维和医疗应急救治体系的建立

赴苏丹维和医疗队根据维和任务区医疗应急救治的难点、特点,建立了以组织指挥网络为主干,伤情信息收集系统为基础,整合医疗救治资源,全方位动员救援力量,启用紧急用血动员机制,广泛普及急救知识为内容的医疗应急救治体系,确保了维和医疗保障任务的顺利完成。     

以"三环理论"为指导建设我国急诊医疗服务体系

“三环理论”系指急诊医疗服务体系中的3个重要环节，即院前急救体系、院内急诊体系和重症监护治疗体系。我国急诊医疗服务体系建设应以“三环理论”为指导，建立务实、高效的急诊医疗制度体系，迅即监护型的转运系统，顺畅、实时的信息系统，合理、长效的法律与预案体系和复合型人才培养体系，构建医院急诊绿色生命通道。     

我国院前急救医疗体系中存在的问题及立法的必要性

我国院前急救医疗体系中尚存在急救组织性质与管理体制不明确、急救网络缺乏统一规划、急救模式混乱、急救系统缺乏统一指挥调度、院前急救机构与人员缺乏统一的资质要求、院前急救与院内的衔接机制不明确、对急救对象缺乏分类管理、公民的急救责任和义务没有明确规定等同题，影响到急救医疗服务功能的发挥，必须以法规的方式予以规范。发达国家和国内部分城市的急救立法经验值得借鉴。通过制定国家和地方层面的急救医疗法规体系，规范急救医疗服务行为，实现我国急救医疗服务的法制化管理。     

Monitoring Prehospital Stroke Care in Utah to Assess the Feasibility of Using EMS Data for Surveillance

Many states are developing data systems that use the data elements from the National Emergency Medical Services Information System (NEMSIS) to monitor prehospital stroke care. To explore the feasibility of using emergency medical services data to monitor prehospital stroke care in Utah, the Heart Disease and Stroke Prevention Program and the state emergency medical services agency identified variables that could potentially be used to describe prehospital stroke care and explored the actual data from the first 16 months since inception of a system compatible with NEMSIS. We were able to develop a case definition for possible stroke and to describe modes of response, response times, destination hospitals, and stroke screening practices. Although not all emergency medical services agencies in Utah used the system and the data were not always complete for each stroke case, it was feasible to design a basic surveillance system for prehospital stroke care by using the data.     

急救室工作站的设计与开发

针对目前急救室医疗信息化程度低的问题,结合急救室工作的特殊性,设计并开发成功急救室工作站信息系统。其功能有病人出入科管理,医嘱、病程文档及费用管理等,实现医嘱自动计价、各类处置单自动生成。系统的应用对推动急诊医疗管理的信息化建设、提高急诊室救治及管理水平有积极意义。     

论我国紧急医疗卫生救援立法——5.12地震的启示

紧急医疗卫生救援制度是在紧急状态下为公民提供医疗卫生服务的卫生法律制度。"5·12"地震的发生暴露出我国现行紧急医疗卫生救援制度还存在法治化程度低、费用保障不明确等问题。健全和完善紧急医疗卫生救援立法是我国应对大规模自然灾害、重大突发事件以及平时提供急救医疗服务的必然选择。     

北京市医药分开综合改革对门急诊患者就医流向的影响研究

目的:评价北京市医药分开综合改革的实施对于门急诊患者就医流向的影响。方法:对北京市卫计委信息中心收集的2016年1月—2017年10月的各级医疗机构门急诊就诊人次数据的变化趋势进行分析,并采用间断时间序列分析(Interrupted Time Series,ITS)方法分析北京市医药分开综合改革对其影响。结果:2017年4—10月,三级医院平均每家医疗机构门急诊人次同比下降12.11%;二级医院平均每家医疗机构门急诊人次同比下降2.10%;基层医疗卫生机构平均每家机构门急诊人次同比上升11.49%。结论:北京市医药分开综合改革通过医事服务费的调整和基层用药目录与三级医院对接等主要措施,使得门急诊患者就诊流向发生明显变化,长期下去需要引起注意的是基层是否有动力接收病人,以及能否接住病人的问题。     

南非公立医院改革的主要做法与特点

相对于私立医院占有五分之三的卫生支出为20%的人群提供服务,南非公立医院约使用五分之二的卫生支出,为南非80%的人群提供医疗卫生服务,但面临着资源不足和人力短缺的问题。为此,南非政府着重建立公平导向的卫生管理体制,加大政府财政投入,重点保障基层公立医院发展,探索公私合作,在优先保障弱势人群基本医疗服务的同时,动员可利用的所有医疗资源,着力保障居民公平地获得基本医疗卫生服务。改革的主要特点是建立以基本医疗卫生保健为基础的医疗管理体制,以更公平的方式分配医疗资源,建立公私合作机制,动员民营机构力量,优先保障居民对基本医疗卫生服务的可及性和公平性。这些经验对于同属于发展中国家的中国有良好启示。     

军队医院参加突发事件应急医学救援体会

军队医院以其快速的机动能力、扎实的战备基础与全面的专业素质,日益成为国家应急医学救援力量的重要组成部分。其主要参与形式有抽组机动卫勤力量、集中收治伤病员和接收支援医学救援力量三种。应根据突发事件应急医学救援特点,结合军队医院自身实力与所处环境特征,从制定卫生应急准备预案、组织应急医学救援训练、建立军地协作机制、加强自身保障水平等方面提高应急医学救援能力。     

大学校医院急诊医学建设的实践与思考

急诊医学是一门新兴的跨专业学科。随着我国急诊医疗体系（emergenuy medical service system,简称EMSS）和社区医疗服务制度的逐步建立和完善,校医院作为高校社区医疗卫生服务中心,在社会急救网络中是不可忽视的急救单位。本文就校医院如何转变观念,发挥在急诊急救中的作用,加强急诊科建设和医院急救体系建设,从实战出发,加强对医护人员的技术培训,加强组织管理,畅通生命绿色通道等方面进行了探讨。     

The decline of ischemic heart disease mortality in Texas

This is a study of the decline of ischemic heart disease (IHD) mortality in the State ofTexas, from 1970 to 1977. The data were collected and analyzed at three different levels: state, health service area (HSA), and county. The study was designed to test hypotheses pertaining to the role of the medical care system as a possible factor associated with the changing IHD mortality trends. The results suggest that factors such as emergency medical services (EMS), intensive care units (ICU) and coronary care units (CCUs) in hospitals, intensive care and coronary care beds and medical specialists are associated with the observed decline in heart disease mortality in Texas.     

军队医院应急医学救援模块化编组研究

依据应急医学救援工作的特殊性,按照不同应急医学救援任务抽组、组合不同医学救援模块,进行应急医学救援力量的模块化编组是提高军队医院以一种体系、应对多种任务能力的较好方法。本文对军队医院应急医学救援的模块化编组可行性与方法进行探讨。     

Well-being revisited: improving the health of a population

Changes in society and the healthcare system are challenging healthcare executives to do more than provide medical services. Leaders now take broader responsibility for the health and well-being of the people and communities they serve. Health--the "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (World Health Organization 1944)--is determined by four forces: environment, heredity, lifestyle, and medical care services. Health-care managers who want to improve the health of their served populations must improve these forces. Strategic and operational lessons can be learned from the pioneering work done by several hospitals, health plans, and healthcare systems to improve their local environment, heredity, lifestyles, and medical care services. Managers who wish to improve health in their communities should strongly embrace and commit to "health" rather than mere "medical services" in their mission, vision, and values. They should collaborate with many other organizations and people--such as schools, churches, police, and businesses--to build partnerships that extend beyond the healthcare sector into the total community. Healthcare organizations should provide some resources and funds to improve the health of their served populations, and they should view this commitment as an investment (especially if there are capitated lives) rather than as an expense. They should also obtain public and private grant funds and leverage the resources of their collaborative partners to improve their local environment, heredity, lifestyles, and medical care services. Finally, leaders can advocate and support public policy that would improve the four forces that shape health.     

家庭急救监护网络系统的研究与设计

目的：分析了远程监护的发展与研究现状,提出构建家庭急救监护网络系统的研究。方法：该系统由家庭部分、救护车部分、社区部分和医院中心站4部分组成,并以深圳宝安人民医院和其所辖的10个社康站作为研究基地,对患者的重要生理参数实行远程监护。结果：构成了功能强大的家庭急救监护网络系统,将急救监护功能延伸到社区和家庭。结论：能够促进疾病的早诊早治,减少院前猝死率,提高急救水平,降低死亡率,加强医疗服务体系间的联系、合作,缓解了医疗卫生资源的缺乏和分布不均。     

重大地震灾害救援中医疗急救力量的部署需求分析

目的 通过建立重大地震灾害救援中医疗急救力量的部署需求模型,在灾害救援初期灾情信息缺失的条件下,提供合理的人员抽组和力量编成策略,进而提升重大灾害应急医疗救援效率。方法 基于中国知网（CNKI）数据库中收录的相关文献,采用文本信息挖掘算法获取“地震灾害救援”与“医疗急救力量”之间的关联系数,构建医疗急救力量部署的各级指标,利用层次分析法建立各级指标的判断矩阵;通过计算指标间的综合权重,建立力量部署需求度的量化评估模型。结果 构建了医疗急救力量部署的3个一级指标和9个二级指标及其权重,具体如下：（1）现场急救（权重40.54%）,其二级指标：伤员搜寻（权重27.14%）,检伤分类（权重9.84%）,紧急处理（权重3.57%）;(2)早期救治（权重11.40%）,其二级指标：现场手术（权重8.86%）,医技保障（权重1.27%）,医疗留治（权重1.27%）;(3)医疗后送（权重48.06%）,其二级指标：急救车辆（权重11.66%）,直升机救援（权重32.17%）,卫生列车（权重4.23%）。结论 直升机救援、伤员搜寻和急救车辆是重大地震灾害救援中医疗急救力量部署的重要组成。基于文献数据库...     

Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation.

As part of an evaluation of whether the addition of paramedic services can reduce mortality from out-of-hospital cardiac arrest compared to previously existing emergency medical technician (EMT) services, factors associated with successful resuscitation were studied. A surveillance system was established to identify cardiac arrest patients receiving emergency care and to collect pertinent information associated with the resuscitation. Outcomes (death, admission, and discharge) were compared in two areas with different types of prehospital emergency care (basic emergency medical technician services vs. paramedic services). During the period April 1976 through August 1977, 604 patients with out-of-hospital cardiac arrest received emergency resuscitation. Eighty-one per cent of these episodes were attributed to primary heart disease. Considered separately, four factors were found to have a significant association with higher admission and discharge rates :1) paramedic service, 2) rapid time to initiation of cardiopulmonary resuscitation (CPR), 3) rapid time to definitive care, and 4) bystander-initiated CPR. Using multivariate analysis, rapid time to initiation of CPA and rapid time to definitive care were most predictive of admission and discharge. Age was also weakly predictive of discharge. These findings suggest that if reduction in mortality is to be maximized, cardiac arrest patients must have CPR initiated within four minutes and definitive care provided within ten minutes.     

北京某医院2007 —2008年急诊患者就诊及付费行为模式分析

目的 分析急诊患者就诊及付费行为模式。方法 定义内急诊就诊流程,计算急诊挂号人次数分布情况等。结果 医院急诊量大,患者缴费次数多。结论 预交金付费模式是改变传统就诊模式、优化医疗服务流程、减少患者排队拥堵现象的可行措施。     

Planning for emergency medical services in Boston.

The results of a survey of 10,200 visits to 11 Boston hospital emergency rooms during a 9-day period in March 1972 are presented. The survey was designed to provide data on emergency room use to permit more informed planning by public agencies concerned with improving areawide emergency medical services. The 11 institutions surveyed provided virtually all of the emergency medical services in the city of Boston. A majority are teaching hospitals affiliated with one or more of the three medical schools in the area. Of the 11 hospitals, 3 accounted for 60% of all emergency room visits. Survey data were extracted from emergency room log sheets and hospital medical records of individual patients. Information collected included the residence pattern of patients within the geographic area, the patient mix by degree of urgency based on presenting complaints, mode of transportation to the hospital, and age and sex of the patients. Only 15 percent of the 10,200 visits were true emergencies. Fifty-seven percent were classified as urgant and 28% nonurgent. The mix among the 11 hospitals ranged from 7 to 22 percent in the emergency category, and 11 to 61 percent in the nonurgent classification. Trauma accounted for 19 percent of all admissions, with 3 percent attributed to fractures and 4 percent to head injuries. Fifty-six percent of the emergency cases required the services of an internist or pediatrician, 38 percent a surgeon, and 1 percent an obstetrician. The highest utilization rate--27 per 1,000 population--was recorded for the under 5 age group. Although the 65 and older age group had the lowest utilization rate of 6 per 1,000, this group had the highest rate of visits classified as emergencies. Children under 5 accounted for the highest proportion of nonurgent visits. The survey revealed that 30 percent of all hospital admissions were from the emergency room. One in four emergency patients lived outside the city of Boston. A neighborhood health center and a hospital general practice unit reduced hospital emergency room workloads appreciably, even when they were open only during daytime hours. Eighty-eight percent of all patients arranged for their own transportation, usually by private automobile. Of those arriving by ambulance, only 35 percent were classified as emergencies. The survey data reinforce the conclusion that major planning efforts should be concentrated on the management of the nonemergency patient. The data also emphasize the need for a single agency to be responsible for overall planning for emergency medical services on an area wide basis.     

近3年国庆假日前后急诊流行病学的特征

目的了解国庆假日前后急诊流行病学特征，指导假期的急诊医疗服务工作。方法对2002年国庆假日期间(10月1—7日)及前后各1周的急诊患者进行调查，并且与近3年国庆假日急诊人次进行比较。结果近3年国庆假日急诊人次呈逐年下降，但同期收住院和收观察室人次反而增多。2002年国庆假日期间急诊人次、收住院和收观察室人次比节前和节后明显增加，其中儿科急诊人次增加最明显，但急诊人次最多是内科。结论：针对假日高危人群，做好卫生宣教预防工作；要加强急诊医疗服务体系建设，为假日经济发展提供有力保障。     

Survival of the hospital emergency department: strategic alternatives for the future

Diverse and pervasive environmental forces are reshaping hospital emergency services as hospitals strive to respond to consumer preferences related to cost and convenience. Complacency can no longer serve as a standard operating procedure for hospital emergency departments competing against lower-priced, consumer-oriented, free-standing facilities. Strategic alternatives, a five-step strategy for survival and growth, and a projection of future models of hospital emergency services are examined.