Mass aeromedical evacuation of patients in an emergency: experience following the 2010 Yushu earthquake.

BACKGROUND: On April 14, 2010, a catastrophic earthquake hit Yushu, China, causing 2698 deaths and 12,135 injuries. A large number of patients were evacuated by air to hospitals in unaffected areas for specialty treatment. STUDY OBJECTIVE: To investigate the overall process and details of patients' aeromedical evacuation (AE) after the Yushu earthquake. METHODS: The study was an observational, retrospective investigation conducted in December 2010 in Qinghai province. Information was gathered from Yushu Batang airport, the Ministry of Health, the Health Department of Qinghai Province, and rear echelon hospitals in five provinces. RESULTS: A total of 2796 patients were evacuated by 152 separate flights from Yushu. The number of AE patients reached a peak (55.8%) within 72 h after the earthquake. Of the total 2796 patients, 2533 were admitted to rear echelon hospitals. This number included 2111 (83.3%) with earthquake-related trauma, 422 (26.7%) with non-traumatic diseases, and 166 (6.6%) with acute mountain sickness. No accident or medical error was reported during the evacuation process. The aircraft used for AE included IL-76 transport aircraft from the Air Force, Airbus A-319s from civil aviation, and MI-17 helicopters from Army aviation. According to our investigation, the need for professional AE training was great (83.7%). In addition, almost all participants (99.3%) agreed that the aircraft needed to be improved for the purpose of AE. CONCLUSIONS: Aeromedical evacuation of a large number of patients after major disasters in remote areas can be done safely and effectively; however, problems such as a lack of suitable AE aircraft and medical equipment, as well as insufficient professional medical training in AE, were revealed after the Yushu earthquake.

Medical evacuation management and clinical characteristics of 3,255 inpatients after the 2010 Yushu earthquake in China.

BACKGROUND: A catastrophic earthquake struck the Yushu prefecture of China's Qinghai province on April 14, 2010. Supported by the China National Ministry of Health, this study performed a detailed medical analysis of injuries and diseases, based on comprehensive medical data of hospitalized patients to share the experiences and lessons learned from emergency medical aid operations in high-altitude regions. METHODS: To survey the management of medical relief, more than 10 interviews with rescuers were held and more than 100 documents were reviewed. Medical records of 3,255 patients from 57 hospitals were analyzed retrospectively. Patient demographic data, complaints, diagnoses, prognoses, injury types, dispositions, and means of transportation were all reviewed. RESULTS: A total of 3,255 patients were admitted to hospitals. Of these, 1,426 (43.8%) were middle-aged (31-50 years), 2,574 (79.07%) were transported by plane, and the first 3 days were the peak period for air transportation. The records of 2,622 patients with earthquake-related injuries were analyzed, and 1,775 (68.32%) of them were admitted to hospital within the first 3 days. Bone fractures were diagnosed in 1,431 (55.08%) patients and crush syndrome was observed in 23 (0.89%). Illnesses accounted for 657 patients who were admitted to surveyed hospitals. Of these, 143 (20.63%) suffered from respiratory diseases and 259 (39.97%) from acute high-altitude sickness. Of the latter, 224 (86.49%) were rescuers. The overall mortality rate was 0.2% (7 of 3,255). Four patients died from earthquake-related injuries and three from other illnesses. CONCLUSIONS: A devastating earthquake occurring in a remote, high-altitude region presented a variety of challenges for external medical aid. Air transportation for those with severe injuries and diseases played a crucial role in decreasing the mortality and morbidity. It is necessary for hospitals to initiate effective emergency measures while facing the peak admission flow within the initial 72-hour period. Characteristic factors such as high altitude, low-oxygen content, local construction features, and lifestyle may contribute to complex injuries and illnesses. More attention should be paid to medical aid training for rescuers, and effective measures should be developed to deal with destructive natural disasters occurring in special geographical environments. LEVEL OF EVIDENCE: Epidemiological study, level III.