Early medical care and trauma management in mass casualties from major explosive accidents: a retrospective analysis and recommendations.

Objective: This study aims to analyze the clinical characteristics and treatment outcomes of mass casualties resulting from major explosive accidents and to identify the shortcomings in the management of such casualties during sudden explosive events. Methods: A retrospective analysis was conducted on data from a gas explosion at a cafeteria in a district of Southwest China. Key treatment measures, including injury assessments, early triage, timing of surgeries, hospital stay duration, and complications, were systematically collected and analyzed. Results: The explosion resulted in 16 fatalities at the scene and 10 survivors, all of whom received prompt triage, classification, transportation, and effective treatment. Among the survivors, two were male and eight were female, aged 26-50 years, with an average age of 39 years. The on-site mortality rate was 61.5%. Among the survivors, one patient with severe traumatic brain injury died 11 days post-incident despite medical intervention, while another was rehospitalized due to the recurrence of a pre-existing chronic condition. Three patients experienced varying degrees of hearing loss upon discharge, with one also reporting intermittent tinnitus. Four patients showed improvement and were discharged. Conclusion: The on-site mortality rate in mass casualties from major explosions is extremely high, and the injuries are often complex. Current early triage methods are limited and overly simplistic. The incidence of pulmonary injuries is high in explosive accidents, with rapid disease progression and elevated mortality. Timely identification of blast injuries and continuous monitoring of injury progression are critical to preventing further exacerbation of traumatic brain injuries and other organ damage. Strengthening regional trauma care infrastructure is essential for reducing preventable deaths.