Emergency response command
After the earthquake, the Sichuan Provincial Health Bureau immediately launched the top level emergency pre-plan. One hour after the disaster, the first emergency mobilization order was issued to the province's health system. Within two hours of the quake, the medical and health relief headquarters was set up and then was joined by the 12 May Sichuan earthquake relief headquarters, which was renamed the ‘Medical Care Assurance Group of the 12 May Sichuan Earthquake Relief Headquarters’. The group consisted of several teams with responsibilities including medical treatment, disease control, medical supply and demand, media coverage, comprehensive co-ordination, logistical support, transportation of the injured, as well as post-disaster reconstruction. Under the leadership of the provincial committee, the provincial government and the earthquake relief frontline co-ordination group of the Chinese Ministry of Health (MoH), the province's health system made disaster rescue and relief top priority, doing its utmost to support the relief work.
Under the direct leadership of the provincial earthquake relief headquarters, hundreds of people quickly gathered from the departments of Health, Drug Surveillance, Traditional Chinese Medicine, Economics, Traffic, Agriculture, and many others in an organized manner with clear responsibilities at all levels. It was a high-speed operation with strong implementation and coherent co-ordination in order to make the relief effort orderly and focused (Fig. 1).
The focus of the first phase of the earthquake relief was medical treatment. The medical treatment group established a team that was responsible for on-site medical treatment management.
Two hours after the quake, the Sichuan Provincial Health Bureau quickly dispatched the first batch of 28 teams of 90 medical and disease control staff with 28 ambulances and first-aid medicines and equipment to Dujiangyan, Deyang, Shifang, Mianzhu, Beichuan, and other areas. At midnight on 12 May, the Bureau sent another 96 medical relief teams of 400 medical staff to Dujiangyan, Deyang, Shifang, Mianzhu, Beichuan, Pingwu, Guangyuan, and other disaster areas for rescue work. From the early morning of 13 May, the third batch of 51 teams of 314 medical staff organized by municipal health departments went to these areas, as well as Qingchuan and Ya’an, to rescue the wounded through the night.
Due to the severity of the disaster, the Sichuan Provincial Health Bureau immediately mobilized hospitals in 13 minimally affected cities for the rapid formation of three-tier medical rescue teams, while contacting the city of Chongqing and the state MoH for support. After 12 May thousands of medical teams rushed to the worst-hit areas by land, water, and air under risk of aftershocks, falling stones, and mud–rock flows. Search-and-rescue and medical treatments were carried out. Forty-eight hours after earthquake, 461 key medical staff members from different medical institutions across the province had set up three first-aid stations (tent hospitals) at Anxian, Mianzhu, and Dujiangyan for fast, accessible treatment.
On 22 May, 10 days after the quake, a Shanghai medical team of 20 staff with first-aid medicines and equipment, and satellite telephones air-dropped by helicopter to the villages of Gengda, Sanjiang, Ginkgo, and Caopo in Wenchuan County, where other medical staff could not enter as a result of traffic blocks. Eleven cities (prefectures), 67 counties (districts), and 950 villages across the province affected by the earthquake had complete medical coverage.
As of 15:00 hours on 30 May 2008 up to 50,456 medical staff had participated in frontline treatment, of which 41,240 (81.73%) were from Sichuan Province; 5,969 (11.83%) were from other provinces and municipalities; 3,048 (6.04%) were from the army, armed police, and public security; and nine medical teams of 199 staff came from Hong Kong, Macao, Taiwan, and eight foreign countries, accounting for 0.39% (Table 1). A total of 45,000 ambulances were dispatched. Between 12 and 30 May, the number of medical staff sent to disaster areas for frontline rescue efforts was developed in two stages: first a rapid growth in numbers and then steady growth (Fig. 2).
Table 1. Origin of frontline medical relief staff
|Medical relief staff source||Total number||Proportion (%)|
|Hong Kong, Macao, Taiwan, overseas||199||0.39|
The first stage from 12 to 15 May showed rapid growth. The disaster situation was uncertain immediately after earthquake as a result of road and communication disruption. With the gradual restoration of roads and communications, information continuously came from the disaster area; the severity of the disaster was greater than expected. Under the urgent action of governments and medical institutions at all levels, within three days medical staff sent by the nation and provinces for rescue showed rapid growth from 90 to 35,880 people, accounting for 71.11% of total medical relief staff. The number of medical staff on the frontline reached 540 on 12 May, 1,676 on 13 May, 4,265 on 14 May, and 35,880 on 15 May. Of these medical personnel 31,000 came from Sichuan Province, accounting for 86.40% of the total, while 4,880 came from other provinces, accounting for 13.60% (Fig. 3). Within 72 hours, the ‘golden time’ for saving life, most of the injured survived because of prompt medical treatment. Medical staff quickly reached the disaster areas from inside and outside of the province. This illustrates the rapid response of the health system, which played a vital role in saving lives (Fig. 2).
The second stage from 16 to 30 May was the period of steady growth. Eleven medical teams from Taiwan, Russia, Hong Kong, Japan, Italy, Macao, Germany, Cuba, Britain, France, and the USA participated in medical relief from 20 May to 7 June.
Hospital infection control
On 16 May, four days after the earthquake, considering possible post-disaster epidemics of gangrene, tetanus, and intestinal and respiratory infections, the provincial headquarters immediately launched a pre-plan on infectious disease prevention. They asked for hospital infection control to be comprehensively applied throughout hospital reception, triage, laboratory, clinical diagnosis, isolation, wound handling, clinical treatment, sterilization, medical waste disposal, transferring, and terminal disinfection. They also strengthened supervision and inspection of implementation as well as simultaneously training relevant medical staff and volunteers. Every hospital set up a special infection ward and operating room. Patients with suspected infection were immediately sent into the infection ward, ambulances underwent strict sterilization, and post-operative waste was cremated after strict disinfection in strict accordance with medical waste management regulations. As of 30 May, hospitals across the province found 61 cases of highly suspected gas-gangrene infection, but no hospital infections were caused by gas gangrene, showing outstanding hospital infection control.
Early psychological intervention
People injured in the quake suffered from instability, fear, and anxiety. Suffering the pain of disability after injury, loss of family and friends, and destruction of homes and property, some experience severe emotional problems. People needed not only physical treatment but also psychological intervention and assistance. Only by effectively carrying out a comprehensive and integrated approach including rescue, treatment, psychological intervention, and resettlement after rehabilitation, can the pain caused by the disaster be alleviated.
With the national mobilization of 247 experts in psychological intervention under MoH coordination and more than 2,000 volunteers, psychological intervention groups were established to offer comfort and psychotherapy to affected individuals in order to encourage, help rebuild confidence, and prevent possible adverse post-disaster mental stress reactions and behaviors. Good outcomes were achieved in terms of preventing and reducing the impact of post-disaster stress on the physical and mental health of victims and rescue workers.
Combination of rescue and disease treatment
The Wenchuan earthquake caused tremendous damage to the healthcare system in Sichuan Province. In the worst areas the health network was completely disabled. In order to ensure basic medical care for disaster victims and inhabitants at resettlements, medical teams were promptly organized and well co-ordinated. Medical service was extended to the villages and families, carrying on ‘treatment on the injuries and disease, combination of prevention and treatment’, which formed the new post-disaster three-in-one medical pattern of treatment and disease prevention and control. To effectively solve the medical problems of the worst hit areas, after consultation with the Chengdu Military Area Command and other concerned departments, 21 field hospitals were set up in locations including Dujiangyan, Mianzhu, Beichuan, Qingchuan, Pengzhou, and Mianyang. Additionally, transitional hospitals were to be established to address health services for people where township health centers had been lost. By the combination of injury treatment and consultation for disease, medical treatment problems have been properly resolved.