush injury （p 〈 0.05） while 4.25 Nepal earthquake had a higher rate of falling injury （p 〈 0.01 ）. Limb fracture was the most common injury type in both disasters. However, compared with 5.12 Wenchuan earthquake, 4.25 Nepal earthquake has a much higher incidence of limb fractures （p 〈 0.01 ）, lung infection （p 〈 0.01 ） and malnutrition （p 〈 0.05）, but a lower incidence of thoracic injury （p 〈 0.05） and multiple injury （p 〈 0.05）. The other complications and death rate showed no significant differences. Conclusion： Major earthquakes of the similar magnitude can cause different injury mechanisms, traumatic conditions and complications in the wounded under different climate and geographic environment. When an earthquake occurs in a poor traffic area of high altitude and large temperature difference, early medical rescue, injury control and wounded evacuation as well as sufficient warmth retention and food supply are of vital significance.

RACING AGAINST TIME

Rescuers work at a collapsed building in the city of Tainan on February 9,three days after a 6.7-magnitude earthquake hit south Taiwan.As of February 12,a total of 93 people had been confirmed dead.

China Medical Team： Medical rescue for ＂4.25＂ Nepal earthquake

In recent years, global natural disasters have been frequent and resulted in great casualties and property loss. Since Wenchuan earthquake, the disaster emergency rescue system of China has obtained considerable development in various aspects including team construction, task scheduling, personnel training, facilities and equipments, logistics, etc. On April 25, 2015, an earthquake that measured 8.1 on the Richter scale attacked Nepal. Chinese government firstly organized a medical team, named China Medical Team, and sent it to the attacked region in Nepal to implement medical rescue. The medical team completed the rescue mission successfully and creatively based on their experiences.