重大灾害事件的紧急医疗救援

目的报告河南省5次重大突发事件和紧急救援的组织管理。方法重大灾害事件发生后，迅速报告上级主管部门和紧急救援中心，公安、消防和医疗急救人员共同参加现场急救，使通讯和道路通畅，维持现场秩序，保证现场急救和顺利转运伤员到医院。河南省突发公共卫生事件应急医疗救治专家迅速赶赴现场和救治伤员的医院，指导急诊手术和重症监护治疗。结果5次重大突发事件现场共死亡259例，181例伤员送入院治疗，其中危重伤员26例。仅2例死于多器官衰竭，其余179例康复出院。结论重大突发事件紧急救援需要消防、警察、医疗急救等多系统的协调合作，急诊医学专家指导大批伤员的分类急救和重症监护治疗，可提高救治成功率。     

突发事件紧急医学救援工作的几点思考

灾害医学是研究在各种自然灾难和人为事故中所造成的灾害性损伤条件下实施紧急医学救治、疾病预防和卫生保障的一门科学［1］。自2003年SARS之后,灾害医学在中国得到了空前重视和迅速发展。到2008年汶川大地震时,初步建立了伤员集中、检伤分类、现场救治、后方转运的救治模式,形成了通讯保障、卫生防疫、心理救援、军民协作等策略,这标志着中国灾害紧急医学救援体系初步建立;但也暴露出相关系统研究的具体成果较少、专业化培训规模小、紧急医学救援人才储备不足、应急指挥和决策系统不完善、全民急救知识普及教育不够等问题［2］。随着中国经济、社会快速发展,人口、资源的流动性将大大提高,传染病暴发、恐怖袭击、安全事故等风险也随之增加,中国的灾害紧急医学救援工作面临着前所未有的形式和严峻挑战。     

发生灾害要立即通知“120”，医院不得拒收伤员

公安部、卫生部日前发出通知，要求做好灭火救援现场紧急救护工作，建立火灾害事故信息通报和联合救护机制，着力提高火灾及其他灾害事故信息传递、现场急救和人员转运等方面的综合反应能力。     

都江堰风景旅游区灾害事故医疗救援的运行模式分析

都江堰市风景旅游区灾害事故医疗救援模式在全国众多医疗救援运行模式中独具特色 ,现报告如下。1　方法与措施为了适应旅游事业的发展 ,最大限度地控制自然灾害带来的人员伤亡和财产损失 ,都江堰市政府从1995年起根据我国卫生部关于加强灾害事故医疗救援的精神 ,加强了全市急救医疗网络建设和灾害突发事件紧急救援的组织工作 :1 1　成立了以当地政府最高行政领导为首的灾害救援领导机构 ,负责指挥、协调本地区突发性灾害事故的紧急救援。1 2　为了保障全旅游区的突发灾害事故的医疗救援 ,都江堰市卫生局在 1998年成立了都江堰市风景区急救…     

基于事故危害评估系统的化学中毒应急演练分析

目的：探讨应用事故危害评估系统开展化学中毒应急救援演练的作用.方法：模拟某大型化工厂发生氯气泄漏事故,应用《广东突发化学中毒事故危害评估与医学应急救援系统》开展卫生应急救援演练,演练内容包括信息报告与核实、建立演练指挥部、事故危害评估、现场区域划分、现场检测调查、现场医疗救援以及应急响应终止等环节.结果：模拟某化工厂氯气泄漏事故造成20名员工急性中毒,按照有关应急预案,从接报核实、启动预案到实战演练过程顺利,达到预期目标.结论：应用中毒事故危害评估系统开展应急演练,对锻炼应急队伍、提高化学中毒应急能力具有重要作用.     

军队医院组织突发事件应急医学救援的探讨

军队医院作为实施平、战时卫勤保障的军队医疗机构,其重要的一项职能就是能担负起突发事件的应急医学救援。由于军队医院组织严密、行动迅速、制度落实好、机动能力强,已经成为国家突发事件医学救援的主要力量。近年来,我院担负了包括水灾、爆炸、重大交通事故等突发事件的应急     

国家级紧急医学救援队药品保障模块化及品量研究

结合突发事件的特点,收集分析近年来国内外处置突发事件类型、药品保障需求特征及各种应急保障中药品使用数据。结合国家级紧急医学救援队的任务目标,联系救援任务中药品的真实应用情况,运用模块化原理,根据药品需求的基本特征,确定药品保障模块的种类、数量标准。利用各模块对应的疾病类型比例,结合治疗药品的平均日用量以及平均用药时间,计算出100名伤病员每天所需的药品数量,初步构建了国家级紧急医学救援队药品保障品种、数量及模块库。为紧急医学救援实现科学救援、精确化保障提供了一个新的模式。     

汶川地震医学救援反思与区域性灾难医学救援体系建设

目的通过全面系统地总结和反思汶川地震医学救援中四川省应急救援的经验和启示,分析并探讨区域性灾难医学救援体系建设。方法收集、整理、分析各类统计数据、信息、专报资料和相关评估报告,采用描述性方法进行分析。结果①汶川地震灾区医疗卫生机构受到重创;②迅速紧急响应,各级、各类医疗救援队伍集结灾区;③震后72 h内为救治最高峰;④各级医院救治91 177例伤病员,跨省大规模伤员转移救治,强化危重伤病员集中收治策略。结论建立区域性灾难医学紧急救援基地和应急医学救援常态化运行管理机制;完善信息指挥调度平台;科学合理的配置医疗资源;建立不同层次、不同类型的应急医疗队伍和响应机制;参与其他区域灾难医学专业紧急医学救援。     

灾害紧急医学救援中的主要做法和建议

汶川地震发生后,由第三军医大学西南医院抽组的医疗队率先到达德阳和映秀灾区实施紧急医疗救援,医院也执行了跨省转运伤病员的专科救治任务,为抗震救灾取得阶段性胜利做出了突出贡献。我们通过总结军队医疗机构在此次医学救援行动中的一些成功的做法,对今后各级医疗机构加强灾害紧急医学救援工作提出了建议。     

城市应急联动系统对120的应用

随着社会的不断进步,社会发生紧急突发事件的种类更加复杂与多变,当前社会生活中公共突发事件如重大交通事故、各类爆炸事故、海啸、SARS、禽流感疫情等对国家安全和社会稳定产生了巨大影响,传统的应对机制已不能适应日益增多的紧急突发事件处置的需要.     

Bilateral choanal atresia--respiratory emergency in a neonate

Bilateral choanal atresia is potentially a fatal respiratory emergency in a newborn. A 2-day-old full term male infant was presented with history of attacks of cyanosis, difficulty in suckling and respiration. On examination cyclical change of body colour, ie, alternating cyanosis and normal colour was observed. CT scan of the base of the skull revealed bilateral choanal atresia. The patient underwent choanal canalisation operation by transnasal route using Lichtwitz trocar and cannula with controlled force.     

Patients' complaints in a hospital emergency department in Singapore

INTRODUCTION: This study analysed the complaint rates, profile and trend, and complainant profile of patients' complaints received by the National University Hospital Emergency Medicine Department. An earlier ten-year study (1986-1995) was done on the complaint profile. METHODS: Records of all patients' complaints, solicited and unsolicited, from January 2002 to December 2003, were retrieved from the Medical Affairs and Quality Improvement Unit files. Complaint profile analysed was reason, validity, and outcome of complaint and staff category involved. Complainant profile analysed was relationship of complainant to patient, ethnic group, gender and residence type of the complainant; and age group and triage category of the patient. RESULTS: Complaint case rate was 1.17 per 1,000 visits, with 1.27 complaints per complaint case. The complaints were organisation/logistics (49.0 percent), communication (26.0 percent), standard of care (22.9 percent) and other issues (1.3 percent). Most standard of care (76.0 percent) and half of organisation/logistics complaints (46.8 percent) were not valid. Most communication complaints were valid (73.7 percent) and involved all staff categories equally. Most complaints (82.8 percent) were resolved with an explanation/apology. Age group specific and triage-specific complaint rates were highest among adult patients and among priority 3 patients, respectively; ethnic group and gender-specific complaint rates were highest among Chinese patients and among female patients, respectively. CONCLUSION: Staff-patient communication and organisation/logistics must be continually improved to reduce complaints, while upholding a good standard of care. These would translate into cost savings for all parties. There must also be appropriate checks and balances particularly where complaints are not valid, so that doctors can practice cost-effective medicine.     

Requests for emergency contraception at an accident and emergency department--assessing the impact of a change in legislation

The aim of this study was to examine the pattern of attendance of patients requesting Emergency Hormonal Contraception (EHC) at an accident and emergency department before and after a government driven change in legislation, which allowed EHC to be sold over-the-counter by trained pharmacists, to women aged 16 years and above. We employed retrospective comparative study using computer records of all accident and emergency attendances coded as requests for emergency contraception for the years 2000 and 2001. The number of patients requesting emergency contraception at the A&E department decreased after over-the-counter sales were introduced, from 196 in the year 2000 to 164 in 2001 (p = 0.037). Despite this, the number of teenagers requesting emergency contraception at the A&E department increased in 2001--from 63 in 2000 to 74 in 2001 (p = 0.0115). Most requests are received outside local pharmacy opening hours--63.77% in 2000 and 62.2% in 2001. This study raises concerns that the government initiative allowing emergency hormonal contraception to be sold in pharmacies is having little impact on teenagers most in need of this service. A&E departments can expect to continue to receive a significant number of requests for emergency contraception. Further measures will be required to reduce the U.K.'s high rate of unplanned pregnancies.