Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire

Epidemiology of bus fires in mainland China from 2006 to 2015

OBJECTIVE

This study analyses the epidemiological characteristics of bus fires in mainland China over the past 10 years to develop prevention strategies and emergency procedures for such incidence and the resulting casualties.

METHODS

We collected reports on bus fires from the media and news websites and looked up on Medline, PubMed, and Chinese National Knowledge Infrastructure databases for relevant publications in English or Chinese from January 1, 2006 to December 31, 2015.

RESULTS

In the past 10 years, there were 382 bus fires in mainland China. The frequency of fires was markedly higher in 2013 and 2014. The vast majority (89.1%) of the fires were caused by spontaneous combustion, followed by arson (5.0%). There were reports of casualties in 41 (10.7%) of the bus fires, including 144 deaths and 567 injuries. The fires leading to casualties resulted from spontaneous combustion in 22 (53.7%) incidents, arson in 12 (29.3%) incidents, and traffic accidents in 7 (17.1%) incidents. Arson caused the most casualties, including 91 deaths and 323 injuries.

CONCLUSIONS

This epidemiological study presents characteristic findings related to bus fires in China mainland. The general trend of bus fires showed a gradual increase but with a fluctuation in several years. The regional distribution of bus fires revealed some specific characteristics, and most of bus fires happened in those regions locating in the eastern area of China mainland. The largest number of bus fires were caused by spontaneous combustion. Bus fires caused by arson accounting for only 5% of the total bus fires resulted in the most severe casualties. Most of bus arson occurred in the morning and evening rush hours.

Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model

OBJECTIVES

Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs.

METHODS

This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command.

RESULTS

Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people.

CONCLUSION

The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

Response and legislative changes after the Kiss nightclub tragedy in Santa Maria/RS/Brazil: Learning from a large-scale burn disaster

PURPOSE

A major fire occurred on January 27, 2013, at 02:30 at Kiss nightclub in the city of Santa Maria, State of Rio Grande do Sul, in Southern Brazil. In this retrospective report, we aimed to describe the nightclub fire event, its immediate consequences, and evaluated its impact on legislation. Our objective was to disseminate the lessons we learned from this large-scale nightclub fire disaster.

METHODS

We conducted a literature review in PubMed and Lilacs database from 2013 to 2015 related to the nightclub Kiss, Santa Maria, fire, burns, and similar events worldwide over the past 15 years. We searched in the general press and online media information sites, and seeking legislation about this topic at the federal level in Brazil. We reported on the legislation changes that resulted from this nightclub fire.

RESULTS

Current federal legislation on fire prevention and the scope of public safety, including night clubs and discos, states is the duty of the state and everyone's responsibility, pursuant to Article 144 of the Federal Constitution of Brazil. Thus, the federal union, individual states and municipalities have the power to legislate on fire prevention, and especially to ensure the security of the population. A state law called "Law Kiss", was passed in 2014, establishing standards on safety, prevention and protection against fire in buildings and areas of fire risk in the state of Rio Grande do Sul. On a national level, a law of prevention and fire fighting in Brazil was also drafted after the Santa Maria disaster (Law project no. 4923, 2013). Currently, this bill is still awaiting sanction before it can take effect.

CONCLUSION

As we push for enactment of the national law of prevention and fire fighting in Brazil, we will continue emphasizing fire prevention, fire protection, fire fighting, means of escape and proper management. All similar events in this and other countries remind us that similar tragedies may occur anywhere, and that the analysis of facts, previous mistakes, during and after the incident are crucial to our understanding, and will help us lessen the chance of future occurrences.