Major incidents

A major incident is one that causes casualties on a scale beyond the usual capabilities of the emergency and healthcare services usual ability to manage. Major incident planning and rehearsal is vital to ensuring an appropriate response. Delivery of a major incident response requires command and co-ordination within and between emergency services, hospitals and specialist charitable organizations. Casualty management will require the set up of major incident infrastructure on scene to effectively extricate, triage, treat and transport casualties to appropriate facilities. There is a role for specialist doctors within the pre-hospital phase of managing a major incident, either within the ambulance command structure or operationally. Debrief and reviewing previous major incidents may identify individual, local and systemic factors that could be altered to improve the response to a future incident.     

以军事斗争卫勤准备为牵引 努力提高海上医疗救护能力

作者总结了医院开展海上卫勤战备训练的做法，在针对海上医疗救护的使命任务不断增强做好卫勤准备的责任感，紧扣海上医疗救护平台的特殊要求努力提高医院船医疗队救治能力，突破海上医疗救护技术的瓶颈制约积极开展海战伤救治技术及应用研究等方面，取得了明显效果。     

湖南省洞庭湖水域洪灾区人群潜在寿命、工作、价值损失年数分析

目的 了解洪灾对人群健康和价值的损害程度。方法 应用标化死亡率和潜在寿命损失年数(WYPLL)、潜在工作损失年数(VYPLL)、潜在价值损失年数(VYPLL)对湖南省洞庭湖水域部分洪灾区人群1995—1999年的死亡情况进行分析。结果 灾区与非灾区两人群死因顺位一致，但损伤、中毒和肿瘤死因的死亡专率，灾区显著高于非灾区。在死因构成中损伤、中毒死亡居第三位，肿瘤居第四位；但在YPLL、WYPLL分析中则跃居第一位和第二位。两人群各年龄段的YPLL、WYPLL、VYPLL分析显示灾区人群40—59岁的各种死亡损失均高于非灾区。结论 降低洪灾区人群损伤、中毒和肿瘤死亡率和重视40—59岁年龄段人群劳动力的保护有重要的社会和经济意义。     

"11.24"海难援救军人的心理健康状况分析

目的 探讨海难后军队应激援救人员的心理健康特点，为建立特定人群的心理健康评定体系提供科学依据。方法 采用症状自评量表和自行编制的调查表对39名1999－11－24烟台“大禹”海难1mo后的善后援救军人进行了心理健康测试，并将调查结果与对照军人和国内军人常模进行了比较。结果 接受调查的应激人群的SCL－90总分79.5%（31／39）的人评定为正常，总分≥160分为8例，占20.5%。SCL－90总分、射体化、焦虑、恐怖与精神病性因子与国内军人常模比较无显差异，但阳性项目数、强迫症状、人际敏感、抑郁、敌对及偏执因子分均显低于国内军人常模（P＜0.05-0.01）；而阳性症状均分显高于国内军人常模（P＜0.05）。应激人群的阳性项目数明显低于对照人群，而阳性症状的痛苦水平明显高于对照人群（P＜0.01）；阳性症状均分仍显高于对照人群（P＜0.05）。结论 提示受调查的应激人群的阳性症状均分显高于国内军人常模，改善婚姻状况和与同胸关系、完善上级领导工作方法和善后处理可以改善SCL－90结果，减少生活事件的刺激量可望改善其心理健康状况。     

An Empirical Evaluation of Eye Movement Desensitization and Reprocessing (EMDR) with Survivors of a Natural Disaster

Controlled studies of treatments effective with victims of natural disasters are almost nonexistent. This is a small study conducted under difficult conditions to test the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in treating trauma related reactions following Hurricane Andrew. The results were positive in that EMDR produced significant improvement over wail list controls in perceived posttraumatic avoidance behaviors and thoughts as measured by changes in the Impact of Event Scale and significant improvement in subjective aversive reactions to representative experiences of the hurricane. These results suggest and support other studies that EMDR can be an effective therapeutic intervention for trauma reactions.     

城市医疗救治体系在应对公共卫生事件中的管理实践与思考

医疗救治体系是公共卫生体系建设的重要组成部分 ,建立和完善医疗救治体系对于提高收治率、降低病死率 ,缓解公共卫生危机具有直接而关键的作用。该文总结回顾了上海在防治SARS期间医疗救治工作的组织与管理 ,简要介绍了上海构建突发公共卫生事件医疗救治体系的基本思路     

阿尔及利亚地震灾后中国危重伤员远程空中转运

目的 总结紧急远程航空医疗运送的经验，分析影响空运的多种因素。方法 通过2003年5月阿尔及利亚地震灾后，中方5名危重伤员的航空转运的实践，就转运计划、医务人员和医疗设备的配置、空中监护、心理干预等对远程航空医疗运送的作用和影响进行分析和总结。结果 5名危重伤员均安全转运至目的地。结论 制订周密的转运计划和进行细致的安排是成功转运的重要条件；灾害伤员的心理干预对安全转运有着特殊意义。     

Posttraumatic stress reactions after single and double trauma

This study evaluated the severity and symptom profile of posttraumatic stress reactions of 202 adults exposed in 1988 to political violence in Azerbaijan and/or the earthquake in Armenia. High rates of severe posttraumatic stress reactions were found among the most highly exposed individuals, irrespective of the type of trauma. There was no difference in symptom profile for subjects exposed to earthquake versus violence. These similarities in severity and symptom profile may be attributable to common features of the exposures, which included experiencing life-threat and witnessing injury, mutilation and death. Recent prior exposure to violence contributed to the severity of reaction to the earthquake. The high rates of chronic and severe posttraumatic stress reactions in Armenia constitute a major public mental health problem.     

移动医院的创建及其在国际救援中的应用

2004年底苏门答腊岛近海发生9级地震和人类历史上最严重的海啸,中国参加了国际救援活动.中国国际救援队创建了移动医院,在亚齐省班达亚齐市实施救援.移动医院的编制为26名医务人员,下分指挥组、分类检伤组、现场救治组、外科救治组、内科救治组、医技组、留观后送组.展开后占地约200平方米.开展了巡诊、院内救治、卫生防疫、灾后医院重建,及培训灾区当地医务人员等工作.总结出如下经验:应加强战役后方,应将所有信息数字化,培训复合型人才十分重要.移动医院是救援队实施救援的重要手段和有效方式,尤其在重大灾害中抢救危重伤员时可发挥重要作用.