title: Lessons learnt from the Wenchuan earthquake: performance evaluation of treatment of critical injuries in hardest-hit areas.
abstract: OBJECTIVE
  Critical injury treatment in the hardest-hit areas after a great earthquake was retrospectively analyzed to determine how best to reduce mortality and disability and increase the rehabilitation rate through postquake medical relief.
  
  
  METHODS
  Retrospective analysis, primary sources, and secondary sources were comprehensively retrieved and analyzed.
  
  
  RESULTS
  According to incomplete data, 30,620 injured were rescued by themselves among the hardest-hit areas in the 72 hours immediately following the earthquake. Critically injured patients accounted for 22% of total inpatients. Mortality rates declined with greater distance from the epicenter: rates were 12.21% for municipal healthcare centers in the hardest-hit areas, 4.50% for municipal medical units in peripheral quake-hit areas, 2.50% for provincial medical units in peripheral quake-hit areas, and 2.17% for Ministry of Health-affiliated hospitals in peripheral quake-hit areas. The number of injured with fractures on body, limbs or unknown-parts, severe conditions as well as other kinds of non-traumatic diseases received in second-line hospitals was much more than those treated in first-line hospitals with more severe injuries. Among 10,373 injured in stable condition transferred to third-line hospitals, 99.07% were discharged from hospitals within four months, while the mortality rate was 0.017%.
  
  
  CONCLUSIONS
  The medical relief model of "supervising body helping subordinate unit, severely stricken areas assisting hardest-hit areas, least-hit areas supporting both hardest-hit and severely stricken areas, and self help and mutual assistance applied between hardest-hit areas" was roughly established for injured from severely stricken areas after the Wenchuan Earthquake. The "four-centralization" treatment principle, which referred to concentrating patients, experts, resources and treatment for those injured in critical condition effectively reduced the mortality from 15.06% to 2.9%. Timely, scientific, and standard on-site triage and postmedical transfer guided by accurate injury information determine rescue effect for the injured, while there is large space to fulfill as for treatment for critical diseases among the hardest-hit areas under extreme conditions after the Wenchuan earthquake.
authors.affiliation: West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Jiang
authors.forename: Youping
authors.initials: Y
authors.lastname: Li
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Huang
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Su
authors.forename: Dake
authors.initials: D
authors.lastname: Zhong
authors.forename: Chenghu
authors.initials: C
authors.lastname: Shi
authors.forename: Mingxu
authors.initials: M
authors.lastname: Li
authors.forename: Juan
authors.initials: J
authors.lastname: Shan
authors.forename: Yin
authors.initials: Y
authors.lastname: Chen
mesh_terms: D002681:China; D016638:Critical Illness / Q000628:therapy*; D055866:Earthquakes; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans