突发事件成批伤急诊护理应对模式回顾性分析

目的:探讨突发事件成批伤急诊护理应对模式,分析本模式在城市成批伤救护中的应用效果。方法:对2010~2012年度我院急诊科接诊的突发事件成批伤进行回顾性分析,采用查看病历、入院病程录回访、半结构式访谈等方法,获取伤员基本资料、伤员转归,医护人员评价,探讨院内救护模式。结果:我院急诊科3年共接诊突发事件36起,涉及患者238例。根据《急诊部突发公共卫生事件紧急医疗救援预案》,以"不同事件性质启动不同级别应急预案"的护理应对模式,以及"以急诊科为主负责院内抢救、院领导协调指导资源调配"的伤员分流模式,各级伤员得到及时救治和分流,救护人员整体评价好。结论:突发事件成批伤急诊护理应对模式值得借鉴,在电子信息化处理、救治流程优化等方面仍可进一步加强,从而提高医院对于突发事件成批伤的整体救护能力。     

成批伤员应急救护系统的组织与管理

目的探讨成批伤员医院内应急抢救和分流等环节。方法按照成批伤员病情严重程度,划分不同区域,合理分配护理人力资源,明确分工,责任到人。结果在动车追尾事故中,温州市第二人民医院共接收伤员35例,以多发伤为主,抢救成功率为97.1%。医院采用"以急诊科为主组织院内抢救,院领导协调指挥"的救护模式,伤员预后良好。结论 医院内协作救护模式值得推广应用,但还需加强训练,才能更大程度地提高医院对于成批伤员的救护能力。     

城市成批伤员院内应急救护模式的探讨

目的探讨城市成批伤员的救护模式,以提高医院有序、高效、安全救护城市成批伤员的能力。方法对第二军医大学长征医院运用"护士首诊负责、急诊科室诊治、病房收治分流"的救护模式实施某次地铁追尾事故的救护过程进行总结与分析。结果 40名伤员均得到了及时的分流及诊治,整体救护效果较为满意,患者均康复出院。结论在城市成批伤救护中采用"护士首诊负责、急诊科室诊治、病房收治分流"的救护模式能使伤员快速分流、及时得到诊断及收治,值得临床推广应用,但需对救护方案进行优化,以进一步提高医院对成批伤员救护的能力。     

上海市9家三级甲等综合性医院成批伤事件特点及救护分析

目的分析三级甲等综合性医院在不同成批伤事件中收治的成批伤员的特点,为医院有效管理、救护成批伤员提供依据。方法采用自制的调查问卷,对上海市9家三级甲等综合性医院2007年10月至2013年9月急诊科收治的成批伤事件中的伤员进行回顾性调查分析。结果上海市发生成批伤事件呈逐年增加的趋势,且伤亡人数也逐年增多;6年中所有类型事件中,交通事故所占比例最高;成批伤员伤情主要以轻度创伤为主,以20~45岁的青壮年为主。结论上海市成批伤事件为以非自然因素为主的突发事件,医院在救护成批伤员的管理方面应根据本城市的成批伤员特点制订相应的应急预案、救护流程,并合理配置资源。     

城市成批伤员救护模式探讨

[目的]探讨成批伤员救护模式。[方法]采用回顾性调查方法,了解某医院对上海地铁10号线追尾事故造成的成批伤员收治的救护模式,了解成批伤员救护方案、救护资源配置及救护人员对救护过程的评价。[结果]采用"护士首诊负责、急诊科室诊治、病房收治分流"的救护模式使40例伤员得到了及时的分流及诊治,整体救护效果满意。[结论]护士首诊负责、急诊科室诊治、病房收治分流的救护模式使伤员快速分流、得到及时诊治,但仍需对救护方案进行优化,提高医院救护城市成批伤员的能力。     

平战结合成批伤员急救预案的组织与实践

正军队医院除担负日常救治工作和突发救治工作外,还是实施平时和战时卫生勤务的主要力量。医院在应对突发事件中起着关键作用,对成批伤员的救护更是整个救治体系中不容忽视的环节,如何快速、有序、安全、高效的救护成批伤员是医院一直关注的重要课题。为适应平战时卫勤保障和突发事件成批伤员的救治需要,本科依托120院前联动救治、院内开展急救技能和     

急诊成批伤员的急救管理

目的：探讨城市成批伤员的院内急救管理及方法。方法：对我科2010年1月到2012年12月的321批伤员病人的急救及护理措施进行总结。结果：按照成批伤员每批次的伤员数量及病情严重程度迅速启动应急预案,进行分类分组抢救,划分不同区域、合理分配护理人力资源、并明确分工及责任。伤员均能得到迅速救治,整体救护效果满意。结论：事先建立详细的应急救护预案,并反复演练,熟悉救护流程及配合。开通绿色通道,有效利用床边检查设备,加强院前急救与院内救护的无缝衔接是成批伤员抢救成功的关键。     

应急预警系统在成批伤员急救中的应用

目的:探讨应急预警系统对成批伤员来院后急救的影响。方法:选择2012年6月~2013年3月救治的成批伤29批次,采用应急预警系统,通过护理流程的改造,完善绿色通道等措施,观察29批成批伤员的救治效果。结果:成批伤员的抢救成功率提高到98.80%。结论:在应急预警系统联动模式下医院急救人员能在伤员未到达医院时,急救人员快速进入岗位,为急救成批伤员赢得了时间,因此应急预警系统的联动应用能提高成批伤的救治效率。     

浅谈二级医院对大型成批车祸伤员的救护体会

大型成批车祸伤发生时,多具有突发性、伤员较多性、伤情复杂性等特点,给救护工作带来很多困难。我们通过建立救护组织体系,加强急救物资的管理,培训急救人员的急救技能,把握好院前救护及院内救护的各个环节,从而提高了抢救效率,同时获得了伤员及其家属、社会的的好评。现将其救护体会报道如下。     

基于桌面推演的成批战创伤伤员院内急救护理人力调配研究

目的探索规范而科学的成批战创伤伤员院内急救护理人力调配方案。方法通过桌面推演,针对不同等级、不同数量的成批伤员,制定符合医院接受能力的战创伤伤员院内急救护理人力调配方案,将其运用到2017年成批伤员接诊流程中,并与2016年成批伤员接诊进行比较。分析两个年度中护理人员的集结时间、现场参与抢救的管理者在调配人力上的难易程度以及医院组织管理部门对护理人员响应的评价。结果与2016年度相比,2017年采用桌面推演制定的护理人力应急调配方案缩短了护理人员集结时间(P0.01),降低了参与抢救的管理者调配人力的难度,获得了医院管理部门的认可。结论医院相关管理部门可以采用桌面推演制定符合本院的成批伤院内急救护理人力调配方案。     

医务人员利器损伤的预警管理

目的了解临床医务人员利器损伤的发生率、损伤原因、环节，有关防护及安全操作行为等问题，并制订出预警方案达到警示作用。方法采用回顾性问卷调查，对医务人员704人的调查问卷进行分析。结果被调查人员中有543人、1740例次在工作中被利器损伤过，占77．13％，其中护士损伤数占护士人数的93．29％。常见利器的种类主要见于注射针头、输液针头、玻璃安瓿；损伤发生的时间常见于治疗集中的上午；戴手套仅占24．71％；受伤后呈报占24．3％。结论临床医务人员针刺伤发生率高，防范意识差，设立预防损伤的预警机制是当前职业防护面临的紧迫课题。     

Improved trauma management with advanced trauma life support (ATLS) training.

OBJECTIVE: To determine the value of advanced trauma life support (ATLS) training for medical staff in a major incident situation, based upon performance in a simulated exercise. METHODS: A major incident exercise was used to assess the management of trauma victims arriving in hospital suffering from multiple or life threatening injuries. The effect of ATLS training, or exposure to an abbreviated form of ATLS training, on the management of patients with simulated life threatening traumatic injuries was examined. The treatment offered by medical staff of different grades and varying exposure to ATLS training was compared. RESULTS: Medical staff who had undertaken ATLS training attained a higher number of ATLS key treatment objectives when treating the simulated trauma victims. CONCLUSION: Medical staff who have either undertaken the full ATLS course or an abbreviated form of the course were more effective in their management of the simulated trauma cases.     

一线三甲医院汶川地震门急诊救护组织管理纪实

5·12汶川地震发生后,绵阳市第三人民医院作为距离极重灾区北川、平武县最近的一所三甲医院,在震后45天内收治了l804例伤员。本文回顾性总结和分析了该院在医疗救援的组织管理、伤员救治和后勤保障工作中取得的成绩和存在的不足,提出应建立和完善突发灾害应急救援预案,加强人员培训,建立应急物质储备和供应体系,重视心理干预和对救援人员的保障。     

Dealing With Radiological Disasters

Dealing with the victims of a radiological disaster can be daunting for nurses who have little experience in this area. Knowing how to set up a response area that protects the hospital and staff from radiation exposure coupled with treatment of victims is the goal. Accomplishment of these goals requires a knowledge base of the different types of exposure and the treatment of each.     

彝良地震伤员的支持性心理干预模式

在“9·7”彝良地震伤员集中救治的医院里,由国家卫生和计划生育委员会指派的彝良心理危机干预工作组发展了以支持性心理干预为核心的整体康复服务模式。该模式以病房心理护士作为联络者,立足于医学服务的整体性与连续性,在全面健康评估与重点评估心理创伤应激的基础上,以解决患者及照顾者的现实问题为重点,提供支持性心理干预,并借助社会心理支持服务内容量化的自评来激励心理护士对地震伤员提供的心理支持工作。在实践中,该模式能够得到医院管理者及医务工作者的积极配合,患者及家属普遍接受,具有连续心理服务的可操作性。     

Medical response of a physician and two nurses to the mass-casualty event resulting in the Phi Phi Islands from the tsunami

The Phi Phi Islands are isolated islands located about one hour by ship from the mainland in Krabi province of Thailand. There is a small medical facility where the director is the one physician that provides care to residents and tourists. This small medical facility faced an enormous mass casualty incident due to the 2004 Tsunami. The hospital was damaged by the Tsunami wave and was not functional, one crew member died and another was injured. Medical care and evacuation posed a unique problem in the Phi Phi Islands due to remoteness, limited medical resources, lack of effective communication with the main land and the large number of victims. An alternative medical facility was located in a nearby hotel. The crew included the medical director, two nurses, two additional staff members, 10 local volunteers, and hotel staff members. The medical crew had to treat 600-700 casualties in 24 hours. Most of the victims were mildly injured, but approximately 100 (15%) of the victims could not walk due to their injuries. The medical director, made a conscious decision to initially treat only circulation ("C") problems, by controlling external hemorrhages. This decision was driven by the lack of equipment and personnel to deal with airway ("A") and breathing ("B") problems. In the post-disaster debriefing, the Phi Phi Island hospital physician noted five major lessons concerning disaster management in such extreme situation in a small facility located in a remote area: (1) effective resistant communication facilities must be ensured; (2) clear, simple "evacuation plans" should be made in advance; (3) plans should be made to ensure automatic reinforcement of remote areas with evacuation vehicles, medical equipment and medical personnel; (4) efficient cooperation with medical volunteers must be planned and drilled; and (5) every team member of such a hospital must participate in an educational program and periodic drills should be done to improve the disaster and emergency medicine capabilities. This case report is an example for caregivers all over the world, of an amazing lesson of leadership and courage.     

A hospital response to a soccer stadium stampede in Zimbabwe

Method: A literature review was done to establish international standards of best practice in major medical incident response. The hospital disaster plan (major medical incident plan) was reviewed and used as local standard. Written submissions and unstructured interviews technique were used to collect information from staff present on the day and involved in the care of the stampede victims and from staff specified in the hospital disaster plan. This was presented as a report to the Hospital Clinical Audit and Quality Assurance Committee (CAQAC), with recommendations.

Results: The hospital's response to the disaster was suboptimal. The initial recommendations were accepted. Implementation is ongoing while discussion is drawing in other people and agencies. An integrated prehospital care system is required. The casualty department needs to develop into a modern accident and emergency department. Individual departments need to develop their own disaster plans that link into the hospital plan. A system for future audits of the hospital's performance after a disaster need to be put in place. Implementation of these recommendations is changing disaster preparedness in and out of the hospital.

Conclusions: The exercise was very useful in raising awareness and the value of audit and specific issues were defined for improvement. Long term and short term goals were set. Despite the shortage of resources, change was felt to be necessary and possible.

     

严重医疗不良事件中第二受害者认知与心理体验的质性研究

目的了解医务人员在严重医疗不良事件中作为第二受害者的认知与心理体验,为医疗不良事件管理体系相关研究提供依据。方法采用质性研究中的现象学研究法,于2019年1—2月,选取3所三级医院9名经历过严重医疗不良事件医务人员进行访谈,根据Colaizzi 7步分析法对访谈资料进行整理分析。结果提炼出4个主题:各种负性体验的经历、对职业认知的改变、认同完善预防不良事件系统的重要性、渴求设立第二受害者支持体系。结论主管部门应关注到医疗不良事件中涉事医务人员的困境,积极构建第二受害者的支持体系,以此来降低他们在医疗不良事件中受到的伤害,从而确保医疗安全。     

Attitude of Medical Staff Towards Victims of Violence and Assaults

Crimes of violence have effects on health care, but have received insufficient attention as regards the questions of identifying hidden violence. What factors could be of relevance to the reception and help given to victims of violence? How much importance should be attributed to the sex factor in staff attitudes? The aim of the present study was to elucidate the attitudes of medical staff towards patients who were the victim of violence or assault. The study covered staff working in the emergency ward at the Central Hospital in Karlstad and at all the health care centres in Karlstad Police District. A questionnaire was sent out to all doctors and nurses at the units involved. In general, the results showed a great commitment and sense of responsibility, and a specific concentration of resources on female patients on the part of the female staff. The explanatory model revealed that attitudes of staff to victims of violence and assault are partly determined by the sex of the staff but that the place of work was definitely not without importance as an explanatory factor.     

医务人员利器损伤的预警管理

目的 了解临床医务人员利器损伤的发生率、损伤原因、环节,有关防护及安全操作行为等问题,并制订出预警方案达到警示作用.方法 采用回顾性问卷调查,对医务人员704人的调查问卷进行分析.结果 被调查人员中有543人、1740例次在工作中被利器损伤过,占77.13%,其中护士损伤数占护士人数的93.29%.常见利器的种类主要见于注射针头、输液针头、玻璃安瓿;损伤发生的时间常见于治疗集中的上午;戴手套仅占24.71%;受伤后呈报占24.3%.结论 临床医务人员针刺伤发生率高,防范意识差,设立预防损伤的预警机制是当前职业防护面临的紧迫课题.