Tornado Disaster Casualties Admitted to a County Hospital in the Jiangsu Province of China.

OBJECTIVE: We analyzed characteristics of tornado-related injuries and medical impact on a county-level hospital in China in June 23, 2016. The objective of this study was to describe and analyze local government rescue responses following the tornado. METHODS: County hospital medical records of 288 tornado-related injury patients were collected. Descriptive analyses to study injury characteristics and associated risk factors were performed. RESULTS: Of the studied population, 84% of the wounded were older than 45 years. Only 30 (10.4%) people were sent to the hospital for treatment within 3 hours following the disaster. Heavy objects or collapsing houses accounted for 191 (66.3%) of the documented injuries. The proportion of people with resulting brain injuries was 46.2% of the entire injured population, and the incidence of lower extremity injuries was 27.8%. A total of 89.6% of the wounded had skin and soft tissue injuries. Multiple injuries were found in 129 (44.8%) people and 156 had a single injury (54.2%), and 3 cases with acute stress disorder were admitted to the hospital. CONCLUSIONS: Preparation plans, including tornado warnings, prevention, and rescue, are a basic requirement for the mitigation of tornado-related injuries. Protection awareness of tornado disasters is also critical to ensure injury prevention.

Injury Patterns and Medical Evacuation of Patients in Chifeng Tornado in China, August 11, 2017.

OBJECTIVES: To study injury patterns and medical rescue operations related to tornadoes that occur in rural areas, this study investigated the data pertaining to the 2017 Chifeng tornado (China). METHODS: Medical records of 52 tornado-related patients were investigated. Data were collected from 3 local hospitals that received all the tornado victims. RESULTS: A total of 148 injuries were diagnosed. Tornado-related injuries were mainly caused by collapsed houses (51.9%) and direct physical trauma caused by the tornado (38.5%). Most injuries occurred outdoors (63.5%). The head (20.3%) and thorax (14.8%) were most 2 frequent anatomical injury sites. Soft-tissue injuries (43.9%) and contusions and lacerations (37.3%) were the 2 most common injury types. On evaluating the Abbreviated Injury Scale scores, a score of 1 was the most common (66.2%), and a score of 6 was not recorded. CONCLUSIONS: A trailing phenomenon in the distribution of time to admission among the victims of a particular tornado in China was observed. The delivery is timely compared with nondisaster situation. There was a statistically significant difference of injury causes between outdoor and indoor patients. Helmets should be used by potential tornado victims. Basement units capable of functioning as shelters should be built in villages.

Factors associated with injuries among tornado victims in Yancheng and Chifeng, China.

BACKGROUND: As extremely violent meteorological disasters, tornadoes often cause serious casualties. The study aims to analyze the characteristics and causes of tornado injuries in China under certain humanistic and geographical conditions. METHODS: A random sampling questionnaire survey was developed and distributed to tornado victims from two separate occurrences: an Enhanced Fujita 4 tornado in Yancheng, and a Fujita 3 tornado in Chifeng. The information of demographic characteristics, disaster environment, and individual behaviors in victims was collected. Chi-square test and binary logistic regression were used to analyze influencing factor of injuries. RESULTS: A total of 94 valid questionnaires (participation rate 95.9%) were finally collected in Yancheng tornado and 67 valid questionnaires (participation rate 93.1%) in Chifeng tornado. Residents' annual income (OR = 0.10, 95% CI 0.02-0.50, P = 0.005), degree of house collapse (OR = 183.12, 95% CI 8.04-4173.34, P = 0.001) have a significant impact on the probability of injury. Differences in tornado disaster drill awareness (P = 0.009), individual behaviors (P = 0.011) and fear level (P = 0.011) significantly affected the incidence of trauma. Whether victims were indoors or not has no statistical difference on injuries in China. CONCLUSIONS: Our study clarifies risk factors and is conducive to the expansion of the investigation in tornado casualties. The government should improve the wind-resistance of residential buildings. Victims should participate in disaster prevention drills to take effective disaster avoidance actions.

Pattern and spectrum of tornado injury and its geographical information system distribution in Yancheng, China: a cross-sectional study.

OBJECTIVES: Few studies of tornado injuries have considered differences related to damage levels and Enhanced-Fujita (EF) scale ratings. This study aimed to evaluate the pattern, spectrum and geographical distribution of injuries related to the Yancheng tornado and provide guidelines for effective emergency medical strategies. SETTING: The study was conducted at three hospitals which treated patients with injuries related to the tornado in Yancheng, China. PARTICIPANTS: We obtained the records of 451 patients with tornado-related injuries. Of these, 401 valid trauma medical records were included; 50 other records were excluded for insufficient information. Informed consent was obtained from all patients by telephone. MAIN OUTCOME MEASURES: We analysed patients' injury sites and types and used the abbreviated injury scale (AIS) to standardise injury severity. Geographical information system and non-parametric tests were used to analyse the effects of geographical factors on casualties. RESULTS: Women, middle-aged/elderly individuals (age>45 years) and children/adolescents (<18 years) accounted for 51.62%, 77.30% and 12.47% of injured patients, respectively. This caused a dumbbell-shaped age distribution. Head (46.63%), body surface (39.90%) and lower-limb (29.43%) injuries were common, as were soft-tissue injuries (90.77%), fractures (38.90%) and organ damage (19.70%). Minor injuries (AIS=1) were common (60.85%), whereas critical/fatal injuries (AIS≥5) were very rare (2.50%). Although the densities of injury varied among damage levels and EF ratings for different areas, area-wise differences in injury severity (AIS scores) were not significant (p>0.05). CONCLUSION: We recommend the use of helmets to prevent head injuries caused by tornadoes and suggest prioritising the treatment of high-risk head and multiple-organ injuries. Additionally, medical rescuers should follow the 'same quality and different quantity' principle: the injured in all affected areas should receive equal attention, but numbers of medical personnel should be allocated based on the level of effects from the tornado.

Investigating Lushan Earthquake Victims' Individual Behavior Response and Rescue Organization.

Research concerning the impact of earthquake victims' individual behavior and its association with earthquake-related injuries is lacking. This study examined this relationship along with effectiveness of earthquake rescue measures. The six most severely destroyed townships during the Lushan earthquake were examined; 28 villages and three earthquake victims' settlement camp areas were selected as research areas. Inclusion criteria comprised living in Lushan county for a longtime, living in Lushan county during the 2013 Lushan earthquake, and having one's home destroyed. Earthquake victims with an intellectual disability or communication problems were excluded. The earthquake victims (N (number) = 5165, male = 2396) completed a questionnaire (response rate: 94.7%). Among them, 209 were injured (5.61%). Teachers (p < 0.0001, OR (odds ratios) = 3.33) and medical staff (p = 0.001, OR = 4.35) were more vulnerable to the earthquake than were farmers. Individual behavior was directly related to injuries, such as the first reaction after earthquake and fear. There is an obvious connection between earthquake-related injury and individual behavior characteristics. It is strongly suggested that victims receive mental health support from medical practitioners and the government to minimize negative effects. The initial reaction after an earthquake also played a vital role in victims' trauma; therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help played key roles in emergency, medical rescue efforts.

Comparison of influencing factors on outcomes of single and multiple road traffic injuries: A regional study in Shanghai, China (2011-2014).

INTRODUCTION: To identify key intervention factors and reduce road traffic injury (RTI)-associated mortality, this study compared outcomes and influencing factors of single and multiple road traffic injuries (RTIs) in Shanghai. METHODS: Based on the design of National Trauma Data Bank, this study collected demographic, injury, and outcome data from RTI patients treated at the four largest trauma centers in Shanghai from January 2011 to January 2015. Data were analyzed with descriptive statistics, univariate analysis, and hierarchical logistic regression analysis. RESULTS: Among 2397 participants, 59.4% had a single injury, and 40.6% had multiple injuries. Most patients' outcome was cure or improvement. For single-RTI patients, length of stay, body region, central nervous system injury, acute renal failure, multiple organ dysfunction syndrome, bacterial infection, and coma were significantly related to outcome. For multiple-RTI patients, age, admission pathway, prehospital time, length of stay, number of body regions, body region, injury condition, injury severity score, and coma were significantly related to outcome. CONCLUSIONS: Emergency rescue in road traffic accidents should focus on high-risk groups (the elderly), high-incidence body regions (head, thorax, pelvis) and number of injuries, injury condition (central nervous system injury, coma, complications, admission pathway), injury severity (critically injured patients), and time factors (particularly prehospital time).

Study on the Health Status and Health Service Utilization of the Elderly of a Remote and Poor Village in a Mountainous Area in Jinzhai, Anhui.

Background: Despite the rapid development of China's economy, a number of poor areas in China continue to exist. The health status of the elderly in the poor areas is a matter of concern. This study aims to explore the status of the elderly in terms of their health status, health service needs, and utilization among rural residents of a remote and poor village in a mountainous area in Jinzhai, Anhui. Furthermore, this study aims to explore the differences between the nation rural area average level and the remote and poor village in the mountainous area in terms of health status and health service utilization. Methods: Cluster sampling was used to obtain the sample. A total of 110 elderly people were selected from the village, and face-to-face interviews were conducted with questionnaires by trained investigators to collect data. Results: All items except vision, language disability, and self-care disability were found to be higher than the national average level. In terms of mental health, Zishu Village has a ratio of 44.1% for the symptoms of anxiety and depression, which is higher than the average for the national rural areas. The two-week prevalence rate, prevalence of chronic diseases, and non-hospitalization rate of those who need hospitalization (%) in Zishu Village was 62.7%, 88.2%, and 47.6% respectively, which was higher than the rural values of the National Survey (2008). Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. The two-week visiting rate was 24.1%, which was lower than 2008. The hospitalization rate in Zishu Village was 10.8%, which is similar to the level of 2008. Conclusions: The health level and the utilization of health services of the people in Zishu Village, Jinzhai, are generally lower than the national average. Financial difficulties continue to remain the major factor affecting the utilization of hospitalization services of this remote and poor village in Jinzhai, Anhui.

A Meta-Analysis of Risk Factors for Post-Traumatic Stress Disorder (PTSD) in Adults and Children after Earthquakes.

PTSD is considered the most common negative psychological reactions among survivors following an earthquake. The present study sought to find out the determinants of PTSD in earthquake survivors using a systematic meta-analysis. Four electronic databases (PubMed, Embase, Web of Science, and PsycInfo) were used to search for observational studies about PTSD following earthquakes. The literature search, study selection, and data extraction were conducted independently by two authors. 52 articles were included in the study. Summary estimates, subgroup analysis, and publication bias tests were performed on the data. The prevalence of PTSD after earthquakes ranged from 4.10% to 67.07% in adults and from 2.50% to 60.00% in children. For adults, the significant predictors were being female, low education level or socio-economic status, prior trauma; being trapped, experiencing fear, injury, or bereavement during the disaster. For children, the significant predictors were being older age, high education level; being trapped, experiencing fear, injury, or bereavement, witnessing injury/death during the earthquakes. Our study provides implications for the understanding of risk factors for PTSD among earthquake survivors. Post-disaster mental health recovery programs that include early identification, on-going monitoring, and sustained psychosocial support are needed for earthquake survivors.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

OBJECTIVE: Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception. METHODS: A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. RESULTS: The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. CONCLUSION: This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.

Comparison of the Ability to Predict Mortality between the Injury Severity Score and the New Injury Severity Score: A Meta-Analysis.

BACKGROUND: Description of the anatomical severity of injuries in trauma patients is important. While the Injury Severity Score has been regarded as the "gold standard" since its creation, several studies have indicated that the New Injury Severity Score is better. Therefore, we aimed to systematically evaluate and compare the accuracy of the Injury Severity Score and the New Injury Severity Score in predicting mortality. METHODS: Two researchers independently searched the PubMed, Embase, and Web of Science databases and included studies from which the exact number of true-positive, false-positive, false-negative, and true-negative results could be extracted. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies checklist criteria. The meta-analysis was performed using Meta-DiSc. Meta-regression, subgroup analyses, and sensitivity analyses were conducted to determine the source(s) of heterogeneity and factor(s) affecting the accuracy of the New Injury Severity Score and the Injury Severity Score in predicting mortality. RESULTS: The heterogeneity of the 11 relevant studies (total n = 11,866) was high (I² > 80%). The meta-analysis using a random-effects model resulted in sensitivity of 0.64, specificity of 0.93, positive likelihood ratio of 5.11, negative likelihood ratio of 0.27, diagnostic odds ratio of 27.75, and area under the summary receiver operator characteristic curve of 0.9009 for the Injury Severity Score; and sensitivity of 0.71, specificity of 0.87, positive likelihood ratio of 5.22, negative likelihood ratio of 0.20, diagnostic odds ratio of 24.74, and area under the summary receiver operating characteristic curve of 0.9095 for the New Injury Severity Score. CONCLUSION: The New Injury Severity Score and the Injury Severity Score have similar abilities in predicting mortality. Further research is required to determine the appropriate use of the Injury Severity Score or the New Injury Severity Score based on specific patient condition and trauma type.