转运呼吸机联合急救转运护理在脑梗死患者中的应用效果

目的探讨转运呼吸机联合急救转运护理在脑梗死患者中的应用效果。方法选取82例脑梗死院前急救患者,按随机数字表法分为观察组和对照组,各41例。对照组采取转运呼吸气囊配合急救转运护理,观察组给予转运呼吸机配合急救转运护理。对比2组生命体征指标（心率、呼吸频率）及救治效果。结果转运前2组生命体征指标对比差异无统计学意义（P>0.05）;观察组转运后心率为（93.47±10.08）次·min-1、呼吸频率为（21.28±4.43）次·min-1,低于对照组的（99.57±10.22）次·min-1、（24.64±4.39）次·min-1,差异有统计学意义（P<0.001）;观察组救治总有效率为95.12%,高于对照组的80.49%,差异有统计学意义（P<0.05）。结论转运呼吸机联合急救转运护理能改善脑梗死患者心率及呼吸频率,增强救治效果。     

航空急救转运危重患者的效果分析

目的：探讨南方城市航空急救体系在危重患者长途转运中的优缺点。方法选取2004年8月至2014年12月期间所有接受过广东省人民医院航空急救转运的患者30例为观察组,情况基本匹配的经地面急救转运的患者30例为对照组,采集两种转运方式患者的病情、转运距离、运输时间、转运费用以及途中并发症等数据,根据数据类型,采用χ2检验以及成组 t 检验或相应的非参数方法进行统计分析。结果两种转运方式的转运距离（km）[578.0（313.0,707.5）vs.214.5（101.5,313.5）,P ＜0.05]、准备时间（min）[95.7（56.7,133.4）vs.10.7（6.8,15.7）,P ＜0.05]、转运时间（min）[112.3（64.3,152.4）vs.146.8（67.8,217.5）,P ＜0.05],费用（元）[14378.5（9887.0,16348.5） vs.557.0（356.5,787.5）,P ＜0.05]及距离／总时间值[2.8（1.3,4.8）vs.1.4（0.8,2.8）,P ＜0.05]比较差异有统计学意义;两组患者在转运途中并发症发生率差异无统计学意义（χ2＝0.058,P ＝0.834＞0.05）。结论航空急救转运能够缩短危重患者的长途转运时间,提高急救效率。但我国航空急救系统仍存在一定的不足,需进一步完善。     

创伤急救中血源性职业暴露的防控

目的：分析创伤急救过程中血源性职业暴露（Blood-borne Pathogens Occupational Exposure,BPOE）的风险并探索其防控策略。方法：问卷调查某医院创伤急救医务人员2010-01-2013-12BPOE发生及其防控情况,查阅统计医院的职业暴露记录。SPSS 19.0软件包描述性统计分析创伤急救BPOE各方面特征。结合创伤急救工作特点和相关文献,探讨创伤急救过程中BPOE的防控策略。结果：48名医务人员4年创伤急救共发生BPOE 192例（次）,发生率1.00次/（人·年）,报告率39.06%（75/192）,伤口处理率76.04%（146/192）,感染率1.04%（2/192）。暴露好发职业：护师〉医师〉护工〉技师。暴露常见原因：环境复杂紧急〉防护设施欠缺〉人力资源不足〉防护操作不当。暴露主要环节：现场处置〉急诊手术〉救护车转运〉院内处置。暴露源物质：血液〉污染器物〉分泌物〉排泄物。暴露源病原：未确定〉HBV〉HIV〉HCV〉TPP。结论：＂急＂、＂难＂、＂险＂、＂重＂、＂脏＂、＂乱＂、＂差＂七个特点是创伤急救BPOE的重要危险因素。创伤急救医务人员在包括出诊准备、现场急救、救护车转运、院内急救与手术以及BPOE后处置等各个环节都应遵循普遍预防和标准预防原则并采取有针对性的BPOE防控策略。     

出诊医师电话医疗指导对院前急救效果的影响

目的：探讨出诊医师电话医疗指导对急性创伤患者院前急救效果的影响。方法：选取2019年1~12月南昌急救中心采用常规院前急救期间收治的急性创伤患者126例作为对照组,另选取2020年1~12月南昌急救中心采用出诊医师电话医疗指导院前急救期间收治的急性创伤患者126例作为观察组。比较两组预后情况、确定性手术治疗时间、住院时间和急救满意度。结果：观察组治疗总有效率为96.03%,高于对照组的87.30%,确定性手术治疗时间、住院时间均短于对照组,急救满意度评分高于对照组,差异有统计学意义（P＜0.05）。结论：出诊医师电话医疗指导能够提升急性创伤患者院前急救效果,有助于患者疾病康复,提升急救满意度。     

2008年北京奥运会802例急救转运病案特点分析

目的 通过对2008年北京奥运会场馆内医疗急救转运病案进行分析,研究大型人群聚集活动中急危重症病案特点和医疗急救转运保障方案.方法 使用国际奥组委统一制定的医疗信息统计表系统(MEFS)对北京奥运会期间(2008-07-27 T 09;00/2008-08-27 T 23:00)场馆医疗救治病案进行统计和分析.结果 在北京奥运期间共从场馆转出802例患者,男471例,女331例;平均年龄42.67岁,中国籍490例,外国籍312例.按MEFS将疾病分为12大类,802例患者疾病种类由多至少依次为外伤(占39.03%)、消化系统(占21.82%)、心血管系统(占7.36%)、呼吸系统(占6.48%)、神经系统(占6.23%)、皮肤科(占4.49%)、眼科(占4.24%)、耳鼻喉科(占3.74%)、热相关疾病(占3.37%)、泌尿生殖系统(占1.87%)、口腔科(占1.37%)、精神科(为0);就诊人群由多至少依次为工作人员(占34.04%)、非注册人员(占33.29%),其他人员(占13.59%)、运动员(占12.72%)、贵宾(占3.74%)、媒体(占2.62%).结论 大型活动的医疗保障应针对重点疾病和高危人群制定合理的现场救援方案并建立高效的医疗急救转运体系.     

不同急救转运方式对严重创伤患者病情影响的研究进展

介绍和总结近年来有关不同急救转运方式对严重创伤患者病情影响的研究进展。回顾国内外文献，对急救转运方式从陆上、空中、水上三方面进行分析，介绍不同转运方式对严重创伤患者生命体征及病理生理改变影响的研究现状，以期为规范急救转运模式，促进立体转运体系的建立及合理利用，提高创伤急救的救治率提供参考。     

危重患者院前转运体会

目的：探讨危重患者院前转运的方法、途径、时间，为提高患者的抢救成功率和降低医疗风险提供科学依据。方法：对危重患者在院前转运关键环节进行分析即迅速评估，准确分类，密切观察，按需处理，安全转运。结果：危重患者的抢救成功率得到提高。结论：急救网络的完善、信息的畅通、设施的完备、车辆的配备、急救专家信息库的建立，是快速抢救成功的前提。     

气动气控型呼吸机在急性呼吸衰竭急救转运中的价值

目的探讨急性呼吸衰竭患者急救转运中使用气动气控型呼吸机辅助呼吸对患者的影响。方法选择郑州市第七人民医院急诊科107例急性呼吸衰竭患者使用随机数字表分组。对照组53例予简易呼吸器辅助呼吸配合急救转运,观察组54例予气动气控型呼吸机辅助呼吸配合急救转运,对比两组患者转运效果、生命体征和肺通气效果。结果干预后观察组患者转运成功率94.44%高于对照组79.24%,转运时间和进入抢救室时间(23.47±2.34)min、(37.25±3.72)h均短于对照组(37.25±3.72)min、(1.32±0.13)h(P<0.05);干预后观察组患者收缩压(SBP)、心率(HR)和自主呼吸频率(SR)(122.15±12.21)mmHg、(97.33±9.73)次/min、(21.02±2.10)次/min均低于对照组(130.32±13.03)mmHg、(102.13±11.21)次/min、(24.65±2.46)次/min(P<0.05);干预后观察组患者动脉血氧分压[p(O₂)]、血氧饱和度(SpO₂)水平(89.96±8.99)mmHg、(95.03±9.50)%均高于对照组(72.36±7.23)mmHg、(90.56±9.05)%(P<0.05)。结论气动气控型呼吸机应用于急性呼吸衰竭患者的急救转运中辅助患者呼吸,能够有效改善患者肺通气,提高转运效果,稳定患者生命体征。     

北京2022年冬奥会医疗急救服务情况分析北大核心CSCD

目的分析北京2022年冬奥会医疗急救转运情况,探讨疫情下举办大型赛事医疗救治保障,为合理统筹并优化冬奥场馆和涉奥酒店急救资源和救治流程提供依据。方法回顾性分析2022年1月27日冬奥村正式启用至2月20日冬奥会闭幕期间北京和延庆赛区涉奥医疗急救转运情况,分析冬奥会与城市、场馆与酒店急救服务等方面的情况。结果北京2022年冬奥会期间,涉奥人员平均每万人急救转运7.5人次,其中损伤与疾病类病例平均每万人为4.8人次、涉奥疫情相关病例平均每万人为2.7人次。涉奥酒店急救服务是场馆的1.7倍;主要疾病类型为疫情相关性疾病467例(39.51%)、外伤236例(19.97%)、呼吸系统疾病165例(13.96%)、消化系统疾病65例(5.50%)、心血管疾病48例(4.06%)、皮肤疾病38例(3.21%),手部冻伤3例。结论北京2022年冬奥会期间医疗急救服务平稳有序,外伤和上呼吸道感染是冬奥会期间最主要的伤病,运动员以外伤为主,无危重病例,工作人员急救转运比例较大,应予以重点关注。     

汶川大地震医疗转运上万灾区伤员“进出成都”的救援学特征

目的 总结强震期间灾区伤员医疗救援大转运的专业特点.方法 查阅120中心抗震救灾调度指令的派车记录和伤员转运的值班统计,收集全市120网络等各医疗机构震灾救援的官方信息,结合120中心应急反应的具体行动等进行归纳分析.结果 经120中心统一调度指挥,震后4周内共救援转运灾区伤员8264人进入成都市内住院救治,转出2431人至外省进一步治疗.入城伤员中,震后头3 d为救援高峰期,占86.30%(7132/8264);重伤员约占总数比例13%;院内死亡伤员中,90.54%(134/148)发生在震后第一阶段;各阶段住院死亡率随救援进程加大呈现下降趋势(2.07%～0.77%).陆路转运成都周边灾区伤员数量最大,占81.53%(6738/8264),用时13 d;空路转运重灾偏远山区伤员数量居次,占16.50% (1363/8264),但耗时最长(24 d);水路转运周期最短(4 d).出城伤员中,第三阶段为转运高峰(53.56%),单日伤员最大出城量专列大于包机.结论 汶川大地震医疗转运灾区伤员具有转运周期长、转运高峰短、重伤员偏多、死亡时段集中等独特的救援学时间特征、伤情特征、路径特征等,对未来的震灾救援具有启示作用.     

Emergency Medical Services in China

The objective of this article is to identify and describe Chinese emergency medical services (EMS) components. Chinese EMS system development began in the 1980s with "importing" of EMS principles from other systems. China is now attempting to unify these principles. Chinese EMS systems are absent in most rural areas. Urban ambulance dispatch or "rescue" centers provide both transport and inpatient care. Ambulances are staffed with either a physician or a driver. There is not extensive overlap between hospital emergency physicians and ambulance physicians and no out-of-hospital providers at the paramedic or emergency medical technician level exist. Access to EMS is accomplished by dialing 1-2-0. Emergency calls go directly to the rescue center and a physician is dispatched. No on-line radio communication between hospitals and ambulances typically takes place. China has assimilated both traditional and unique EMS components and is undergoing development. It remains unclear whether a systematized EMS structure will emerge.     

Prehospital Emergency Care in Shanghai: Present and Future

Background

In Shanghai, prehospital emergency medical services are provided by the public Ambulance Services. The 60th anniversary of the local Ambulance Services is a good opportunity to provide an overview of the current trends in prehospital emergency medical care in Shanghai.

Objectives

In this report, the features of Shanghai prehospital emergency medical care are described, as well as the Shanghai model of purely prehospital emergency medical care, including the communications and dispatch system, ambulance depots and ambulances, and prehospital rescue teams. Responses to major incidents including public health emergencies and natural disasters are also discussed, with the intention of highlighting future directions in emergency medical services, as well as the influence of international trends in emergency patient care.

Discussion

Although Shanghai has the most advanced dispatch system in China (equipped with a Global Positioning System, Global Information System, and more) and can be expanded quickly in case of mass casualty incidents, there is, as yet, no uniform Emergency Medical Service (EMS) dispatching for the entire city. Nor are there certifications, degrees, or special continuing education programs available for EMS dispatchers. Although there are more and more ambulance depots spread all over Shanghai, the city struggles with inadequate prehospital emergency caregivers, because every ambulance has to be staffed with a qualified Emergency Physician, and there are also recruitment problems for ambulance physicians.

Conclusions

Although faced with many challenges, substantial progress is expected in Shanghai prehospital emergency care.     

Ambulance Diversion and Emergency Department Offload Delay: Resource Document for the National Association of EMS Physicians Position Statement

Abstract

The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS systems, and their patients, are significantly impacted by emergency department (ED) crowding. While protocols designed to limit ambulance diversion may be effective at limiting time on divert status, without correcting overall hospital throughput these protocols may have a negative effect on ED crowding and the EMS system. Ambulance offload delay, the time it takes to transfer a patient to an ED stretcher and for the ED staff to assume the responsibility of the care of the patient, may have more impact on ambulance turnaround time than ambulance diversion. EMS administrators and medical directors should work with hospital administrators, ED staff, and ED administrators to improve the overall efficiency of the system, focusing on the time it takes to get ambulances back into service, and therefore must monitor and address both ambulance diversions and ambulance offload delay. This paper is the resource document for the National Association of EMS Physicians position statement on ambulance diversion and ED offload time.     

中山市群体性突发事件流行病学特点与应急医疗救援的研究

目的:从事件中找出特点和趋势,探讨应急医疗救援策略,为紧急医疗救援体系建设、提高应急反应能力和医疗救援品质提供科学依据.方法:从中山市急救中心调度信息数据库中提取2006~2010年间发生3人(含3人)以上伤亡的3474起群体性突发事件资料,总结分析其流行病特点和应急处置情况.结果:中山市发生群体性突发事件呈逐年上升趋势,突发事故类型依次是交通事故、外伤、火灾;交通事故和外伤事件有逐年增加趋势,食物中毒呈下降趋势.人员伤亡主要集中在21~50岁的年龄段;事故发生高峰在晚上18:00~凌晨2:00;平均反应时间(从呼叫受理至急救车到达事发现场的时间)由2006年的12.4 min缩短到2010年的11.6min;救治结果:显效6490例(52.83%),有效4738例(38.57%),无变化870例(7.080/0),恶化187例(1.52%),总有效率为91.4%.结论:建立健全的院前急救系统、合理布局急救站点、规范现场处置工作、加强120系统内外联动的协作配合、完善预案并加强演练和普及急救知识是降低突发群体伤亡事件病死率和伤残率的主要措施.     

急性心肌梗死患者急救医疗服务使用状况及影响因素分析

目的探讨影响急性心肌梗死患者选择急救医疗服务的因素及性别对选择急救医疗服务的影响。方法选择2008年1～11月上海三家三甲医院250例AMI患者,使用汉化版"急性心肌梗死患者就医行为调查问卷"进行调查研究。结果有30.8%的患者应用EMS到达医院,男性和以前用过救护车的患者更易使用EMS,多元Logistic回归分析显示:自认为症状严重、疼痛严重、以前用过救护车是患者应用EMS的预测变量,而他人催促来院、之前有相似症状和身为女性是不应用EMS的预测因子。结论 AMI患者EMS使用率低,男性比女性更倾向于选择使用EMS,EMS效率有待提高。     

Resource reallocation in an emergency medical service system using computer simulation

Emergency medical service (EMS) policy makers must seek to achieve maximum effectiveness with finite resources. This research establishes an EMS computer simulation model using eM-Plant software. The simulation model is based on Taipei city's EMS system with input data from prehospital care records from December 2000; it manipulates resource allocation levels and rates of idle errands. Presently, EMS ambulance utilization is about 8.78%. On average, 20.89 minutes are required to transport a patient to the hospital. Computer simulations showed that reducing the number of ambulances to one at each of the 36 response units increases the utilization rate to 15.47% but does not compromise the current service quality level. Thus, ambulance utilization improves, times of patients waiting for pre-hospital care and arrival at hospitals are only slightly affected, and considerable cost savings result. This study provides a research methodology and suggests specific policy directions for resource allocation in EMS. Limiting the number of ambulances to one per response unit reduces costs, increases efficiency, and yet maintains the same operational pattern of medical service.     

急救护理流程在高速公路患者救护中的应用

目的：探讨急救护理流程在高速公路交通事故伤员救护中的应用效果。方法将本院2009年1月-2010年1月实施高速公路救护护理流程前180例患者作为对照组,将2010年3月-2011年3月实施高速公路救护护理流程200例患者作为观察组,比较两组救护车开出时间、到达现场时间、现场抢救时间、到达医院时间和抢救成功率。结果观察组救护车开出时间、到达现场时间、现场抢救时间、到达医院时间分别为（1．33±0．35）,（6．74±1．78）,（6．25±3．61）,（28．61±6．03）min,均低于对照组的（2．62±0．64）,（9．34±2．62）,（13．50±8．27）,（43．10±7．36）min,差异均有统计学意义（t 分别为2．63,8．18,2．51,4．84;P＜0．01）。观察组除10例因现场抢救无效死亡,2例手术后5 d死亡,其余均治愈、愈合出院,抢救成功率为91．5％,与对照组的85．6％比较,差异有统计学意义（χ2＝3．91,P＜0．05）。结论护理流程在高速公路救护中有助于快速到达现场和缩短现场抢救时间,提高抢救成功率,在高速救护中有较高的实用性和可操作性。     

患者与院前急救服务伦理冲突的调查分析

目的 了解院前患者与救护人员判断及急救网络管理制度的冲突情况.方法 采用〈院前急救中遇到伦理学问题调查表〉,对全市80家急救网络医院从事院前急救工作的80名医生和248名护士进行问卷调查,调查患者与院前急救服务伦理冲突的情况.结果 328份问卷中,认为需要救护的患者中完全拒绝的患者占（8.046±6.990）%,部分拒绝的占（14.544±10.558）%;需要救护车转运的患者中拒绝的占（14.451±14.747）%;拒绝救护和转运的原因中付费问题占（23.52±19.79）%.认为自己不需要占（22.22±20.84）%,自己想死占（5.77±4.47）%,难以判断占（19.44±18.65）%,其他原因占（30.08±25.78）%;（20.31±16.66）%的患者拒绝救护人员判断其处于某种状态;得到救护车服务的患者中（29.66±24.02）%的患者认为无出车必要;（22.11＋19.52）%患者的要求与院前急救服务管理的规定有冲突.结论 院前患者与院前急救服务伦理存在一定程度上的冲突.     

Child and Provider Restraints in Ambulances: Knowledge, Opinions, and Behaviors of Emergency Medical Services Providers

Background: Approximately 16,000 children are transported by ambulances each day, and there are an estimated 4,500 ambulance crashes each year. Information about emergency medical services (EMS) provider knowledge, opinions, and behaviors regarding occupant restraint is lacking. Objectives: To measure the knowledge, opinions, and behaviors of EMS personnel regarding child and provider restraint use in ambulances. Methods: A survey was given to all EMS providers in two large ambulance‐service organizations and in a hospital‐based pediatric ambulance service in a midsized urban area. Results: A total of 302 EMS providers were surveyed, for a return rate of 67.7%. Nearly half were involved in an ambulance crash at least once; of those, 7.6% were injured and 1% had patients in their care injured. The majority (91%) reported some training in child‐restraint use in ambulances, and half reported that they know a lot or very much about securing a critically ill child for transport. However, 30% did not identify the correct method of transport for a stable 2‐year‐old, and 40% did not choose the correct method of securing a child seat to the ambulance cot. Securing a child seat to the cot was viewed by 81% to not take too much time from patient care, and 63% did not view caring for a child in a car seat as difficult. Although 80% of providers regularly transported children in a car seat, 23% transported them on an adult's lap at least sometimes. Specialized pediatric‐transport providers were more likely to report safe pediatric and occupant restraint practices than were community EMS providers. Pediatric restraint behaviors were not associated with years of service or history of a crash. Two thirds of respondents reported not wearing their seatbelt on the squad bench while treating patients, and half believe that wearing a seatbelt interferes with patient care. A total of 95% report wearing seatbelts in the front seat of the ambulance. Provider seatbelt use in the patient compartment was not associated with years of service, with number of crashes, or with reporting correct use of pediatric restraints. Conclusions: This study indicates that the frequency of crashes in ambulances, and therefore the potential for injury, may be underappreciated. Current restraint practices of some of the study group are outside recommendations and may be placing at risk some children who are being transported by ambulances. This problem is complicated by the relative infrequency of pediatric ambulance transports compared with adults. Improved equipment and education may help providers safely transport pediatric patients. In addition, providers are risking their own safety by not wearing seatbelts in the rear ambulance compartment. Improved equipment may help alleviate this risk and allow providers to take care of patients safely.