To investigate the characteristics of acute respiratory distress syndrome (ARDS) in the casualties of a great earthquake in Wenchuan China on May 12, 2008. Records of the hospitalized patients in ICU injured in the earthquakes were examined retrospectively. Among the total of 153 critical patients injured in the earthquake, 52 (34.0%) had ARDS. Among these 52 patients with ARDS, 24 (46.2%) had multiple organ dysfunction syndrome (MODS). 9 (17.3%) patients with ARDS dead. Approximate 34.0% of the casualties of a great earthquake in ICU had ARDS, MODS is a common associated conditions in these patients, infection play a great role in these patients.