A7.0-magnitude earthquake took place in Lushan county, Ya’an in southwest China’s Sichuan Province at 8:02 a.m. Beijing time, April 20, 2013. The epicenter was located approximately 110 km away from Chengdu, at 30.3 degrees north latitude and 103.0 degrees east longitude. The earthquake caused 196 deaths and left 21 missing and 11 470 injured.

The earthquake relief experience gained from the 2008 Wenchuan earthquake2-5resulted in a very fast response to the Lushan earthquake. Within 5 hours of the event, the Sichuan Health Department had sent out 12 medical teams with a total of 200 medical personnel for emergency help; at the same time, nearly 100 intensive care unit beds were being prepared in Chengdu. On the day of the earthquake, the National Health and Family Planning Commission (NHFPC) dispatched 5 national medical rescue teams and a national medical expert group to assist in and oversee the treatment of the injured. On April 21 and 29, the second and third expert teams were selected from Beijing, Shanghai, and Jiangsu. These teams travelled to Chengdu to assist in the medical treatment of the severely injured earthquake victims. The expert team was composed of specialists in critical care medicine from the fields of orthopedics; neurosurgery, thoracic surgery, general surgery, and pediatric surgery; infectious disease; nephrology; and rehabilitation. From April 21 to May 13, the expert teams assisted the local medical forces in treating the critically injured patients and in designing one-on-one treatment plans through the assessment of injuries, to improve the level of medical service. Further, to improve national disaster response and management, the team carried out a top-level epidemiological study of earthquake-related injuries intended to clarify the specific damage caused by earthquakes and the subsequent complications, as well as to determine risk factors for personal casualty and disability. The aid from the expert team improved the overall level of the clinical research on earthquake injury and our international status by providing a scientific basis of enacting earthquake injury prevention and treatment policies for the government.

In line with the earthquake rescue principle of patient, resource, expert, and treatment centralization, the expert team screened all of the critically ill patients, set individualized therapy regimens, and implemented a daily reporting system for the severely injured. Owing to the unexpected and sudden nature of a natural disaster and the varying levels of care available at different hospitals, a standardized assessment is needed to quantify the trauma. As a result, on April 24, 2013, a national expert team along with other experts in the Sichuan Province enacted the Wounded Condition Assessment and Management Standards of Earthquake Victims assessment to ensure the condition of victims can be accurately assessed and identified.Using this tool, victims can obtain prompt treatment and effective rehabilitation; it also allows stable victims to be transferred to general wards in a timely manner, allowing access to appropriate services for critically injured patients.

Earthquake victims are often coinfected with various pathogenic microorganisms; the main pathogens were gram-negative bacilli.Retrospective studies of the Wenchuan earthquake revealed that the use of antibiotics was mainly empirical rather than specific, and irrational use was common. The expert group of infection disease physicians travelled to the hospitals where the injured earthquake victims were admitted for infection prevention and control. They standardized infection prevention and control at different levels; instituted risk of infection assessment for earthquake victims, especially postoperative injuries; reinforced preventative measures based on the risk assessment, such as controlling blood glucose, treatment of the underlying disease and infection; monitored nosocomial infection and other related factors especially in high-risk cases; achieved early infection identification, treatment and prevention; and promoted infection control knowledge to the injured and their families such as self care, hand hygiene, and environment cleanliness maintenance. A primary summary of the data shows that the individual and hospital infection rate of the Lushan earthquake was significantly lower than that of the Wenchuan earthquake.

Early rehabilitation intervention to reduce disability

The most common injuries in earthquakes require orthopedic or neurosurgical care.,The Lushan seismic intensity was much lower than that in the Wenchuan earthquake, so the number of patients with amputation and paraplegia was relatively small, 9 and 20, respectively. Even so, there were still a large number of fractures and peripheral nerve injuries that needed rehabilitation therapy. After the Wenchuan earthquake, the rehabilitation therapy facilities in Sichuan Province underwent rapid development. Several rehabilitation centers were established, laying a good foundation for the rehabilitation of those wounded in the Lushan earthquake. The Sichuan provincial rehabilitation medical expert group was founded in the early stages of the Lushan earthquake and included rehabilitation specialists. These specialists carried out early rehabilitation treatments and attempted to reduce the onset of disability, while saving lives and treating injuries.

Natural disasters often occur suddenly; therefore, emergency treatment is often conducted on large quantities of patients simultaneously, affecting the working order of treatment hospitals. Further, medical recordkeeping is very different under these circumstances. Additionally, post-disaster reconstruction and the subsequent relocation of the majority of the injured make it very difficult to complete a thorough epidemiological investigation, which is the main reason why there are so few complete seismic epidemiological reports to date. China is an earthquake-prone country; in the past 5 years, 3 earthquakes measuring over 7.0 in magnitude have occurred, including the Wenchuan, Yushu, and Lushan earthquakes. Earthquakes and their effects often lead to a large number of casualties. The physical and mental disability caused by earthquakes seriously affects survival and a person’s quality of life, bringing a heavy burden to the state, society, and family. There is a demand for national disaster response and management, and carrying out systematic, standardized earthquake-injury epidemiological studies will clarify earthquake injury and its complications. These data can be used to change laws, improve conditions for the injured, and modify risk factors for death and disability. Overall, it will improve the level of clinical earthquake damage research in China and internationally, while providing a scientific basis for the government to enact earthquake injury prevention and control policies. In the case of the Lushan earthquake, a week after the event, the expert group conducted the Lushan earthquake injury epidemiology survey and complied the data collected during the treatment by using data management software.0-12Currently, an epidemiological survey is being carried out in all related hospitals under the umbrella of the NHFPC and the Sichuan Provincial Health Department. It is the first time that primary epidemiological data of all inpatients has been included in the survey, providing a scientific basis for earthquake disaster treatment domestically and internationally.