BACKGROUND: Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. Th is supplement provides suggestions for all those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government offi cials. Th e fi eld of disaster medicine does not have the required body of evidence needed to undergo a traditional guideline development process. In result, consensus statement-development methodology was used to capture the highest-caliber expert opinion in a structured, scientifi c approach. METHODS: Task Force Executive Committee members identifi ed core topic areas regarding the provision of care to critically ill or injured patients from pandemics or disasters and subsequently assembled an international panel for each identifi ed area. International disaster medicine experts were brought together to identify key questions (in a population, intervention, comparator, outcome [PICO]-based format) within each of the core topic areas. Comprehensive literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of suffi cient quality were identifi ed. Th erefore, the panel developed expert opinion-based suggestions that are presented in this supplement using a modifi ed Delphi process. RESULTS: A total of 315 suggestions were draft ed across all topic groups. Aft er two rounds of a Delphi consensus-development process, 267 suggestions were chosen by the panel to include in the document and published in a total of 12 manuscripts composing the core chapters of this supplement. Draft manuscripts were prepared by the topic editor and members of the working groups for each of the topics, producing a total of 11 papers. Once the preliminary draft s were received, the Executive Committee (Writing Committee) then met to review, edit, and promote alignment of all of the primary draft s of the manuscripts prepared by the topic editors and their groups. Th e topic editors then revised their manuscripts based on the Executive Committee’s edits and comments. Th e Writing Committee subsequently reviewed the updated draft s and prepared the fi nal manuscripts for submission to the Guidelines Oversight Committee (GOC). Th e manuscripts subsequently underwent review by the GOC, including external review as well as peer review for the journal publication. Th e Writing Committee received the feedback from the reviewers and modifi ed the manuscripts as required. CONCLUSIONS: Based on a robust and transparent process, this project used rigorous methodology to produce clinically relevant, trustworthy consensus statements, with the aim to provide needed guidance on treatment and procedures for practitioners, hospital administrators, and public health and government offi cials when addressing the care of critically ill or injured patients in disasters or pandemics.

Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement

Objectives: To conclude experience and lessons from emergency medical rescue after Wenchuan Earthquake from national and overall review for consideration on worldwide catastrophe rescue in the future.



Methods: To systematically collect huge amount of primary data, and to make analysis, draw conclusions and lessons in terms of five aspects respectively as quake-damage conditions, command system, emergency medical rescue, prevention and control over infectious diseases as well as pairing-assistance for medical system and service reconstruction.



Results: 1. Numbers as of the death, injured and migrants made Wenchuan Earthquake ranked one of the top 9 catastrophes around the world during the past two decades. 2. Countermeasures such as four-level linkage by nation-province-city-county model, mutual assistance between military force and local forces, frontline commanding did effectively ensure the dispatch and cooperation among rescue forces. 3. Three-leveled medical transfers, “four concentrations” prevention and treatment besides whole-course rehabilitation at early stage managed to lower mortality and disability rate to minimum levels respectively. 4. “Four-keynote infectious disease control” under whole coverage and “five measures and four reinforcement measures” in settlements made rates as for those infectious diseases under the average level as those in the 3 pre-quake years. 5. Pairing-assistance in terms of talents, finance, materials as well as capacity building between other 18 provinces/municipalities and those 18 extremely-stricken/severely-stricken areas in Sichuan Province guaranteed efficient post-quake reconstruction, system reconstruction and long-term mechanism construction.



Conclusions: Successful experience from Wenchuan Earthquake could be summarized as: one goal as people-oriented life-rescuing. Two tasks as medical rescue for diseases of those injured and healthcare & anti-epidemic for safe and sound of those lives. Three strategies respectively as medical transfers after on-site triage, treatment for severe diseases in quake-hit areas and rehabilitation in non quake-hit areas for medical rescue, and quick post-quake evaluation, quick promotion for whole coverage and scientific regulation in long term for healthcare & anti-epidemic. Four measures as concentration for patients, experts, resources and treatment respectively for medical rescue, and key regions, key groups, key infectious diseases and key steps for healthcare & anti-epidemic. Five links as overall commanding, medical rescue, healthcare and anti-epidemic, physical/mental rehabilitation and post-quake reconstruction. And whole course surveillance as information guidance, policy guarantee, data collection, evidence producing, effectiveness evaluation, and academic communication.

Lessons learned from the Wenchuan earthquake.

Resource-poor settings: response, recovery, and research: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

AIM :Thefrequencyofhyperten - sion events increases after a strong stress, but the mechanism has not been fully investigated. This study aimed to investigate its prevalence and risk factors after theWenchuan earthquake (8.0ontheRichterscale),soastoprovideasci- entific basis for the prevention of hypertension innaturaldisastersorunforeseenaccidents. SUBJECTS AND METHODS: Victims stayingin temporaryshelterformorethan1yearbetween MarchtoMay2009wererandomlyselectedbymulti- stagestratifiedclustersamplingmethod.Andprede - terminedquestionnaire surveyand physicalexami- nationwerecarriedout.Inthisstudy,allparticipants signedinformedconsentform. RESULTS: A total of 3230 victims aged over 20 yearsparticipatedinthisstudy,andtheprevalence rate of hypertension among those victims was 24.08%(778/3230),mostofwhomhadfirst-levelhy - pertension;andthestandardizedratewas18.44%. Moreover, the rates of hypertension awareness, dosing and controlling was only 34.58%, 53.43% and 17.84%, respectively. Among this cohort, the prevalencerateofhypertensionincreasedwithage (p 0.05). Logistic regression analysis showed that age, family history of hypertension, sleep quality, waist-to-hipratio,bodymassindexandbloodglu - coselevelwereriskfactorsofearthquake-induced hypertension among victims in temporary shield district,butmentalstresswasnot. CONCLUSIONS: Though mental stress was not a risk factor of hypertension in this study, earthquake-inducedhypertensionshouldnotbe ignored.Forvictimsafterearthquake,theeduca - tionofthepreventionandtreatmentofhyperten - sionshouldbestrengthened.

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Clinical characteristics of hypertension among victims in temporary shield district after Wenchuan earthquake in China

Theories and strategies of social mobilization, capacity building, mass and interpersonal communication, as well as risk communication and behavioral change were used to develop health education and promotion campaigns to decrease and prevent injuries and infectious diseases among the survivors of the Wenchuan earthquake in May 2008. We evaluated the effectiveness of the campaigns and short-term interventions using mixed-methods. The earthquake survivors' health knowledge, skills, and practice improved significantly with respect to injury protection, food and water safety, environmental and personal hygiene, and disease prevention. No infectious disease outbreaks were reported after the earthquake, and the epidemic level was lower than before the earthquake. After a short-term intervention among the students of Leigu Township Primary and Junior School, the proportion of those with personal hygiene increased from 59.7% to 98.3% (p< 0.01). Of the sampled survivors from Wenchuan County, 92.3% reported to have improved their health knowledge and 54.9% improved their health practice (p< 0.01). Thus, health education and promotion during public health emergencies such as earthquakes play an important role in preventing injuries and infectious diseases among survivors.

Health education and promotion at the site of an emergency: experience from the Chinese Wenchuan earthquake response:

The 12 May 2008 earthquake caused damage to 88% of the health systems in the worst hit areas of Mianyang with 326 casualties and the direct economic loss of RMB 3124 billion. Within 30 minutes of 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, four hours after the earthquake. A total of 22,947 wounded and sick people were delivered to local hospitals after simple triage and rapid treatment through three stations. By 30 June, the Mianyang medical organization had received 379,600 people and admitted 21,628 inpatients. These 2772 severely wounded (including 146 with limbs amputated and 846 who died in hospital). Since 17 May, 3381 wounded had been transferred to 14 provincial and city-level hospitals across China. On 20 June, the Mianyang Rehabilitation Center for wounded and sick people was established and received 156 rehabilitation inpatients. Together with the medical team for psychological intervention, they provided psychological support for over 70,000 people. Within two hours of the earthquake, the Mianyang Organization for Health and Epidemic Control and Prevention launched the emergency response plan for major natural disasters. The organization sent emergency teams for disease prevention and control and completed disinfection and burial of corpses and disposal of carcasses, monitoring of water quality and epidemics, disinfection of environmental ruins, epidemic control in resettled areas, precautions against secondary disasters caused by the earthquake, and large-scale health education. The emergency command system for medical rescue and disease control and prevention in the Mianyang areas integrated resources, carried out unified command, and responded rapidly. Furthermore, the headquarters of medical relief co-ordinated and united the governmental and nongovernmental organizations, achieving good performance for both medical relief and epidemic control. This experience of earthquake medical relief will benefit post-disaster reconstruction, as well as the establishment of national and regional emergency response systems.

Yong Qing Li

Papers

Emergency response and medical rescue in the worst hit Mianyang areas after the Wenchuan earthquake.