Objective To evaluate the performance on the project of health system recovery using World Bank loan for ‘5.12’ Wenchuan earthquake after three years of these projects have been finished. Methods From March to December 2016, we formulated evaluation frameworks and indicators, used statistical reports and surveys to collect data of the 60 post-earthquake recovery projects using World Bank loan in Chengdu, Deyang and some other cities. Data of pre-earthquake (2007) and post-earthquake (2015) were compared. The evaluation indicators included institutional size, institutional environment, institutional services and social benefits. A descriptive analysis was performed using SPSS 22.0 software. Results Compared with the year of 2007, in 2015, the building and utilized for business purpose areas of loan benefited hospitals increased 4.49 and 3.58 times, respectively. The budgeted and actual beds count increased 43% and 55%, respectively. All inside structure and processes of hospitals were optimized, and green areas, parking slots and waiting areas increased greatly. Headcount of budgeted and actual increased 15.09% and 70.31%, respectively. Qualifications of healthcare technicians were improved in country level hospitals as well; there were more undergraduates and more senior competent personnel. In maternal and child health care hospitals and township hospitals, more diploma holders and personnel who had passed the middle level professional appraisals were observed. Numbers of hospital treatments, hospitalizations counts, numbers of surgeries performed increased 2.0, 2.1, and 2.0 times, respectively. Accuracy of diagnosis on hospitalized counts increased 3.12%. Utilizations of bed counts increased from 63.87% to 66.53%. The average duration of hospitalizations decreased from 7.36 days to 7.10 days. Numbers of clinical and surgery types increased 928 and 285, respectively. Both customer and staff satisfactory score reached 4.5 points in 2015. Conclusion The completed projects of health system recovery using World Bank loan for ‘5.12’ Wenchuan earthquake is running well, and meet the expectations.
Objective To summarize the experience of epidemic prevention in order to offer the first-hand data for reconstruction after the earthquake and epidemic control and prevention in the active seismic zone. Method We collected and analyzed the data of epidemic control and prevention and summarized their strengths and weaknesses. Results Of the 13 counties in Aba Prefecture, 12 were affl icted with 2 worst-hit counties and 5 worse-hit disaster areas. A total of 20 233 people were dead and 7 873 people were missing. Health system was severely damaged. Aba Center of Disease Control and Prevention started the contingency plan and sent 4 epidemic prevention teams to the disaster areas. With the combination of local materials and external aids, the epidemic prevention network of county, township and village was established. (1) Environment cleaning and el imination: up to August 27, 2008, 2 591 group times of teams involving 88 298 person times and 5 294 set times of vehicles were allocated. Disinfection area covered 18 181.3 m2 including 14 132 dumps, 33 271 cesspits and 154 391 breeding grounds of mosquitoes, fl ies and mice. (2) Critical supervision for the safety of drinking water and food: up to June 20, 21 central ized and 1 032 dispersed water supply sources were restored. We monitored 829 drinking water samples, among which 594 were qual ified with the qual ified rate of 66.59%. (3) A total of 86 396 people were resettled in 17 temporary sites. (4) Wild dogs were killed in Kala-azar epidemic areas. Mosquitoes, flies and mice were supervised once a week. (5) Disease supervision: A total of 762 cases in 15 legal infectious diseases were found within 90 days after the earthquake, and no death was found. No outbreak of infectious epidemic situations and burst publ ic health events was reported. A total of 57 157 Hepatitis A vaccinations were inoculated in the children aged from 18 months to 12 years old and 16 268 in children aged from 13 to 16 years old, medical staff, mil itary personnel and first-l ine workers. A total of 4 435 Japanese encephal itis vaccinations were inoculated in people in Xiaojin county. On June 15, routine inoculation cl inic recovered and on July 1, expansive inoculation was started on schedule. Conclusion Phased victory is gained in epidemic control and prevention in Aba Prefecture, although it is only a latter-wit. It is suggested that a long-term system of the earthquake disaster as well as human and environmental protection should be reconsidered through the first-hand data of anti-epidemic measures of the Wenchuan earthquake.
Objective To analyze the spinal injury in Wenchuan earthquake and to investigate its cl inical features. Methods Data of 146 patients in Wenchuan earthquake with spinal injuries (79 males, 67 females; aged 11-88 years old, average 51 years old) were collected and analyzed epidemiologically. Two patients under 16 years of age, 15 patients withthe fractures of spinous process, transverse process or vertebra lamina, 1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification, and 9 patients with upper cervical injuries were excluded. The remaining 119 patients were divided into two groups according to their age: group A in which 78 patients were under 60 years of age, including 40 males and 38 females aged 18-58 years old (average 41 years old), and group B in which 41 patients were 60 years of age or above, including 24 males and 17 females aged 60-88 years old (average 71 years old). Analyses for the two groups were compared. Results The leading causes of spinal injuries were fall from high places (27.40%) and crush by heavy objects (67.81%). According to Denis classification, the major types of spinal injuries were burst fracture (54.62%) and compression fracture (33.61%). Serious nerve injury, defined as grade A, B and C in ASIA neurological function assessment, occurred in 31.51% of patients. The most common injured site was in thoracic or lumbar vertebrae (78.77%), and 52.74% of patients had combined injuries, among which the fractures of l imb (30.14%) and rib (19.86%) were the most common. Multilevel spinal fractures happened to 22.60% of patients. Comparative analysis revealed the rate of injury caused by fall from high places in group A (34.62%) was much higher than that in group B (12.20%). The commonest type of fracture in group A was burst fracture (58.97%), and it was compression fracture in group B (48.78%). The rate of serious nerve injury in group B (24.39%) was much lower than that in group A (44.87%). The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%, respectively, which was much higher than that in group A (combined injury 43.59%; multilevel vertebral body injury 21.79%). There were significant differences between two groups in all the indicators derived from cl inical data (P lt; 0.05). Conclusion In Wenchuan earthquake, the leading causes of spinal injuries are fall from high places and crush by heavy objects, the major types of fracture are compression fracture and burst fracture, and the occurrence rates of spinal injury, combined injury and multilevel vertebral body injury are high.
ObjectiveTo evaluate the quality of life of residents in stricken area five years after Wenchuan earthquake, so as to explore the main influential factors such as gender, age, ethnic group, marriage status and the extent affected by the earthquake. MethodsUsing WHOQOL-BREF, 500 residents from Hanyuan county in Sichuan province were assessed in order to analyze their life quality and related factors. ResultsThe score on the overall WHOQOL-BREF and the level of each factor were significantly lower than the score on the normal people (P < 0.001). Male score in the factor of social relations significantly higher than female (t=3.963, P < 0.001). The overall score and the score of social factor were significantly lower in the minor than in the adults (t=-2.667, P < 0.01; t=-19.287, P < 0.001). And the quality score of social relationship was significantly lower in the single than in the married and cohabiting couples (P < 0.001; P < 0.01). ConclusionThe quality of life of residents in stricken area five years after Wenchuan earthquake was significantly lower than the national norm. There are significant differences in terms of gender, age, marriage status and earthquake damage on social relations. Steady intimate relationships with others help improve the quality of life of residents in stricken area. Besides, compared those with average damage or no damage, the residents with serious damage are relatively worse in the overall quality of life as well as environmental conditions.
Objective To analyze retrospectively the overall situation of medical rescue in the First Affiliated Hospital of Guangxi Medical University after the Wenchuan earthquake, so as to provide references for the emergency preparation for the disaster of earthquake. Methods Analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the hospital. The software Microsoft EXCEL was used for data management, and SPSS 13.0 was used for statistical analysis. Results From May 22 to May 26, 91 cases from the disaster area had been treated in the hospital, of which 90 were from Mianyang and 1 from Chengdu. These patients included 44 males with a median age of 38 (27, 53) years old and 47 females with a median age of 51 (33, 62) years old. Most patients were sent to the hospital within the first 10 or 11 days after the earthquake, with 86.8% hospitalized after 10 days and 22.0% after 11 days. The number of outpatients reached its peak of 37.1% of all the outpatients (33 cases) within 34 days after the earthquake. The wounded were mainly admitted into the Department of Orthopaedics, with 34.81% of the patients having lower limb fracture, 18.26% having spine fracture, and 12.59% suffering pelvis fracture. Only 2 out of the 89 patients died. One death was due to 60% burning injury and 1 died of multiple catastrophic injuries. Conclusion Based on the data, it is important to develop an emergent plan for medical rescues after an earthquake disaster and to strengthen the reserve of medical supplies, personnel training, scientific field triage and the construction of information platforms.
Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods. Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of openinjuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 l imbs) and 6 cases of acute renal failure due to crush syndrome (8 l imbs) received amputation; 32 cases of interfascial space syndrome crisis (42 l imbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT). Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospital ization time was 53 days. Twenty-two cases (26 l imbs) were fixed with artificial l imbs 3-6 months after amputation and achieved good functional outcome. Conclusion The treatment principle of crush injury is “be active to decompress and be prudent to amputate”, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earl ier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.
To investigate the method of using vacuum seal ing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic effect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 woundson the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or flap transposition was used to repair the wounds. Results In 21 cases (40.4%), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia col i, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or flap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stabil ity of condition. Conclusion VSD treatment can cover the wound promptly, el iminate contamination, prevent secondary infection and benefit late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can rel ieve the pain suffered by the injured and decrease theworkload of medical stuff, thus facil itating the rescue work.
The May 12 8-magnitude earthquake caused damage to 87.7% of the health systems in the worst-hit Mianyang areas with 326 casualties and the direct economic loss of RMB 3 124 billion. Within 30 minutes after the earthquake, the Mianyang headquarters for earthquake disaster relief and the Mianyang public health headquarters for medical rescue and treatment were organized. Five medical teams were sent to Beichuang County, the worst-hit Mianyang area within four hours after the earthquake. A total of 22 947 wounded and sick were delivered to local hospitals after simple triage and rapid treatment through three station. By June 30, the Mianyang medical organisation had received 379 600 person times and admitted 21628 inpatients in total, including 2 772 severely-wounded (including 146 with limbs amputated and 846 dead during the stay). Since May 17, 3381 wounded had been transferred to 14 provincial and city-level hospitals across China. On June 20, the Mianyang Rehabilitation Center for wounded and sick people was established and received 156 rehabilitation inpatients and cured 32 ones. Together with the medical team for psychological intervention, they provided psychological support for victims for over 70 000 person times. Within two hours after the earthquake, the Mianyang Organisation for Health and Epidemic Control and Prevention launched the emergency response plan for major natural disasters, prepared and improved the technical scheme for disease prevention after the earthquake. The organisation rapidly sent out emergency teams for disease control and prevention and completed the following tasks: disinfection and burial of corpses and disposal of carcasses, monitoring of the water quality and epidemics, disinfection of environmental ruins, epidemic control in resettled areas, precaution of the secondary disasters caused by the earthquake and conduction of large-scale health education. The emergency command system for medical rescue and disease control and prevention in the worst-hit Mianyang areas after Wenchuan Earthquake integrated resources, carried out the unified command and responded rapidly. Moreover, the headquarter of medical relief coordinated and orderly unified the governmental and non-governmental organizations, which achieved good performance for both medical relief and anti-epidemic. The experience of earthquake medical relief will benefit the post-disaster reconstruction, as well as the establishment of national and regional emergency response systems.
After the devastating Wenchuan earthquake, a rapid response with emergency logistic support was the basis for medical rescue. This article describes the timely and scientific measures taken by the Department of Logistics of West China Hospital shortly after the Wenchuan earthquake, based on a series of workflows that were predefined to provide an emergency response for any unexpected events. This logistic workflow may contribute to the emergency response to similar unexpected events in the future.
After Wenchuan earthquake, the West China Second University Hospital immediately started the preparation of emergency pharmaceutical administration. The pharmaceutical department effectively controlled the provision, purchasing, utilization and donation of medications through a double-track operation system. In this way, the medication supply was ensured for both the patients suffering from the disaster and routine patients, which guaranteed the rationality in medication and promoted the utilization of the donated drugs so that more than 80 000 drug cost was saved for the hospital.