方舱式机动医疗系统超压集体防护的技术研究

目的：建立一种方舱式机动医疗系统对大气环境中有毒有害生物、化学及放射性物质超压防护的技术体系。方法：按照监测预警、报警控制、滤毒净化、建立超压、超压监测5个控制环节进行设计，采用中央集中监测与报警控制、各分布式舱室终端同时动作响应的工作模式实现超压集体防护。结果：该防护系统能对大气环境中的有毒有害物质监测预警，能使单舱和系统各舱连接使用时分别建立并保持300Pa和130Pa以上的超压防护，并能实时监测各舱内的超压状态。结论：方舱式机动医疗系统的超压集体防护系统能对大气环境中的有毒有害物质实施有效防护。     

一种正压生物防护服细菌气溶胶防护效果的研究

目的研究某种正压生物防护服对生物气溶胶的防护效果。方法采用人工发生黏质沙雷茵气溶胶,用Andersen6级采样器采样,对该正压生物防护服对细菌气溶胶的防护效果进行了检测。结果与结论该正压生物防护服对暴露于颗粒质量中值直径约1．674μm的细菌气溶胶粒子防护效率达到99．90％以上。该正压生物防护服通过高效过滤系统为防护服内提供洁净空气,对细菌气溶胶有较好的防护效果。     

重症监护型救护车空气净化系统设计与防护效果评价

目的：研制一种重症监护型救护车空气净化系统,用于救护车伤病员室空气中悬浮微生物的过滤净化和消毒灭菌。方法综合 TiO2光触媒与高效空气过滤材料,设计一种救护车空气净化装置,通过光触媒实现对车厢内空气微生物的氧化分解,通过高效过滤器实现对空气尘埃粒子的高效过滤,测试空气洁净度和消毒效果对空气净化系统的作业效果进行评价。结果在空气净化系统正常运行状态下,救护车伤病员室内空气洁净度达到10万级,细菌菌落总数＜1 CFU ／（皿·15 min）,满足重症监护作业对车厢卫生学环境的要求。结论救护车空气净化系统能有效实现对救护车伤病员室空气的消毒灭菌和过滤净化,满足运送途中对伤病员实施紧急救治和重症监护等作业的需求。     

具有超压功能的手术舱室环境设计与仿真研究

目的:对手术舱室建立超压防护,按照夏、冬两季不同应用地区的气候环境设计手术舱室制冷与供热系统。方法:根据压力平衡下手术舱室漏气量与新风补充量相等的原理实现超压防护设计;根据手术舱室的冷热负荷设计空调与暖风系统的总体结构,运用计算流体动力学方法进行手术舱室内温度环境仿真。结果:手术舱能够保持300 Pa以上的超压防护;仿真结果表明制冷与供热系统的设计方案能够使手术舱室内温度保持在(25±3)℃,人体操作区的微风速在0.5 m/s以下。结论:手术舱室能够满足静止状态下的内部超压指标要求,以及医疗作业对手术舱室温度环境的总体要求。     

具有超压防护功能的机动手术舱室污染物运动扩散的仿真研究

目的:对具有超压防护功能的机动手术舱室污染物运动扩散进行仿真研究,通过空气过滤净化和气流组织设计等方式减少生化污染物的危害,为患者和医生提供安全的舱室环境.方法:应用计算流体动力学方法对具有超压防护功能的机动手术舱室污染物运动扩散进行了仿真研究,分析了在超压防护系统工作前后两种状态下,污染物在室内的运动扩散及其对舱室内人员的影响.结果:在外部气态污染物浓度为5 mg/L的条件下,超压防护系统工作前,在10 s时呼吸区污染物达到最大浓度0.21 mg/L;超压防护系统工作后,在125 s时呼吸区污染物最大浓度达到0.01 mg/L的安全阈值.在整个计算过程中,污染物最大浓时积为0.1 mg·min/L,最小浓时积为0.011 mg·min/L.结论:机动手术舱室超压防护系统可以有效地将其工作前扩散到室内的气态污染物进行稀释,使室内人员周围不产生局部高浓度区,减小污染物对室内人员的影响.     

医用外科口罩生物防护效果测试平台的建立和应用

目的:为评价医用外科口罩性能的优劣而建立医用外科口罩的生物气溶胶防护效果的测试方法.方法:选择适当微生物作为指示生物,进行气溶胶的发生、采样、培养,根据医用外科口罩细菌的过滤效率而检测其防护性能和安全性.结果与结论: 建立了针对医用外科口罩防护性能的生物学测试平台,在此基础上,依据YY0469-2004《医用外科口罩技术要求》,对多家的送检产品进行了检测,结果发现产品质量良莠不齐,产品的合格率并不高.这种测试平台针对医用外科口罩防护性能的优劣,统一了评价标准,筛选了合格产品,满足了对医用外科口罩防护性能和安全性的检测和评价.     

新疆尼勒克县荒漠草原生产性能与降雨量的关系研究

2017年至2020年,对新疆尼勒克县的荒漠草原进行地面监测,通过分析鲜草产量、草群平均高度、盖度3个生产性能指标,以及各生产性能指标与不同时期降雨量的相关性,探讨荒漠草原的生产性能与降雨量的关系.结果表明:鲜草产量和草群平均高度之间存在极显著正相关性,两者的年际变化基本一致,2017年显著高于其它3个年份,2018年和2019年相接近、差异不显著,2020年显著低于其它3个年份.盖度与鲜草产量、草群平均高度之间的相关性均不显著,4个年度间的盖度差异不显著.牧草生长季4月至7月的总降雨量对鲜草产量、草群平均高度的影响最大,存在显著正相关性,其它10组不同时期的降雨量与鲜草产量、草群平均高度之间的相关性均不显著.盖度与11组降雨量之间的相关性均不显著.     

美宝湿润烧伤膏治疗微创腋臭根治术后创面的疗效观察

目的:探讨美宝湿润烧伤膏治疗腋臭根治术后延期愈合创面的疗效.方法:将80例要求微创腋臭根治术的患者随机分为治疗组及对照组,各40例.治疗组在常规消毒创面后用美宝湿润烧伤膏外涂创面,对照组常规消毒创面后用碘伏湿纱布湿敷创面,两组均换药1次/天,至创面愈合.结果:实验组平均愈合时间为7.53天±2.12天,切口瘢痕平均高度0.6mm±0.08mm,切口痊愈35例,治愈率占87.5%;对照组平均愈合时间为12.24天±1.26天,切口瘢痕平均高度1.8mm±0.05mm,切口痊愈15例,治愈率占37.5%.经统计学处理,两组疗效差异具有显著性.结论:美宗湿润烧伤膏治疗腋臭根治术后延期愈合伤口疗效显著,可缩短创面愈合时间,并且使切口瘢痕不明显,实现了微创腋臭根治,值得临床推广应用.     

留置不同类型镍钛记忆合金气管支架的动物实验研究

目的 比较留置不同类型镍钛记忆合金气管支架后,实验犬的机体反应及气管增生情况,探讨不同气管支架植入的应用价值.方法 健康成年杂种犬18只,随机平均分为3组,气管内留置不同类型支架.①组:留置全覆膜支架(全长6cm覆膜);②组:留置中段覆膜支架(全长6cm,上下两端各1 cm不覆膜,覆膜长度4cm);③组:留置不覆膜支架(全长6cm).术后观察进食、呼吸情况,饲养24周后分别处死.观察大体气管标本和镜下改变,并行增殖细胞核抗原染色,定量分析增生细胞的阳性表达.结果 ①各组实验犬均未发生支架留置后的急性呼吸困难,有轻至中度咳,均可正常饮水、进食,发声无异常.部分犬活动减少.②支架不覆膜处,气管内壁组织增生较明显,气管腔狭窄程度大于支架覆膜处.③苏木素-伊红(HE)染色镜下均表现为炎性反应,低柱状上皮细胞鳞状化生、肉芽增生和纤维增生性改变.④全覆膜组与不覆膜组,半覆膜组的覆膜处与不覆膜处的黏膜增殖细胞阳性表达的差异有统计学意义(P<0.05).不覆膜处的黏膜增殖细胞比率较高.结论 ①气管支架覆膜的有无在留置的短期内对于进食、呼吸状况无明显影响.②气管支架留置后,覆膜段气管内膜组织增生水平要低于不覆膜段.③气管支架留置后,覆膜段的黏膜增殖细胞阳性表达小于不覆膜段.覆膜支架的生物相容性好.     

浸润性导管癌的实时灰阶超声造影研究

目的:分析乳腺浸润性导管癌的实时灰阶超声造影特征及诊断价值.方法:回顾性分析67例浸润性导管癌的超声造影形态学增强模式和时间一强度曲线定量参数,并比较常规超声和超声造影对该组肿瘤的诊断准确率.结果:67个浸润性导管癌中,造影增强显示病灶形态不规则49个(73%),边界不清51个(76%),周边穿入或扭曲血管50个(75%),内部对比剂分布不均匀58个(87%),其中可见局灶性充盈缺损21个(31%).超声造影增强前、后病灶的平均大小分别为(23.3±9.9)mm、(26.1±9.5)mm,造影后肿块明显增大(P<0.01).对比剂到达时间、达峰时间、峰值强度的平均值分别为(11.9±4.5)e、(20.1±4.6)s、4.9±2.8.本组浸润性导管癌超声造影的诊断准确率为82%(55/67),低于常规超声的诊断率91%(61/67).结论:乳腺浸润性导管癌大多具有典型的恶性造影增强特征,但部分呈低增强模式而易导致误诊,超声造影较常规超声未能进一步提高其诊断准确率.     

Training of flight nurses on fixed-wing air ambulance services

Introduction: The purpose of this study was to determine the background of fixed-wing air ambulance nurses, what level of training they receive before assignment as a flight nurse, and how closely supervised these fixed-wing air ambulance programs are by their medical directors.

Methods: In 1993, a retrospective statistical questionnaire was sent to 113 fixed-wing air ambulance programs. Chief flight nurses for all 113 fixed-wing air ambulance transport companies were requested to complete a written survey consisting of 17 multiple choice and fill-in-the-blank questions about previous experience, flight nurse qualifications, and content covered in their initial training program.

Results: Of 113 surveys, 72 (64%) responded. The majority (87%) of the flight crew were 30 to 39 years of age. The crew mix is RN/EMT-P in 49%, RN/RN in 25%, and RN/RT in 25%. Experience before flying showed emergency department/intensive care unit in 87% with 13% specialized to a specific type of patient care. The initial training in classroom hours was less than 21 hours in 50% of programs. Training programs were taught by the chief flight nurse in 75%, the medical directors in 74%, and outside organizations in 30%. Fifty-five percent of programs use pilots or other flight crew members to supplement initial training. Only eight of the programs did not have yearly refresher classes. Programs providing more extensive training appear to be affiliated with hospital-based services. Medical directors were involved with the everyday running of air medical transports in 35 of the pro grams (50%), 20 medical directors (28%) did monthly chart reviews only, and 12 (17%) were not involved with their programs. There were three responses to “Other” and two with no responses.

Conclusions: Although fixed-wing flight nurses appear to be medically experienced personnel with previous intensive care unit or emergency department experience, this survey would suggest that fixed-wing flight programs are variable in the amount of initial training, level of instructors, ongoing medical education, and involvement of the medical director. This survey indicates the need for increased standardization of continuing education, as well as increased involvement of medical directorship in fixed-wing air ambulance services.     

Physician-staffed HEMS dispatch in the Netherlands: Adequate deployment or minimal utilization?

INTRODUCTION: In the Netherlands, a physician-staffed helicopter emergency medical system (HEMS), called the Helicopter Mobile Medical Team (HMMT), provides prehospital care for severely injured patients in addition to ambulance services. This HMMT has proven to increase chances of survival and reduce morbidity. HMMT dispatch is performed following certain dispatch criteria. The goal of this study was to analyze actual dispatch rates and assess the protocol adherence of the emergency dispatchers in Rotterdam regarding HMMT dispatch. METHODS: All high priority ambulance runs between April 1 and July 1, 2003, were prospectively documented and cross-referenced to dispatch criteria. It was determined whether the emergency call warranted either immediate dispatch of the HMMT or a secondary dispatch after arrival of the first ambulance. When dispatch actually occurred, this was also documented. RESULTS: In The Studied Period A Total Of 5765 A1 Ambulance Runs During Daylight Were Documented. Of These, 1148 Runs Met Primary Dispatch Criteria And 38 Runs Met Secondary Dispatch Criteria. Actual Hmmt Dispatch Occured In 162/1186 (14%) Cases. CONCLUSIONS: HEMS dispatch rates and dispatch criteria adherence are low (14%). Better protocol adherence by emergency dispatchers could lead to a sevenfold increase of HMMT dispatches. The reasons for suboptimal protocol adherence remain unclear and persist, despite proven value of the HMMT in reducing patient mortality and morbidity.     

Air Force expeditionary medical support unit at the Houston floods: use of a military model in civilian disaster response

From June 6 to 10, 2001, Tropical Storm Allison delivered 40 inches of rain to the city of Houston, Texas. Nine of the city's hospitals were closed or severely curtailed services as a result of the flooding. All area hospitals were full to capacity, intensive care unit beds were unavailable, and patient wait times for emergency department care were 18 to 21 hours. Emergency department and intensive care unit congestion placed the entire emergency medical system of Houston in jeopardy. In response to a Federal Emergency Management Agency request, the Air Force deployed a 25-bed expeditionary medical support field hospital to Houston on June 13, 2001. The expeditionary medical support unit treated its first patient only 3.5 hours after arrival and was fully operational 8 hours later. During its 11-day stay, the facility treated 1,036 patients, including 312 ambulance arrivals, 48 inpatients, and 33 intensive care unit patients, and performed 33 dental procedures and 16 operations.     

Field evaluation and management of head and neck injuries

This article presents clear, concise guidelines for classification, evaluation, and emergency management of injuries that occur to the head and neck as a result of competitive and recreational sports. There are several principles that must be considered by individuals responsible for an athlete who sustains a serious head or neck injury: a person who "captains" the medical/first-aid team; knowledge of the appropriate emergency management techniques; availability of emergency medical equipment including a spine board, telephone, and ambulance; and a clear understanding of the philosophy that emergency management should "do no further harm."     

急救车氧气灌充系统设计

目的研制一种急救车用氧气灌充系统,实现车载氧源不间断供应。方法使用SolidWorks软件进行氧气灌充管路结构设计,运用可编程逻辑控制器（programmable logic controller,PLC）结合触摸屏实现灌充系统的自动控制及人机接口界面设计。结果氧气灌充系统实现了车载氧气瓶的实时灌充,满足急救车辆用氧需求。结论氧气灌充系统安全稳定,操作简单,为急救车辆氧源的不间断供应提供了新的技术途径及方法。     

深圳市急救网络医院2002-2004年创伤患者院前死亡情况分析

目的 分析2002-2004年深圳市创伤院前急救的时效关系,以期降低死亡率.方法选择2002-2004年67个急救网络医院经电话呼救创伤院前死亡患者的资料,用Foxpro 6.0软件建数据库,用SPSS 11.0软件进行分析. 结果 2002-2004年全市院前呼救创伤患者共161 364例次,死亡3 967例(院前和院内);院前死亡分别为360,528和645例,占当年所有创伤急救死亡总数的32.57%、37.69%和44.15%;院前死亡率分别为1.15%、0.88%和0.99%;死亡年龄分别为(29.04±13.98)岁、(27.84±18.54)岁和(29.25±17.06)岁;男/女构成比分别为79.17/20.83、77.65/22.35、71.63/28.37;交通伤/非交通伤构成比分别为48.33/51.67、26.14/73.86和37.98/62.02;救护车院内反应中位数时间分别为2,2和1 min;到达现场中位数时间分别为5,8.5和7 min;往返医院中位数时间分别为15,35和30 min. 结论 深圳市院前创伤死亡患者数量有增加趋势,其中交通伤构成比和死亡率有下降趋势,院前创伤死亡平均年龄较全市所有急救患者死亡年龄的平均值低10岁.救护车院内反应时间加快,但到达现场时间和往返时间延长.     

Iraqi community members' knowledge, attitude and practice of emergency medical care: assessing civilian emergency medicine in an area of conflict

The objective of this article is to assess community member knowledge, attitude, and practice of emergency medical care in Baghdad, Iraq. We performed a randomized, cluster-based, household Knowledge, Attitude, and Practice (KAP) survey regarding pre-hospital and hospital-based emergency medical care among Baghdad community members. A total of 1172 individuals participated in the survey. While most (93.5%) understood that for a serious injury, one should go to the hospital within three hours, only half (50.6%) felt that ambulances were beneficial and only 5% knew that there was a number to call in case of medical emergency. Regarding attitudes, only half (50.2%) of those interviewed felt an ambulance would arrive within an hour, while higher proportions of people believed that paramedics (59.1%) and medical staff working in emergency departments were adequately trained (71.5%). In terms of practice, most Iraqis responded that they would seek care in a hospital (84.8-90.0%) by means other than an ambulance (98.0-99.2%). However, if an ambulance arrived, 77% would allow it to transport their friends/family and 73.5% would trust the medical staff in the hospital to appropriately treat them. Our conclusion is that emergency medical care in Iraq is still in the development phase. Although numerous ambulances have been commissioned, scores of paramedics have been trained, and staff working in Baghdad Emergency Departments have undergone updates in their practice, the public does not appear to be fully informed of these changes. Future developments in Iraqi emergency medical care should include targeted efforts to expand the public awareness of such services.