伤情评估和战场伤员分类(江)

分类的目的
• 分类的目的在于保证每个伤病员得到及时合理的 救治和后送。保证在伤病员众多的条件下, 做好 救治工作，使救治工作有条不紊地进行；充分发 挥卫勤人力物力作用，促进医疗后送工作的多快 好省。区分伤病的轻重缓急, 确定救治和后送的 先后次序; 根据伤类、伤情, 确定伤员救治措施; 确定伤员后送体位和工具。以保证各种伤员得到 最合理的处置。
伤情评估和战场伤员分类
江 雷 卫生勤务学教研室
Mass casualties
• Any large number of casualties produced in a relatively short period of time, usually as the result of a single incident such as a military aircraft accident, hurricane, flood, earthquake, or armed attack, that exceeds local logistical support capabilities.
9～12
76～-89 > 29
6～ 8
50～75 6～ 9
4～ 5
1～49 1～ 5
0.9368
0.7326 0.2908
简易战伤评分方法
A.呼吸次数（/分） 等级 10~29 >29 积分 4 3 B.收缩压（mmHg） 等级 >89 76~89 积分 4 3 C.神志昏迷状况 等级 13~15 9~12 积分 4 3
Eye Opening
Best Verbal Response
Abnormal Flexion 3
2 Incomprehensive Sounds 2 1 No Response 1
Add the scores for each category.
A total score of 7 or less indicates a severe injury.
The term mass casualties means that a large number of casualties has been produced simultaneously or within a relatively short period of time. It also means that the number of patients requiring medical care exceeds the medical capability to provide treatment in a timely manner. An absolute disparity exists between the number of patients, the available medical resources and timely treatment.
• P3-Minimal Treatment
• P1 Hold-Expectant Treatment
1-16分，
＜12分为重伤
Glasgow Coma Scale，GCS
Best Motor Response
Obeys Localizes Pain Withdraws Extension None 6 5 4 2 1 Spontaneous To Verbal Command To Pain No Response Oriented, Conversing 4 Disoriented, Conversing 3 Inappropriate Words 5 4 3
指标 SBP(KPa) 脉搏(次/分) 0 >13.3 51-119 1 11.5-13.3 2 10-11.4 >=120 3 4 5 0-9.9 <=50
呼吸(次/分)
意识状态
正常
正常
浅费力
模糊或烦 躁 4
<10次/分或 需插管
言语不能理 解
合并穿通 伤
轻伤：0-3分
重伤：4-20分
CRAMS评分法
6~9
1~5 0
2
1 0
50~75
1~49 <1
2
1 0
6~8
4~5 3
2
1 0
伤员伤势评估及处置顺序
伤势 重伤 得分 6～9 处置顺序 紧急处置
中度伤 轻伤
危重伤
10～11 12
＜5
优先处置 常规处置
期待处置
二、战场伤员分类
Triage of mass casualties
• The evaluation and classification of casualties for purposes of treatment and evacuation. It consists of the immediate sorting of patients according to type and seriousness of injury, and likelihood of survival, and the establishment of priority for treatment and evacuation to assure medical care of the greatest benefit to the largest number.
分类的方法
• • • • 伤部 伤类 伤型 伤情
急救优先等级
• 紧急处置——重伤
• 优先处置——中度伤
• 常规处置——轻伤
• 期待处置——危重伤
Treatment categories: P systems
• P1-Immediate Treatment
• P2-Delayed Treatment
参数 循环C 呼吸R 胸腹A 运动M 言语S 2 毛细血管充盈正常 sBP>100 mmHg 正常 均无压痛 遵嘱动作 回答切题 1 毛细血管充盈迟 sBP 85～ 99 mmHg ＞35 次/分钟 胸或腹压痛 只有疼痛反应 错乱、无伦次 0 毛细血管无充盈 sBP < 85 mmHg 无自主呼吸 连枷胸、板状腹或 深穿刺伤 无反应 发音听不懂或不能 发音
Mass casualty situation
• A mass casualty situation is present when one combat medic is confronted with two critically injured patients at the same time. • With a large number of casualties, the disparity may be multiplied many times; this greatly disrupts the doctrinal approach to treatment and evacuation. • In addition to the treatment and evacuation of a large number of military and civilian casualties, problems may occur from disruptions in the supply, communication, and transportation systems.
“在包扎所内最重要的是伤员优先分类，
然后对所有伤员合理配置医疗救护工 作，比起仓促慌忙上手术好得多，后
者仅只能救活不多的伤员。”
——[俄]皮洛果夫
N.A.叶菲缅科主编（涂通今主译）：野战外科学，P5.人民军医 出版社，2005年10月
什么是伤情评估？
• 伤情评估是指在战场上运用简明的应急诊 断技术，迅速地对伤员情况进行初步判断， 进而以量化标准来判定伤员损伤的严重程 度，从而指导战场伤员分类救治，预测战 伤结局以及评估救治质量。
The most common patterns of comatose patients are M=5 of less, V=1, E=1.
校正的创伤积分 ( Revised Trauma Score，RTS )
编码值cv 4 3 2 1 校正值w
GCS
SBP RR
13～15
> 89 10～29
Triage is accomplished by highly experienced medical personnel who can make sound and quick clinical judgments.
Medical personnel identify each patient by a category title which indicates the urgency of his receiving treatment and likelihood of his survival based upon the clinical problems and availability of medical care. Rapid triage assures that the available treatment is directed to the patients who have the best chance to survive.
分类的意义
• 战场伤病员分类是实施战场伤病员救护管理的一个 重要环节。战时伤员数量大，伤病种类复杂，救治
时间紧迫，救治力量有限。由此产生了救治需要与
可能之间的矛盾, 重伤病员与轻伤病员之间、部分 伤病员与全体伤病员之间救治的矛盾。为解决这些 矛盾，就必须对伤病员进行分类。通过分类将有限 卫勤力量首先用到需挽救生命的危急伤员上。
一、伤情评估方法
院前评分
院内救治和创伤研究评分
伤势分度与百分比
伤 轻 情 伤 损伤程度 软组织伤
广泛软组织伤、
治愈时间 30天内 60天内
预后 良好
部分伤员机能 障碍，影响归队
比例 40% 35%
中等伤
上肢骨折、一般脏器伤
重
伤
伤情严重、 有生命危险
60天以上
严重残废 或后遗症
25%
院前指数（Pre-hospital index，PHI）
轻度：9-10分，重度：7-8分，极重度：0-6分
创伤计分（Trauma score）
参数 呼吸 次数 0 0 1 < 10 2 > 35 3 25～35 4 10～24 5
源自文库
幅度
循环 SBP 毛细血管充 盈 意识状态 GCS
浅或困难
0 无充盈
正常
<50 充盈迟缓 3～ 4 50～69 正常 5～ 7 8～10 11～13 14～15 70～90 > 90
History
The word triage is a French word meaning "sorting", which itself has been influenced from the Latin tria "three". The term has historically meant sorting into three categories, although this is no longer necessarily the case. Much of the credit for modern day triage has been attributed to Dominique Jean Larrey, a famous French surgeon in Napoleon’s army who devised a method to quickly evaluate and categorize the wounded in battle and then evacuate those requiring the most urgent medical attention. He instituted these practices while battle was in progress and triaged patients with no regard to rank. Others have cited the Russian surgeon, Nikolai Pirogov, as developing the triage system during the Crimean War.