院前急救型的天津市急救中心

2005 年投入使用的天津市急救中心是2003 年抗击"非典"后全国建成的首家省级急救中心,它属于院前急救型运行模式.如何建设院前急救型急救中心?建筑设计有哪些特点?需要注意哪些方面呢?我们结合天津市急救中心6 年来的运行情况进行总结.     

从思想政治工作入手加强院前急救职业道德建设

针对全国院前急救工作中仍存在垄断或独家服务,不顾患者利益＂舍近求远＂收取＂好处费＂转送病人等百姓反映强烈、影响大、违背职业道德的表现,提出在加强院前职业道德建设方面,应考虑从思想政治工作入手,抓创新理念的教育,明确职责抓重点,建章健制抓制度,监督管理抓实效,提高对职业道德建设的认识,努力提高院前急救人员道德修养水平,不断开创院前急救工作新局面。     

公立医院实施激励体系的分析与探索——基于医院知识型员工心理契约的构建

医院是知识型员工高度聚集的组织.知识型员工作为一类特殊的群体,在个人特质、心理需要及价值观念等方面表现出特殊性.研究医院知识型员工的特殊需要,并运用心理契约来设法满足他们的这些需要,能极大地调动其积极性,激发其创造力,从而增强医院的竞争优势.本文分析了公立医院里知识型员工的特征和需要,阐述医院知识型员工的特点,提出基于心理契约的医院激励机制的构建方法.     

中国院前急救发展中的问题与对策

迎战“非典”疫情,对中国院前急救事业是一个严峻的考验,同时也带来了发人深省的机遇。迎战“非典”的实践表明,面对大面积公共卫生突发事件及意外灾害事故的救援需要,中国院前急救战线表现出了自己的战斗力,同时也暴露出在发展模式、网络建设、质量装备、标准建设、处置突发公共卫生事业的应急能力及与社保体系的衔接等方面,都还有大量亟待完善和发展的地方。同时,面对现代世界医疗急救事业快速发展的形势和人民群众不断提高的医疗健康需要以及应对公共卫生突发事件,我们必须加快步伐,切实解决好这些问题。1中国院前急救事业进一步发展亟待…     

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。     

论质控管理在紧急医疗救援中的作用

随着社会经济的快速发展,人民物质及文化水平的提高,人们对紧急医疗救援和日常急救医疗服务质量的需求就越高.急救中心如何满足百姓的需求,如何质控考核职工为院前急救病人提供文明、优质、快捷、满意的医疗服务是本文研究探讨的课题.院前急救是集通讯、医疗、转送为一体,以维持病人生命、减轻病人痛苦、防止病人病情加重,为院内急救创造条件为目的的医疗急救服务体系.建立和完善运转有效的紧急医疗救援质控管理考核机制,对提高院前急救医疗服务质量,避免医疗不良事件的发生至关重要.笔者从工作实践中对紧急医疗救援全程医疗服务质量进行了质控考核的探讨已取得了初步成效.     

我国八个大中城市院前急救流行病学调查分析

Objective To investigate the epidemiological information of patients in pre-hospital medical care for our large and medium-sized cities and probe the patients' characteristic. Method The data in 2008 were exported from the computer databases of 8 large and medium-sized cities' emergency medical centers in our country.The thorough records of data were conducted to statistical analysis. Results ( 1 ) The scheduling time, running time, rescue time, returning time, total time and service radius in the pre-hospital medical care group were 2.16± 1.10(min), 14.01 ±6.82(min), 12.12±5.96(min), 14.08± 6.85(min), 42.34± 20.21(min)and 8.50±4.18(km), and the above parameter in the non-death group were 2.19 ± 1.13(min), 14.15 ± 7.14(min),11.60±6.72(min), 14.92 ±6.89(min), 41.86± 19.53(minutes) and 8.63±4.31(Km), and the above parameter in the death group were 2.10± 1.08(min), 13.68 ± 7.14(min), 25.25 ± 12.34(min), 13.75±6.48(min), 54.74 ± 25.47(min) and 7.86± 3.91(Km), and the above parameter in the non-sudden cardiac death group were2.09± 1.03(min), 13.58±6.78(min), 25.53± 12.34(min), 13.60± 6.54(min), 53.79±23.77(min) and 7.67 ± 3.86(Km), and the above parameter in the sudden cardiac death group were 2.12 ±1.02(min), 14.10±7.05(min), 24.79± 12.08(min), 13.79±6.61(min), 54. 80 ± 25. 36( min) and 7.90±3.92(Km) respectively. The scheduling time, running time, returning time and service radius in the death group were less than those of the non-death group, but the rescue time and total time of the former were more than those of the latter respectively ( P ＜ 0.05 or P ＜ 0. 001 ). The scheduling time and returning time didn' t have significant difference between the sudden cardiac death group and the non-sudden cardiac death group respectively ( P ＞ 0.05), but the running time, total time and service radius of the sudden cardiac death group were more than those of the non-sudden cardiac death group, and the rescue time of the former was less than that of the latter respectively ( P ＜ 0.05 or P ＜ 0.001 ). (2)The patients' amount in pre-hospital medical care group, the non-death group, the death group, the non-sudden cardiac death group and the sudden cardiac death group were at most in first quarter, and the least time slice of patients' amount were 4:00～ 6:00, 4:00～6:00, 4:00～ 6:00, 22:00～ 24:00, 2:00～4:00 respectively, and the most time slice of patients' amount were 20:00～ 22:00, 20:00～22:00, 8:00～ 10:00, 2:00 ～ 4:00, 8:00 ～ 10:00 respectively. (3)In 241 876 cases of pre-hospital medical care group, the patients' amount of trauma was at most, whose age grades was by far among21 ～50, and the others in sequence were nervous system, circulatory system, other group, digestive system, respiratory system and poisoning group respectively, whose age grades in nervous system, circulatory system and respiratory system was by far above 51, especially above 70. The patients' age grades in other group and digestive system had two climax age groups, which the one was 21 ～ 30, and the other was above 70. The patients' age grades in poisoning group was by far among 21 ～ 50, which the patients' amount of acute alcoholism was at the most. (4) In 12 568 cases of death group, the death amount of circulatory system, other group, respiratory system, nervous system and digestive system ranked at the lst,2nd,4th,5th 8th respectively, whose age grades was by far above 51, especially above 70,and the patients' amount of sudden cardiac death was at the most in the death amount of circulatory system. The death amount of trauma and poisoning group ranked at the 3rd, 6th respectively, whose age grades was by far among 21 ～ 50. (5)The total amount, the death amount and the sudden cardiac death amount of male patients were more than those of female patients. (6)The percentage of the death group to the pre-hospital medical care group was 5.20%, and the percentage of the sudden cardiac death group to the pre-hospital medical care group was 1.29%,and the percentage of the sudden cardiac death group to the death group was 24.87 %, and the percentage of the sudden cardiac death group to the circulatory system group was 67.33 %. Conclusions ( 1 )The trauma and the sudden cardiac death are the overriding reason of disease and the overriding reason of death in our large and medium-sized cities respectively. (2) It is very important to cut the death rate of the middle-old age patients by strengthening prevention and cure of cardiovascular and cerebrovascular diseases, discerning the critical illness early and improving the level of pre-hospital medical care. (3)It is a strong method to decrease the total amount and the death amount of the trauma, especially in traffic accident, by strengthening safety in production, observing traffic regulation and enhancing the legal awareness.     

我国大中城市院前心脏性猝死流行病学调查分析

目的调查我国大中城市院前心脏性猝死患者流行病学情况,探讨院前心脏性猝死病例特点。方法从我国8个大中城市急救中心系统数据库中导出2008年度全部死亡数据,就其有完整记录的资料进行统计分析。结果①院前心脏性猝死的调度时间、到达时间、现场时间、返回时间、总时间、急救半径分别为（2．12±1．02）min、（14．10±7．05）min、（24．79±12．08）min、（13．79±6．61）min、（54．80±25．36）min、7．90±3．92（km）;②院前心脏性猝死的病例数以第一季度为最多,且最多时间段是8：00～10：00,最少时间段是2：00～4：00;③男性院前心脏性猝死明显多于女性,但年龄明显小于女性;④院前心脏性猝死目击者CPR为4．48％,医护人员现场CPR成功率2．26％。结论①心脏性猝死已成为我国大中城市最常见的院前死亡原因;②加强心血管病防治,提高中老年患者的常见急危重症早期识别与院前急救水平以及普及公众CPR对降低死亡有重要意义。     

急救中心建设发展面临的形势和对策

在我国院外急救是急救医学的一个分支。急救中心经过近十几年的发展,院外急救从无到有,从小到大,取得了长足的进步和显著的成绩,院外急救医疗工作己经在医疗卫生体系中占有了一定的位置,发挥着不可替代的作用。笔者结合院外急救医学发展现状和天津市急救中心工作的体会,旨在探讨院外急救医学发展所面临的形势和对策。