Medical support in the Tangshan earthquake: a review of the management of mass casualties and certain major injuries.

The Tangshan earthquake was probably the worst catastrophe in this century. It took a death toll of 242,769, with 164,851 injured in addition. This presentation describes the organization of disaster relief work after the earthquake, the rescue of buried victims, the organization of medical resources, and the sanitation work to forestall epidemics. It also presents the author's reflections on the management of three major injuries, namely, crush syndrome, fracture of pelvis, and traumatic paraplegia, by reviewing the available data pertaining to these injuries. The author concurs with the prevailing opinion that fasciotomy plays an important role in the successful management of crush injury. It not only prevented acute renal failure subsequent to intracompartmental increase of pressure, but also the occurrence of Volkmann's ischemic contracture as a late sequela. Herbs to induce catharsis and diuresis were used to alleviate intracompartmental pressure. For the management of pelvic fractures, two newly developed treatment techniques are described. On analysis of clinical data, it is the author's opinion that traumatic paraplegia should not be given the priority of early surgery in the circumstances of mass casualties. The primary concern should be the stability and restoration of normal curvature of the spine, especially in cases of complete paraplegia. Decompression of the spinal cord through an anterolateral approach gave promising results in hyperflexion type of spinal fracture.