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Keywords:

  • Foreign medical team;
  • rescue pattern;
  • Wenchuan earthquake

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Objective To retrospectively analyze the rescue activities of 11 foreign medical teams during the Wenchuan earthquake in Sichuan, China, and summarize their rescue patterns and procedures to provide a reference for disaster medical treatment.

Methods Statistics in the study are based on information from the Sichuan Provincial Earthquake Relief Headquarters. The authors also directly involved foreign medical teams in the data collection and statistical analysis.

Results The different rescue patterns and procedures of foreign medical teams were based on specific conditions and were in strict accordance with scientific and prudent work processes. This resulted in high efficiency and effectiveness in the rescue.

Conclusion Chinese medical staff could learn from foreign medical teams’ serious work attitude, patient service, and scientific working patterns.

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Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

At 14:28 hours on 12 May 2008, the Wenchuan earthquake occurred with a magnitude of 8.0 on the Richter scale. This was a very destructive earthquake. It was the most difficult relief situation in the history of modern China. A total of 11 cities (prefectures), 67 counties, and 950 townships (towns) in Sichuan Province were affected. There was a total disaster area of 280,000 km2, a hard-hit area of 125,000 km2, an epicenter, or worst hit area, of 11,000 km2, and a total affected population of 29.61 million people (1).

As of 18 June 2008, hospitals across Sichuan Province had treated a total of 1,736,367 injured people from the disaster areas. Of those injured, 90,499 were hospitalized, 16,500 were seriously injured, 2,536 died, and 75,274 were subsequently discharged. A total of 10,015 of those injured were transferred to 20 other provinces for further treatment, and 4,494 still remained in local hospitals (Medical Care Assurance Group of Sichuan Provincial May 12 Earthquake Relief Headquarters, unpubl. data, 2008).

The Wenchuan earthquake raised great concern and support from the international community, Hong Kong, Macao, and Taiwan. Eleven medical teams of 304 members from Hong Kong, Macao, Taiwan, and eight foreign countries participated in Sichuan earthquake medical relief from 20 May to 18 June. Foreign medical teams won the respect and praise of Chinese medical personnel and of injured people because of their strict work attitude, scientific management, sophisticated medical skills, and rich experience in earthquake relief. This article reports the work done by foreign medical teams in the Wenchuan earthquake relief with a goal of providing first-hand examples for Chinese medical rescue teams.

Materials and methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Data resources

Data reported by the Sichuan Provincial Disaster Relief Headquarters, State Earthquake Relief Headquarters, and the Sichuan Provincial Liaison Group of Hong Kong, Macao, Taiwan, and international rescue teams were primary sources. We also involved foreign medical teams directly in the data analysis.

Statistical methods

We established a database for data processing using SPSS v11.0 and Microsoft EXCEL, and performed descriptive statistical analysis.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Medical team composition

Eleven foreign medical teams consisting of 304 members covered 20 specialties including surgery, orthopedics, internal medicine, emergency, ICU, gynecology, pediatrics, family medicine, psychology, ENT, pharmacy, anesthetics, clinical laboratory, radiology, ECG, nursing, epidemiology, rehabilitation, medical technology, and engineering (Table 1). The medical staff in the main force and who could carry out on-the-spot rescue independently accounted for two thirds of team members. The staff was made up of 127 doctors (41.78%), 76 nurses (25%), and 28 technicians (9.21%). Each foreign medical team paid much more attention to logistics assurance and organizational management than the Chinese team. There were 73 people involved in this work. Some medical staff served as administrators without logistics personnel. Sichuan Province also provided comprehensive support for foreign medical teams in terms of logistical service to ensure medical treatment.

Table 1.  Foreign medical team compositions
Medical teamsDoctorsTechniciansNursesAdministrative and logistics personnelTotal
Composition%Composition%Composition%Composition%
Russia4 surgeons34.3313 technicians19.4011 nurses16.428 engineers29.8567
10 physicians 7 first-aid personnel     7 administrative personnel  
1 gynecologist–pediatrician 1 anesthetist     5 logistics personnel  
Hong Kong10 orthopedics specialists 2 first-aid personnel53.061 laboratory technician2.0416 nurses32.654 administrative personnel12.2449
3 psychiatrists 2 epidemiologists     2 logistics personnel  
3 rehabilitation doctors        
6 anesthetists        
Macao2 surgeons51.22  2048.78  41
7 orthopedics specialists        
6 first-aid personnel        
3 physicians        
2 anesthetists        
1 ENT doctor        
Taiwan1 surgeon 1 physician 2 first-aid personnel13.512 pharmacists5.404 nurses10.8126 administrative and logistics personnel70.2737
1 1 general practitioner        
Cuba3 surgeons52.781 pharmacist16.674 nurses11.112 administrative19.4436
2 orthopedics specialists 1 laboratory    personnel  
1 first-aid personnel  technician   5 logistics  
2 gynecologist–pediatricians 2 radiologists    personnel  
4 general physicians 2 ECG technician      
1 epidemiologist        
3 rehabilitation doctors        
3 anesthetists        
Japan5 physicians 4 first-aid personnel39.131 pharmacist4.357 nurses30.432 administrative personnel26.0923
      4 logistics personnel  
Italy3 surgeons50.00  7 nurses50.00  14
1 orthopedics specialist        
1 first-aid personnel        
2 anesthetists        
France3 doctors 3 first-aid personnel42.86  4 nurses28.572 administrative personnel28.5714
      2 logistics personnel  
Germany1 pediatrician9.091 laboratory technician45.451 nurse9.093 administrative personnel36.3611
  4 technicians   1 logistics personnel  
UK1 surgeon85.71  1 nurse14.29  7
3 orthopedics specialists        
1 first-aid personnel        
1 epidemiologist        
USA1 trauma doctor80.00  1 nurse20.00  5
1 anesthetist        
1 ICU personnel        
1 doctor        
Total12741.78289.217625.007324.01304

Work patterns of foreign medical teams

As soon as they arrived, foreign medical teams were sent either to the frontline disaster area or second-line hospitals according to the team's composition and the disaster situation. The teams were classified by location, duration, and method. The teams adopted four major methods to help the medical relief effort (Table 2).

Table 2.  Work pattern of foreign medical team after Wenchuan earthquake
Medical teamLocationDurationMethod
TaiwanGaoping and Guanghan city20–25 MayMedical station
Hong KongWest China Hospital of Sichuan University20–30 MayWard management
JapanWest China Hospital of Sichuan University20 May–1 JuneTreatment team
RussiaPengzhou city20 May–2 JuneTent hospital
ItalyMianzhu city21 May–4 JuneTent hospital
MacaoChengdu City No. 3 People's Hospital23 May–3 JuneTreatment team
North Sichuan Medical College Affiliated Hospital10–15 JuneTreatment team
CubaSichuan Provincial People's Hospital23 May–6 JuneTreatment team
GermanyDujiangyan city23 May–18 JuneField hospital
FranceGuangyuan City Central Hospital25 May–6 JuneTreatment team
UKMianyang City Central Hospital24–26 MayTreatment team
Chengdu City No. 2 People's Hospital27–30 MayTreatment team
USAWest China Hospital of Sichuan University7–16 JuneTreatment team

The first method was to set up medical stations in frontline disaster areas. The Taiwanese medical team, for example, set up a medical station nearby the Gaoping township earthquake refugee relief center of Guanghan city. Three tents were set up within one hour for a medicine warehouse, a traditional medicine clinic, and a western medicine clinic. Besides offering medical treatment for the injured at a medical station, the Taiwanese medical team frequently made rounds at the refugee relief station.

The second method was to set up tent or field hospitals in the frontline disaster area, as did the medical teams of Russia, Italy, and Germany. The Russian medical team arrived in Pengzhou city on 20 May and set up more than 20 inflatable tents for a clinic, operating room, examination room, therapy room, and a ward of 25 beds. They had the ability to operate on five patients simultaneously and treat almost 300 injured every day. The Italian medical team arrived in Xiaode town of Mianzhu city on 23 May and set up a 600-m2 tent hospital, including an emergency room, orthopedic therapy room, ICU, and surgery room. With advanced medical facilities and first-aid medicines, the team treated 100 injured people per day. The German medical team sent by the German Red Cross arrived in Dujiangyan city on 23 May and set up the Sino–German Red Cross Field Hospital tent at Tianfu Road. Two teams of 68 rescue staff each sent by the Shanghai Red Cross Huashan Hospital were also involved in the treatment carried out in this field hospital. It was a typical field hospital divided into outpatient, inpatient, and accommodation areas. The outpatient area consisted of a command office; triage room; clinics for internal medicine, surgery, gynecology and pediatrics; delivery room; operating room; clinical laboratory; radiology; pharmacy; and a central supply room. It had a potential for 120 beds, but there were only 80 beds in the inpatient area. With advanced medical equipment, first-aid medications, and instruments, three tent hospitals carried out on-the-spot treatment for injured people and transferred critically injured to the second-line hospital immediately after surgery.

The third method was participating in medical treatment at second-line hospitals, most of which were at the Sichuan Provincial People's Hospital, West China Hospital of Sichuan University, Chengdu No. 3 People's Hospital, Mianyang City Central Hospital, and Guangyuan City Central Hospital. The medical teams worked on treatment for the critically injured through ward management. Taking charge of ward management directly, foreign medical teams decided on and implemented treatment plans, while one or two Chinese doctors assumed the responsibility of medical record writing and pre-operative preparation and co-ordination. This system was efficient and co-ordinated because it preserved the team's original structure. For example, a team from Hong Kong was in charge of an orthopedic ward in the West China Hospital of Sichuan University.

Some foreign medical personnel were assigned to departments within hospitals in accordance with their specialties so that they could adapt to the environment and begin treatment as soon as possible. This created medical groups composed of foreign and Chinese medical staff working together. For instance, a Japanese medical team at West China Hospital was divided among the emergency, ICU, dialysis, gynecology and pediatrics, radiology, pharmacy, and six other departments. The Macao medical team participated in orthopedics, emergency, ICU, and surgery at Chengdu No. 3 People's Hospital. The French medical team sent to Guangyuan City Central Hospital was divided into groups of three: a doctor, a nurse, and a relief staff member. Workdays were divided into three eight-hour shifts covering emergency, reception, and pre-hospital care work. Off-duty medical staff made clinical rounds all over three counties and three districts of the disaster-struck Guangyuan city. The treatment modes had their own respective advantages with overall outstanding performance in medical relief.

Medical team workflow

Foreign medical teams followed different workflows in accordance with their different working patterns. Medical teams at frontline medical stations and tent hospitals worked in close co-operation with rescue teams. According to frontline first-aid and classification procedures, the critically injured and non-critically injured were sent to frontline and second-line hospitals for treatment immediately after emergency surgery and first-aid, respectively. Those with minor injuries were treated on the spot or nearby. The injured also administered self-aid and buddy aid to save valuable time (2). The frontline foreign teams used the workflow with one-stop service at reception, triage, transfer, inspection, and surgery to offer timely and effective treatment for the injured (Figure 1).

image

Figure 1. Workflow of the frontline medical station and tent hospital.

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The foreign medical teams at the second-line hospitals carried out medical relief using fixed work models from different countries and areas. The Cuban medical team, for example, worked in small medical groups. Every group examined the injured before therapy or surgery, had a case discussion, made therapy and surgery plans, confirmed surgeons and specific therapy according to the situation of the injured person, had post-operative discussion, adjusted the treatment plan, and offered nursing, timely mental intervention, and rehabilitation training to promote quick recovery (3) (Figure 2).

image

Figure 2. Workflow of Cuban rescue medical team.

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Treatment results

Foreign medical teams carried out rapid and effective medical relief in close collaboration with Sichuan medical staff. From 20 May to 18 June, foreign medical teams treated a total of 24,587 people injured in the quake, performed 594 operations, gave nursing care to 3,186 people, performed 3,164 clinical rounds, provided 812 doctor's consultations or recorded casuistics, provided psychological counseling to 305 people, and trained and promoted academic exchange for 2,743 medical staff across the province (Table 3). Foreign medical teams saved hundreds of lives with exquisite skills and careful service. They also relieved the pain of those injured and helped patients to gradually recover and return to their family, community, and work. This demonstrated the international responsibility and selfless dedication of the foreign medical teams to treating the injured, which in turn won the praise and respect of the Sichuan people and medical staff.

Table 3.  Workload of foreign medical teams
Medical teamTreatmentSurgeryNursingPsychological counselingClinical roundsConsultation of doctorsCasuisticsAcademic exchange and training times (persons)
Taiwan   437  1    50114  
Hong Kong   193 69 102    7 19 2317 (931)
Japan  1015  214   36   3 (335)
Russia  1516102 305    
Italy   912260  73   4812611 (163)
Macao   480 72 611  433 78 6911 (183)
Cuba   484 36 398  809 41 41 
Germany18,905 431689 1805 62  312 (217)
France   225   67    4105  1 (216)
UK   128 11     8  3  4 8 (348)
USA   292   32   12 53 23 9 (350)
Total24,5875943186305316452328972 (2743)

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Evaluation of treatment capabilities of foreign medical teams

Foreign medical teams were composed of medical personnel experienced in international natural disaster relief. The Russian medical team has a good reputation following medical relief efforts with the tsunamis in Sri Lanka and Indonesia, and the earthquakes in Turkey and Pakistan. The team can assemble from across Russia within three hours regardless of when they receive the order, and they immediately rush to anywhere in the world using a dedicated airplane. The team rushed to Sichuan Province for medical relief with advanced medical equipment, 7 t of medicines, and 28 t of supply material after the Wenchuan earthquake.

The Italian medical team was composed of experts from Pisa Medical College and other hospitals experienced in international relief. The French medical team was well-equipped, well-trained in field aid, and had taken part in the Indonesian tsunami, as well as Egyptian earthquake relief activities. The German medical team created a typical field hospital with the greatest size and best equipment. The American medical team was sent by the University of Maryland. Its Trauma Emergency Center belongs to the first-aid medical system of Maryland, is a global authority on trauma and emergency care, and is particularly experienced in head and spinal cord injuries, and severe trauma fractures.

Almost all members of the Taiwanese medical team had experienced the 21 September 1999 Taiwan earthquake, and possessed a wealth of experience in earthquake relief. The Hong Kong medical team, mainly including orthopedics doctors, anesthetists, infection specialists, and operating theatre nurses, were in charge of the management of an orthopedics ward. The team treated critically injured people with the support and co-operation of West China Hospital.

The Japanese international emergency assistance team has 30 years of medical relief experience in the earthquakes, tsunamis, and other major natural disasters. It has maintained normal operating procedures and regular training in Japan, and participated in cross-border medical treatment operations. For the Wenchuan earthquake, the Japanese medical team made appropriate preparations before arriving, ready to support the Sichuan earthquake relief.

Each medical team was skilled, experienced, well-equipped, and played a positive role in the Wenchuan earthquake medical relief.

Relief location and treatment evaluation of foreign medical teams

Eleven foreign medical teams carried out treatment in relief areas immediately after arriving and worked for a total of 136 days, with an average of 12.4 days for each team. The German medical worked for the longest, 26 total days, while Taiwanese medical team worked the shortest at 5 days. On average 181 injured people were treated by the 11 foreign medical teams per day, and 81 people per medical staff member per day. Medical teams working in frontline medical stations and tent hospitals from Taiwan, Russia, Italy, and Germany averaged 249 patients for teams per day and 455 for each staff member involved in treatment. Other foreign teams working in second-line hospitals treated a daily average of 49 patients, with 24 patients per day for each staff member involved in treatment. The numbers of patients treated at frontline stations and tent hospitals were more than those treated by second-line foreign medical teams. Foreign medical teams were involved in treatment mostly for disaster patients at different respective rescue places starting on 20 May, one week after the earthquake, when most of the injured had already received effective treatment. Thus, the number of people treated at frontline stations and tent hospitals included the injured and disaster area patients, with the latter in the majority.

Foreign medical teams at second-line hospitals treated the critically injured who were mainly transferred from the frontline. It is noticeable that the German medical team's workload included the workload of 68 members of Shanghai Red Cross Society Huashan Hospital rescue team. All foreign medical teams, whether in the frontline or second line, did their utmost and made a significant contribution to the Sichuan earthquake relief with medical treatment for injured people.

Working models and workflow evaluation of foreign medical teams

Creating good working models and scientific and reasonable workflow is the key to improving health care quality and efficiency. Eleven foreign medical teams worked in accordance with national and regional expertise and equipment, applied medical treatment for seismic specific circumstances, and carried out efficient and effective medical treatment using different models in strict accordance with scientific, standardized workflow. Foreign medical teams in the earthquake relief not only treated a large number of the injured, but also brought advanced management and medical skills, trained a large number of medical personnel, and improved medical workers’ medical skills across Sichuan.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Giving their top priority to people injured in the earthquake medical relief, foreign medical teams either at the frontline or second line were conscientious in their treatment of every injured person. They used their skills to save as many lives as possible with their exquisite medical skills and sound professional ethics. The Chinese medical system could learn from foreign medical teams’ rigorous and scientific working patterns, serious work attitude, strong sense of responsibility, careful and patient service, excellent medical skills, deliberate organization, and spirit of international humanism.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References
  • 1
    Information Office of the State Council. Daily Update on China Quake Relief (2008/05/27). http://www.china-un.org/eng/xw/(accessed Nov 2008).
  • 2
    Dai XZ, Shen J, Zhao WH, Jiao YZ. Phase report of medical treatment during Wenchuan earthquake. Chinese Journal of Evidence-Based Medicine 2008; 8(10): 797802.
  • 3
    Hong Jiang. Work patterns and processes of Cuban medical team after Wenchuan earthquake. Practical Journal of Clinical Medicine 2008; 5(6): 4142.