Road safety and medical care to victims of road accidents in Moscow in 1999-2003

There has been an increase of victims including lethal cases, primarily among male aged 20-39, in road accidents (RA) in Moscow during the recent 5 years, 1999-2003. A high level of RA severity (number of lethal cases per 100 of victims) is especially typical of novice drivers. First aid on the RA spot is rendered only to 4% of victims; the percentage of lethal cases before hospital has been recently on the rise: victims die mainly of blood loss or shock, in other words, they die not of injuries, which are incompatible with life, but of a lack of emergency medical care. More drive time needed by the ambulance vehicle from the RA place to hospital as well as worse standards of emergency care rendered to RA victims are also unfavorable factors. Purpose-oriented actions undertaken under the existing circumstances in respect of socially vulnerable categories of people as well as implementation of preventive measures could be most effective for the protection of public health.     

基于物联网技术的军地一体医疗急救系统研究

为变革军队医院平时医疗急救的方式及遂行多样化军事保障任务时卫勤保障的手段,研究并利用物联网技术,再造医疗急救业务流程,设计构建军地一体医疗急救系统,以实现高效率、高质量医疗急救服务模式,提升基地医院医疗急救服务保障能力。     

Analysis of early treatment of accidents at work and on the way to or from work with special consideration of traumatic-hemorrhagic shock

The study investigates the quality of the management of occupational accidents and of accidents on the way to or from work. Special consideration is given to the prevention and effective early treatment of traumatic-hemorrhagic shock, which in serious accidents is often the pathophysiological cause of reversible or irreversible damage of organ systems, disability or death. In a series of 725 consecutive occupational accidents, accidents on the way to or from work and road accidents over a period of 2 years, and in 31 additional individual cases, the emergency treatment and further care of patients with incipient or advanced shock were examined. Assessment was based on protocols of initial emergency treatment and medical records of further hospital care. Specific attention was given to the development of shock-induced organ damage. When the emergency physician arrived at the site of the accident, of the 725 cases, 82 patients showed early signs of shock, 37 were in advanced shock, and 24 were dead. In accidents with early intervention of experienced medical personnel, securing of the airways, control of bleeding and sufficient substitution of volume and oxygen were usually done professionally, but analysis of the management of other cases showed delays and various shortcomings. In 25% of those who died, protracted circulatory shock due to insufficient volume substitution was the cause of death. Occupational rehabilitation failed in two thirds of the patients with advanced shock, but only in one third of the patients with incipient shock. The study demonstrates that immediate intervention by non-professionals in first aid, rapid arrival of the emergency care team, sufficient volume and oxygen substitution along with other emergency measures, and rapid transport to an appropriate trauma care facility, all improved the prognosis of the accident victims. Specific areas for improvement in the management of accident victims were found, especially in co-operation and co-ordination among non-professional first aid providers, occupational health and auxiliary personnel, and emergency medicine professionals.     

野战医疗方舱在地震灾害危重伤病员救治中的作用

自的：探讨我军第二代野战医疗方舱系统的急救方舱在地震灾害危重伤病员救治中的作用。方法：通过对地震灾害46例急危重伤病员的救治，分析抢救成功率与急救方舱设备、人力资源配置及心理干预的关系。结果：野战医疗急救方舱共收治急危重伤病员46例，抢救成功率100％。结论：现代化的急救设备，合理的人员配置和适当的心理干预，是野战医疗急救方舱伤病员抢救成功率高的重要保障。     

孵化理论在基层医疗机构急诊急救护理能力建设中的应用效果分析

目的探讨医联体背景下孵化理论在基层医疗机构急诊急救护理能力建设中的应用效果。方法对南通市两家基层医疗机构的护理人员进行急诊急救理论和技能培训,对护理管理者进行管理工具等培训。结果经过孵化培训后,两家基层机构护理管理者管理能力得到提高;急诊护理人员理论及技能水平均得到提升,差异具有统计学意义（P＜0.05）。两家基层医疗机构急诊护理人员对培训效果满意。结论医联体背景下孵化理论在基层医疗机构急诊急救护理能力建设中应用能够提高基层医疗机构急诊急救水平。     

突发核事故应急生物检测研究进展

核事故或核恐怖事件的医学救援是应急救援的重要环节, 建立健全突发核事故应急检测体系, 对核辐射伤员尽快进行伤情分类、实施有效救治至关重要。对突发核事故应急救援中的生物检测方法进行了总结, 对生物检测方法的特点、优缺点和适用性进行了讨论。     

'Advanced trauma life support' in Netherlands

Introduction of the principles of advanced trauma life support (ATLS) in the management of accident victims has been in progress in the Netherlands since 1995. The main ATLS principles are that the aid giver treats the most dangerous disorder first and does no further damage. After assessment and, if necessary, treatment of the airways, the respiration, the circulation and any craniocerebral injury, an exploratory examination is carried out. Physicians receive theoretical and practical instructions in this form of management during an intensive two-day course, counselled by a coordinating organization in the USA. Most of those attending are interns in general surgery, traumatology and orthopaedics, gatekeeper doctors of emergency rooms and army medical officers. The standardized way of thinking improves the communication and understanding between the various disciplines involved in trauma care, in part because there exist comparable programmes for ambulance care and emergency care. Other measures improving the quality of trauma care are regionalization of the trauma care, medical helicopter teams and evaluation of the effects of ATLS as an operating procedure.     

Emergency room guidelines. Providing services to victims of toxic spills.

Guidelines for developing hospital policies and procedures to provide emergency services in cases involving chemical accident victims have been developed under the auspices of the Hospital Disaster Committee of the Seattle Area Hospital Council. The proposed guidelines are consistent with the standards of the Joint Commission on Accreditation of Hospitals, hospital internal and external disaster management plans and the recent requirements for hazard communications (Right-to-Know). Although medical care of the patient is not a primary purpose of the guidelines, some of the procedures, such as identification of the type of chemicals involved, will aid in direct patient care.     

基于远程医疗的突发急诊创伤救治效果分析

目的探讨医院依托远程医疗应对突发急诊创伤事件的效果。方法采用回顾性总结方法,选取2011年3月—2014年3月运用远程医疗系统前198例北京市某三甲医院的院前急诊创伤患者作为对照组,选择2014年4月-2016年8月运用远程医疗系统后198例院前急诊创伤患者作为观察组。观察组依托远程医疗系统进行急诊,远程医疗系统由家庭与社区急救、院前急救、院内急诊等组成,利用移动4G、云计算、大数据分析、物联网等新技术进行急救干预。结果观察组与对照组在患者的心率、呼吸、血氧饱和度与血糖值对比无明显差异(P>0.05),观     

Emergency department utilization among victims and offenders involved in non-lethal violence

The medical literature has focused on violent victimization as a public health concern, examining its correlates and evaluating intervention models. However, the emphasis on victimization in this literature overlooks the strong ties between victimization and offending risks outlined in the criminological literature, which may unnecessarily limit the scope of public health efforts to influence violence in our communities. This study examines whether the similarities observed in the criminological literature are evident in a health care setting. More specifically, do victims and offenders exhibit similar health care utilization patterns? We address this question by comparing the emergency department utilization records, criminal histories, and demographic characteristics of a sample of victims and offenders involved in non-lethal violence in Bernalillo County, New Mexico, USA in 2001. Our results suggest that victims and offenders have similar emergency department utilization patterns, with most visits being for injury. Moreover, most victims seen in the emergency department have criminal records that, in many ways, mirror those of offenders. The results suggest that violence intervention programs in public health settings should target both victims and offenders and capitalize on the overlap across these populations in outlining the long term risks of criminal involvement and motivating individual level change.     

做好援外医疗卫生装备保障工作的体会

研究分析了非战争军事行动,特别是援外人道主义医疗救助的特点和要求,提出由于援外人道主义医疗救助情况紧急、环境特殊,对卫生装备的管理、维修及保养有极高的要求。总结了在突发自然灾害、紧急援外条件下,卫生装备维护工程人员的配备、卫生装备运输安全、设备工作场所的布局以及卫生装备的日常维护保养等方面的成功经验,针对工作中遇到的各种问题,给出了切实可行的对策。     

从抗震救灾实践论野战传染病医院应急医学救援

通过抗震救灾的实践,对野战传染病医院的应急预案、人才培养、卫勤保障力量建设、政治工作等方面进行思考。提出了优化突发传染病应急预案;注重对复合型人才的培养;组织高效的协调指挥与扎实的卫勤演练;加强卫勤保障力量建设;有针对性的政治工作等观点,为野战传染病医院遂行非战争军事行动应急医疗救援行动提供经验。     

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。     

Foods provided through U.S. Government Emergency Food Aid Programs: policies and customs governing their formulation,selection and distribution

This report describes the food commodities that are used in U.S. emergency food aid programs and outlines issues in their distribution, selection and formulation that may limit their ability to meet the nutrition needs of recipients. Issues are being raised at this time because the U.S. Congress plans to renew the authorizing legislation by the end of 2002. The author summarizes quantity and quality problems with food aid contributions and the difficulties experienced with the coordination of food aid with related needs of disaster victims. He identifies the foods supplied for emergency feeding by the U.S. Government and the World Food Program, and describes the limited applications of nutrition science to the formulation of the processed foods provided through U.S. food programs. The core of the report outlines the dominant nonnutritional priorities, stemming from the linkages to U.S. agricultural supply markets, U.S. commercial food interests, food aid pledging customs and difficulties in U.S. Government humanitarian response coordination. The presentation concludes with a review of issues, emphasizing the need for further studies, and some suggestions for shaping future food aid programs and policy with a strengthened capacity for protecting and promoting the nutritional status of disaster victims.     

Do not forget the battered male! A comparative study of family and non-family violence victims.

This study is based on interviews with and psychiatric ratings of female family violence victims and male non-family violence victims. Despite differences in the type of violence and the relation to the assailant, the psychological consequences of the battering were very much the same in the two groups. The background and present social situation of the victims were very similar. The conclusion drawn with regard to the medical services, is that both groups of victims need the same attention and treatment when attending the emergency department. Apart from routine medical care, they might need treatment for alcohol problems, depression or other psychiatric conditions frequently occurring in victims of violence.     

遇险飞行员救护技术要求和装备的研究

目的：论证搜救直升机医疗救护技术和方法,探讨其配备药品、器械的品种和数量,研制机载医疗救护装备,解决我军搜救直升机缺少标准医疗救护装备问题。方法：采用调研和资料分析等方法,论证搜救直升机医疗救护装备的勤务需求,研制医疗救护装备。结果：提出的技术方法、救治原则和药品、器械品量及装备形成了技术规范;搜救直升机医疗救护装备体积与质量小,功能配套齐全,在机上固定牢固,展、收迅速;该装备在直升机的震动、噪声、颠簸、低气压等工作条件下工作状态不受影响,性能稳定,达到了设计要求。结论：研究的搜救直升机医疗救护技术、方法和装备满足被迫跳伞受伤飞行员的救治要求．解决了部队训练的需要。     

医疗救援卫生耗材的保障策略

目的:加强医疗救援卫生耗材的应急保障。方法:分析日常医疗耗材的供应基础和要求,明确应急医疗耗材供应的管理要素。结果:应急医疗耗材的供应保障需要更多的经验积累和科学统筹的管理。结论:应该充分重视应急医疗救援的耗材供应,克服管理混乱的弊端,才能保障应急救援工作更快捷、更顺利、更精细。     

Comprehensive medical care for victims of sexual assault: a survey of Illinois hospital emergency departments

BACKGROUND: Sexual assault is a major public health problem affecting 17 million women in the United States. Hospital emergency departments (EDs) are often the primary point of care for these women. We propose the concept of "comprehensive medical care management" (CMCM) at the primary point of care for victims of sexual assault. The objectives of this study were (a) to describe medical care services provided to sexual assault victims presenting at the EDs in Illinois hospitals, and (b) to identify the percentage of hospitals that always provide all 10 elements of CMCM. STUDY DESIGN: This is a cross-sectional prevalence study. A 14-item phone survey was administered to 187 eligible EDs in Illinois from July to September 2004. Outcome measures were the percentages of EDs that provide the elements of CMCM: (a) acute medical care; (b) history and physical exam; (c and d) acute and long-term rape crisis counseling; (e and f) prophylactic and therapeutic sexually transmitted infection (STI) management; (g and h) prophylactic and therapeutic HIV management; and (i and j) counseling and provision of emergency contraception. RESULTS: An 83% response rate of eligible emergency rooms provided the following data: while 100% of emergency rooms provide acute medical care upon presentation, two thirds provide rape crises counseling, two thirds provide STI management, 4 of 10 report counseling and provision of emergency contraceptives, and only 28.2% provide HIV management. About 1 in 10 (9.6%) provides all elements of CMCM. CONCLUSION: Although there are recommendations from various medical organizations for all 10 elements of CMCM for victims of sexual assault, very few hospitals provide CMCM. Improvements must be made to provide quality comprehensive care for victims of sexual assault.     

The zone principle in the organization of emergency medical services

The analysis of basic shortcoming of the centralized system of functioning of emergency and ambulance aid stations in a large city has been carried out. Methodological principles of zone development of emergency medical aid in Moscow are provided.     

重庆市化学毒剂数据库的研制

目的研制重庆市化学毒剂数据库。方法以化学品的事故频次、毒性和储存状况为主要参数确定化学物的入库标准；以医学救援、科学研究、事故处理咨询为信息分级标准，收集本地区可能使用或发生事故的化学品资料。以Visual Bisual2．0为开发平台，Access为数据库后台，开发能运行于Windows 2000／XP操作系统的数据库。结果研制开发了“重庆市化学毒剂数据库”，其收录了包括化学战剂和毒素战剂在内共4200余种化学毒物的理化性质、毒性、中毒原理和救治方法。建立了汉语拼音、汉字、症状等检索平台。结论该数据库操作简便，针对性强，基本满足化学救援需要，具有较好的应用前景。