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首页> 外文期刊>The Internet Journal of Rescue and Disaster Medicine >Triage Of Fire Smoke Intoxicated Victims In A Disaster Situation
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Triage Of Fire Smoke Intoxicated Victims In A Disaster Situation

机译：灾难情况下火灾烟雾中毒受害者的分类

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Fire and disasters are often linked together. The smoke inhalation is one of the important pathologies found in fires and that could be lethal, lead to serious sequels or it could be of no importance, as well. In a disaster situation, the number of intoxicated victims could be large and their triage is of importance to select those who can benefit of treatment. We focus our attention on smoke inhalation cases, clinical presentation and importance of diagnostics even in a disaster situation. Measurement of breath carbon monoxide in the pre-hospital setting is interesting to diagnose poisoning and to help to find real smoke inhalation victims in a crowd of involved and stressed people. Fire and Disasters Fire and disaster are linked together : every fire can become a disaster, for example a building fire, especially when it is a public building where potential victims are numerous as in dancing hall (Cocoanut Grove Night Club Fire in Boston,USA [1,2] in 1942 where 489 people died and 131 wounded were treated in the hospital) or an airport fire (fire of the airport Dusseldorf, Germany [3] where 62 people were intoxicated) or forest fire near residential zone ( Berkeley California forest fire [4] in 1991 with report of 25 fire-related deaths and 241 people with fire-linked health problems). A long list of disaster fires are listed by Favre [6] where one can find historical fires such as a circus fire in St. Petersburg, Russia in 1836 (800 dead), a theatre fire in Canton China in 1845 (1670 dead), a church fire in Santiago, Chile in 1848 (2500 dead) or more recent disasters as the fire of the MGM Hotel in Las Vegas, USA in 1980 (86 dead) or the stadium fire in Bradford, UK in 1985 (53 dead) or a forest fire in the North of China in 1987 (193 dead). Fire could be secondary to traffic, train or aeroplane accidents. Tunnel fire accidents are dominated by smoke inhalation, for example in a train fire in Zurich [5] with 140 passengers of the train trapped in a tunnel while the train was burning, resulting in 58 inhalation injuries or the Subway Fire in Baku in 1995 resulting in 289 dead and 256 poisonings and other casualties [16]. More classical major disasters as earthquake, volcano eruption, terrorist bombing, urban riots, classical or nuclear bombing,... are followed by fire. Pathological states often caused by the fire Some of the pathologies encountered during fire are highly specific and others nonspecific. The specific pathologies include burns and smoke intoxication and nonspecific ones are traumatic lesions, blast injuries and hyperthermia. The smoke intoxication is very frequent in the context of fire but it is frequently hidden by an other state more visible and better known, such as a burn. Emergency clinicians must keep in mind all the possible diagnoses in the context of the fire. Closed trauma and blast injuries have in common with smoke inhalation their hidden lethal potential : an apparently unharmed patient can collapse because of a major lung oedema [15] (in the smoke example), or intestinal perforation (in the blast example) and will thus escape the medical attention even more easily in a disaster context where rescue teams have other things to do than running after apparently unhurt victims. Smoke More than hundred toxic substances are known to be present in the fire smoke. Research in the chemistry and occupational hygiene [7, 8, 9, 10, 11] showing the presence of all these toxicants have to be validated by clinical research [12,13]. On the top of the list is the carbon monoxide which plays certainly a role, but other products could be as toxic like hydrocyanic acid [14], acrolein, hydrogen chloride, phosgene, sulphur and nitrogen dioxide among others. These products are found in the smoke as gases, aerosol or are adsorbed on solid soot particles. Clinical effects of smoke could be divided into two categories : asphyxia and lung irritation or respiratory tract injuries.Asphyxia by deprivation of oxygen in ambient
机译：火灾和灾难经常联系在一起。吸入烟雾是火灾中发现的重要病状之一，可能致命，导致严重的后遗症，也可能不重要。在灾难情况下，中毒的受害者人数可能很大，他们的分流对于选择能够受益于治疗的人很重要。我们将注意力集中在烟雾吸入病例，临床表现以及即使在灾难情况下诊断的重要性。在院前环境中测量呼吸中的一氧化碳对于诊断中毒和帮助在受累且压力重重的人群中发现真正的烟雾吸入受害者很有趣。火灾与灾难火灾与灾难联系在一起：每场火灾都可能成为灾难，例如建筑物火灾，尤其是在公共建筑中，潜在的受害者像舞厅一样多的时候（美国波士顿的Cocoanut Grove夜总会火灾[ 1,2]在1942年造成489人死亡，131人受伤在医院接受治疗）或机场大火（德国杜塞尔多夫机场大火[3]，其中62人被陶醉）或居民区附近的森林大火（加州伯克利森林1991年发生的大火[4]，报告了25起与火有关的死亡和241人与火相关的健康问题。法弗尔（Favre）列出了大量灾难性火灾[6]，其中可以找到历史性火灾，例如1836年在俄罗斯圣彼得堡的马戏团大火（800人死亡），1845年中国广州的剧院大火（1670人死亡）， 1848年智利圣地亚哥的教堂大火（2500人死亡）或最近的灾难，例如1980年美国拉斯维加斯的MGM酒店大火（86人死亡）或1985年英国布拉德福德的体育场大火（53人死亡）或1987年发生在中国北方的森林大火（193人死亡）。火灾可能是交通，火车或飞机事故的继发因素。隧道火灾事故以烟雾吸入为主，例如苏黎世发生的火车大火[5]，火车燃烧时，有140名乘客被困在隧道中，造成58人的吸入伤害或1995年巴库的地铁火灾。造成289人死亡，256人中毒和其他人员伤亡[16]。地震，火山爆发，恐怖分子炸弹袭击，城市暴动，古典或​​核轰炸等更为典型的重大灾难，紧接着是大火。火灾经常引起的病理状态火灾中遇到的某些病理状态是高度特异性的，而其他则是非特异性的。特定的病理包括烧伤和烟雾中毒，非特定的病理包括外伤性病变，爆炸伤和体温过高。在着火的情况下，烟雾中毒非常频繁，但通常被其他更可见，更广为人知的状态（例如燃烧）所掩盖。紧急临床医生必须谨记在发生火灾时所有可能的诊断。闭合性创伤和爆炸伤与吸入烟雾具有相同的潜在致死潜力：似乎未受到伤害的患者可能会因严重的肺水肿[15]（在吸烟示例中）或肠穿孔（在爆炸示例中）而崩溃。在灾难情况下，救援队还有其他事情要做，而不是追赶显然没有受伤的受害者，从而更容易逃脱医疗救助。烟雾已知烟雾中有一百多种有毒物质。化学和职业卫生研究[7、8、9、10、11]显示所有这些有毒物质的存在必须通过临床研究进行验证[12,13]。排在首位的是一氧化碳，肯定起一定作用，但其他产品可能有毒，例如氢氰酸[14]，丙烯醛，氯化氢，光气，硫和二氧化氮等。这些产品以烟雾，气溶胶的形式被发现在烟雾中，或者被吸附在固体烟灰颗粒上。烟雾的临床效果可分为两类：窒息和肺部刺激或呼吸道损伤。周围环境缺氧引起的窒息

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