灾害医疗救援中应急车辆的装备

介绍了灾害医疗救援的严峻形势,叙述了医疗救援运输工具的装备和改进是灾害救援的重要组成部分,指出了加强对车载救护设备和野战救援器材的装备和改造应从救援工作的实际需要出发,配备医疗应急通讯指挥车、医疗应急物资保障车及多患者转运越野救护车,以提高医疗救援的组织指挥和应急救援能力。     

重大灾害早期现场医疗救援探讨

通过对我国近几年地震灾害医疗救援的回顾,对重大灾害应急救援进行探讨.总结经验,避免失误,不断完善重大灾害应对,提高灾害医疗救援的能力.     

应急医疗救援与临床医学工程

目的：探索应急医疗救援的新模式和新方法,以提高应急医疗救援的保障水平、效率与质量。方法：分析应急医疗救援成功的条件与临床医学工程的学科特点,提出临床医学工程应用于医疗救援的方法。结果：将临床医学工程相关理论、技术和保障措施应用于某院参加的历次抗震救灾、其他自然灾害和人为灾害的医疗救援实践．均高质高效地完成了保障任务。结论：临床医学工程是医疗救援的重要理论和技术支持,在医疗救援的各个阶段,医学工程科的积极参与有助于高质高效地保障救援任务的完成。     

建立提高应急医疗救援后勤保障力的“三三”机制

本文提出并阐述了建立提高应急医疗救援后勤保障力的"三三"机制,即①建立应急医疗救援保障物品的"三实"配备机制:救援的实效性、功能的实用性和维护应用的实际性;②建立应急医疗救援出发前后勤物资保障的"三快"机制:确定后勤保障人员和物品的快速化、启动易供性物品购买通道的快捷化和完成应急医疗救援人员对物品点验工作的"快载化";③建立应急医疗救援后勤保障物品"三省"储用机制:资源共享,节省大型救援设备配置、使用、保养开支、合理设置,节省应急医疗救援物品仓储用地和爱护装备,节省应急医疗救援易损性物品经费开支。     

综合医院应对群发性灾害事故的策略

目的探讨医院在灾害事故应急救援中的策略。方法综合国内外有关研究和近年来发生的群发性灾害事故的处理实践,比较不同医院在院前救援、院内组织等方面的经验。结果有比较完善的抢救预案和灾害救护规程,在处理不同的群发性突发灾害事故时,有相关机构和人员能及时地针对事件的性质和需要制定有针对性的方案,其救护时效和绩效比较好;除了医疗救护外,在灾害发生后及时建立应急心理干预也已成为综合性医院治疗的主体之一。结论政府和医疗卫生部门应重视发展处理群发性灾害的能力,应建立合理的灾害事故应急救治体系,以保证应对突发事件的及时有效性;即使是综合性医院平时也应重视救援应急队伍的建设,及时更新急救医疗装备,使灾害事故的应对和救护原则更趋合理有效。     

建立区域医疗救援中心 提高突发事件应对能力

汶川大地震后,卫生部门将工作重心转移到区域医疗救援力量的建设,当前的工作重点是在全国分片区建立区域性的医疗救援中心,全面提高突发事件应对能力。文章简要概述国内外区域应急救援现状,阐述了我院作为广东省应急医院在探索广东省紧急医疗救援中心建设中取得的成效,针对性地提出几点建立区域医疗救援中心的建议。     

日本应急医疗救援体系建设的基本做法和理念

世界各地不断发生的各类突发公共事件,考验着各国政府和人民的智慧。如何正确认识、研究和预防各种突发公共事件,提高应急医学救援能力,是世界各国政府必须面对和攻克的共同课题。笔者就日本应急管理中应急医疗救援体系建设的做法和理念进行讨论,浅谈我国在应急医疗救援体系中存在的问题,为完善我国应急医疗救援体系的建设与发展提供可借鉴的资料和实践经验。     

基于抗震救灾医疗救援的军队医院应急准备

以汶川地区“5·12”特大地震救援实践为引导，探讨抗震救灾医疗救援应急准备的特点和规律，指出有哥对性的做好应急准备是出色完成抗震救灾医疗救援任务的前提，应以提高救援效能为目标，以坚持统筹兼顾为原则，扎实推进抗震救灾医疗救援的各项准备工作，确保随时处于优良的应急准备状态，做到一声令下，迅即行动，准确施救、高效保障。     

区域性核事故应急医学救援能力问题与对策研究

医疗机构是区域性核事故应急医学救援的中坚力量,提高医院的核应急救援能力,是医学救援行动及时、高效实施的关键。为了更好提升区域核事故应急医学救援能力,从核事故应急管理、队伍建设、医学救援条件和救援经历等方面阐述了医疗机构核事故应急医学救援能力的现状,对组织管理能力、快速反应能力、救援技术能力、救援保障能力等方面存在的问题进行了深入分析,在救援预案制定、应急医学响应系统建立、救援队伍的专业救治能力建设、核安全意识宣教、培训及现场演练开展、应急救援物资保障等六个方面提出了相应的对策建议。     

应急医疗救援背景下军队医护人员体能储备

聚焦频繁高发的应急医疗救援任务,梳理军队医护人员在医疗救援中"三高一长一混乱"的工作特点,即高难度、高危险、高感染、工作持时间长、工作环境混乱,分析其体能需求.通过构建组织管理、训练内容、方法手段、考核评价体系,进行专项体能储备,以期提高医护人员完成应急医疗救援任务的能力,进而提升救援的质量和效率.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.