WMS Guidelines 2012 Lightning Safety 雷擊指引, 逆向檢傷 (2/2014)

Jackwabbit

在這星期的交流會提到這個指引:
Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries
http://www.wemjournal.org/article/S1080-6032(12)00180-9/fulltext
http://www.worldcongress2007.org.uk/images/Lightning%20Injuries.pdf

其它有關雷擊意識, 安全和急救的資料 Other links related to lightning safetys:
http://www.wec.ufl.edu/safety/BackcountryLightningSafety.pdf
http://www.wildmed.com/blog/lightning-strike-prevention-7-things-to-remember/
http://www.medofficer.net/page.cfm?pageid=16455
Lightning Strike Injuries (Joseph Mistovich, Nov 2008): http://www.ems1.com/ems-products/ambulances/articles/439502-Lightning-Strike-Injuries/
NOLS MythCrushers Episode 3: Lightning : http://www.youtube.com/watch?v=PVSCD1mdzY0
推荐 Don't miss this one! (英文)   Lightning MCI at 13,000 ft (W Smith, 2012):   http://www.wildernessdoc.com/assets/lectures/2012/2012Sept%20ExpedMed%20Lightning%20MCI%20slides.pdf

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Jackwabbit

在處理雷擊患者的「逆向檢傷/逆向分流」  Using Reverse Triage in treating lightning victims
Reverse triage 即是沒有呼吸及心跳的患者(we sometime refer them as the "healthy deads") 必須要做 CPR，而非如傳統的「大量傷患事件」(MCI, Mass Casualty Incident) 中的「檢傷分類」(triage) 去先救有生命徵象的患者！
1.  www.disaster.org.tw/chinese/active/ACLS.ppt  (第29張ppt: 雷擊)
2. www.disaster.org.tw/chinese/active/enviro.ppt (第4張ppt)
3.  Lightning - Awlsmedstudents.org , if this site is down, google it and then go to the "Cashed" page to view this pdf:
Excerpt..."  The typical description of a multiple casualty lightning strike is one of a sudden flash of bright light followed closely by a loud boom and then chaos. There will likely be several people who arewalking around, but confused. There will be people who are lying on the ground, but are moving or breathing on their own. These first two groups of people do not require immediate attention.
The final group of casualties may include one to several people who are unconscious, not breathing, and do not have a pulse.
This final group is the one that requires immediate attention. The fact that you are first treating persons who appear dead is called reverse-triage. The reason for this reverse triage is due to the fact that victims who are awake or breathing have survived the most immediate and potentially critical injury, which is cardiac and respiratory arrest. Victims who are not breathing and have no pulse require CPR. Some of these victims will regain a heartbeat and respiratory drive, but it may take up to 10-15 minutes before this occurs. Performing CPR on these victims can save their lives if their heart and brain are not too severely damaged.
In attempting to decide on which victims you should start the CPR, remember that those with head burns are four times more likely to die than persons without head burns."

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因為這張 jpeg 的原版不能再在網上看到, 所以 post 在這裡給大家一個參考.
Since the original jpeg can no longer be found on the web, I'm posting it here as a reference:

Jackwabbit

雷擊事故
9月15日2013年, 浙江寧波市九峰山雷擊事故:
     http://the-sun.on.cc/cnt/china_world/20130916/00429_005.html
     http://orientaldaily.on.cc/cnt/china_world/20130916/00178_009.html
     http://big5.xinhuanet.com/gate/big5/news.xinhuanet.com/local/2013-09/15/c_117371566.htm
"Thunderstruck": Penetrating Thoracic Injury From Lightning Strike (van Waes et al., 2013):
     http://www.annemergmed.com/webfiles/images/journals/ymem/FA-YMEM5654.pdf
Boys Go Camping, Get Shock of Their Lives (PR Newswire, 2013):
    http://www.emsworld.com/news/11173343/boys-go-camping-get-shock-of-their-lives

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Jackwabbit

This photo is from:
https://www.facebook.com/AccidentsInNorthAmericanMountaineering/photos/a.475295539174959.98161.459858344052012/868012579903251/?type=1&fref=nf  and
http://publications.americanalpineclub.org/articles/13201213207/Lightning-Exposure-Weather-Poor-Position