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

In this paper, we review the previous classic research paradigms of a mass casualty incident (MCI) systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus fire, in order to outline and develop an improved research paradigm for MCI management. We searched PubMed, EMBASE, China Wanfang, and China Biology Medicine (CBM) databases for relevant studies. The following key words and medical subject headings were used: ‘mass casualty incident’, ‘MCI’, ‘research method’, ‘Wenchuan’, ‘earthquake’, ‘research paradigm’, ‘science of surge’, ‘surge’, ‘surge capacity’, and ‘vulnerability’. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods (medical severity index (MSI), potential injury creating event (PICE) classification, and disaster severity scale (DSS)), which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored—vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research. 系统回顾大规模伤亡事件(MCI)经典研究范式, 结合2008年汶川地震和2014年杭州7·5公交车起火事件, 优化MCI应对的研究范式。 需求激增理论是MCI应对实时评估的显著进步, 结合2008年汶川地震和2014年杭州7·5公交车起火事件, 我们发现MCI应对评估中一个非常重要的脆弱性因素被忽略。 采用关键词和医学主题词(大规模伤亡事件、 MCI、 研究方法、 汶川、 地震、 研究范式、 激增科学、 激增、 激增应对能力和脆弱性等), 通过检索数据库PubMed、 EMBASE、 中国万方及中国生物医学(CBM)的相关研究资料库, 进行理论的回顾性分析和结合实际案例的分析。 除需求激增理论中的激增和激增应对能力这二个基本维度外, 应引入第三个维度脆弱性, 形成更为全面和客观的三个互为关联维度构建MCI的新研究范式, 突破MCI传统研究范式的局限性。