空运医疗后送建设的体会与策略

本文分“前期准备阶段、京内集训阶段、银川训演阶段”等三个阶段简要介绍了医院空运医疗队参加卫勤保障演习的基本情况,从“加强领导,统一思想;严密组织,力求实效;科学预想,深入研究;加强协同,严格管理”等四个方面总结分析了空运医疗队参加演习的经验做法,并结合医院以往组织空运医疗后送的实践经验及新时期、新阶段的特点,提出了加强空运医疗后送建设的三点思考与建议,即“进一步提高空运医疗后送的战略地位,进一步加强空运医疗后送的体系建设,进一步完善空运医疗后送的组织指挥”。     

“5.12”地震伤员空运后送的思考

目的总结汶川大地震灾区伤员急救和空运后送的组织管理经验,为各种突发灾害时组织伤员的急救和空运提供有益的参考。方法回顾性分析本院医疗队在汶川县映秀镇组织急救和空运113名伤员的管理经验。结果全部伤员经现场急救后,乘直升机安全飞抵目的地。结论科学救治分类、有力指挥协调是确保伤员急救和空运后送工作有序运行的关键。     

2009年卫勤演习空运后送护理及其装备的实践探讨

介绍了在卫勤演习中空运伤员登机前的医学护理装备、空运后送机上护理及其卫生装备,对空运医疗队防护、消毒和无菌技术提出了要求。通过对国外空运后送装备的分析,指出了国内空运后送装备存在的问题,以期为提高国内空运后送装备提供借鉴。     

空运后送的组织与实施

空运后送在卫勤保障工作中的地位和作用日益突出,本文结合演习实践,对空运后送的组织与实施进行了探讨。阐明了空运后送的相关概念和特点,阐述了空运后送在卫勤保障工作中的地位和作用,并从构建信息化的组织指挥体系、研发现代化的空运后送装备、培养专业化的空中救护力量三个方面总结了空运后送的组织实施要旨。     

海军陆战队远程空运医疗后送探讨

空运后送在卫勤保障中的地位和作用日益突出,海军陆战队是国家执行重大军事任务时的重要力量,作者分析了美军海军陆战队伤员空运后送的现状、存在的问题及要求,并就其空运后送卫勤保障中常用药品、护理设备及医疗人员的配置情况做了总结,明确了提高空运医疗后送能力对于保证海军陆战队战斗力的重要作用。     

空运后送颅脑损伤术后病员的护理

颅脑损伤患者病情多变,病情复杂,其致死率及致残率均居首位,颅脑损伤术后患者病情观察及护理尤其重要,我院驻基地医院医疗队成功的空运一名术后不足24小时的重度颅脑损伤患者,对于如何做好患者病情生命体征的观察、物品充分准备、空运后送过程中的护理以及做好患者的心理护理等,我们进行了总结,现将空中后送中的护理组织与时间报告如下:(临床资料:患者病情、手术名称、时间等介绍)经过术后观察、远程会诊,患者符合后送标准,经上级指示,抓住时机,尽快后送.     

玉树地震伤病员空运后送的几点思考

目的分析玉树地震伤病员后送工作,为完善灾害救援的医疗后送提供科学依据.方法通过对玉树地震医疗后送的系统调研和相关资料的分析,总结分析玉树抗震救灾空运医疗后送流程、分级救治情况及空运后送组织情况.结果玉树地震空运医疗后送总体分三个层次进行,缺乏专用卫生运力,检伤分类策略及分级救治原则不尽完善.结论应建立健全特大地震空运医...     

美军空运医疗后送体系及对我军的启示

回顾了美军空运医疗后送体系的历史和发展过程,介绍了美军空运医疗后送的流程和特点,并与我军空运医疗后送发展现状进行比较,阐明了美军美军的相关经验对我军的启示,为我军空运医疗后送能力的发展提供参考。     

芦山地震黄金救援期伤员空运后送组织与实施

特大地震往往造成灾区医疗卫生体系瘫痪,无法承载大量伤病员救治需求,伤病员快速安全后送是必然选择,而空运后送快速、灵活、有效,是降低伤死率和致残率的关键。本文介绍在芦山地震后72小时内伤员空运后送组织实施体会及对策思考。     

地震批量伤员空运后送体系的构建

文章介绍了汶川地震的震中地区一映秀镇地震伤员的空运后送情况，分析了存在的问题。并以此为背景，对灾害救援中批量伤员空运后送体系的建立进行了探讨，认为建立强有力的组织指挥系统、完善空运后送的救治链是保证批量伤员实施有效空运后送的关键。文章还就建立我国专业空中救援机构提出了建议。     

伤病员空运后送护理与医学准备

通过分析空运情况下对伤病员影响的主要因素,提出了伤病员空运后送前医学准备的主要要求:维持伤病员生命体征的稳定;减少机上医疗护理操作;处置伤病员使其符合航空环境要求。指出伤病员空运后送前医学准备的主要内容包括:对伤病员进行分类,确定其空运后送的顺序;对伤病员进行更换敷料、包扎固定等一般性处置;针对不同的伤类、伤部和伤势进行特殊处置等。     

A research of students' experience of nursing skills in clinical practice of adult nursing (acute period)

The purpose of this research was to find out the state of nursing skill education and tools available to the students in their clinical practice of adult nursing (acute period). The research was carried out between 2005 and 2007, and the subjects were 111 third or fourth degree nursing students who had finished the clinical practice of adult nursing (acute period). The research method was to measure the degree of learning experience and self-appraisal during clinical practice of adult nursing (acute period). This research covered 11 areas of nursing study and 50 items in nursing skills which consisted of "fundamental nursing skills which students do in clinical and practical training", suggested by the investigative commission on the shape of nursing skills by the Ministry of Health, Labor and Welfare, and the basic nursing skill of new graduates which was determined. The result showed that there had been more learning experience during the clinical practice of management of safety, prevention of infection, support of cleaning and changing clothes and observation of symptoms and function of the body. However, there had been less learning experience in support of evacuation and help of breathing and circulation. The result also showed that there was a significant positive correlation between the learning experience in the clinical practice and self-appraisal of the 8 nursing study areas, whereas there was none in the 3 areas of support of eating, support of cleaning and changing clothes and help of breathing and circulation. From the research, it is concluded that it is necessary to devise ways and means to increase the application of nursing skills by the nursing students in clinical practice.     

重型颅脑外伤术中护理体会

目的探讨重型颅脑外伤开颅术的术中护理特点。方法回顾性分析江阴市人民医院2008年80例重型颅脑外伤手术资料,总结护理经验。结果80例患者均行开颅血肿清除术,术中手术顺利,护理方法得当,术后安全返回ICU。74例康复出院,3例死亡,3例自动出院。结论手术室护士掌握重型颅脑外伤的病理生理知识,熟悉手术过程,可提高手术效率。     

Nursing home evacuation plans

Objectives. I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes cited for deficiencies in their evacuation plans.Methods. Evacuation plans were assessed according to criteria developed by an expert panel funded by the Office of the Inspector General. Deficiency citations came from the Online Survey, Certification, and Recording database, collected from 1997 to 2005. Four specific citations, for written emergency plans, staff training, written evacuation plans, and fire drills, were examined with multivariate logistic regression.Results. Most plans had water supply provisions (96%). Only 31% specified an evacuation route. The rate of citations was relatively stable throughout the study period: each year approximately 0.6% of facilities were found to be deficient in written emergency plans, 2.1% in staff training, 1.2% in written evacuation plans, and 7.9% in fire drills.Conclusions. Some nursing homes need more specific evacuation plans. Water supply was the most and evacuation routes were the least well-addressed areas.The US Department of Health and Human Services recently reported that administrators from 5 of 13 nursing homes evacuated as part of Hurricane Katrina described negative effects on residents’ health, such as dehydration, depression, and skin tears. The report further stated that “problems can be tied to a lack of effective emergency planning.”1^(pii)In nursing homes, an important tool used as part of emergency planning is the evacuation plan. Federal law requires that Medicare-and Medicaid-certified nursing homes have written plans for evacuation. Nursing homes are subject to deficiency citations (and fines) if the Medicare or Medicaid survey and certification process determines that they do not have adequate written evacuation plans.State Medicaid programs are responsible for approximately 50% of all nursing home expenditures, and Medicaid recipients consume 70% of all bed days. Because the federal government is such a dominant purchaser of nursing home care, it is also the dominant overseer of care quality. This oversight primarily occurs via the certification process. Titles XVIII and XIX of the Social Security Act require that all nursing homes accepting Medicare or Medicaid residents must be certified. Specific minimum standards were established for this certification, and surveyors inspect facilities for compliance.2 The standards require facilities to have “detailed written plans and procedures to meet all potential emergencies and disasters.”3^(p19) In addition, facilities must “train employees in emergency procedures when they begin work in the facility, periodically review procedures, and carry out unannounced staff drills.”3^(p19)The intent of the survey and certification process is to monitor and ensure quality of care. Several mechanisms are available to the government when facilities fail to meet certification minimum standards. These include varying levels of fines (≤ $10000/day) and termination from the Medicare and Medicaid programs. In all cases, however, when a facility does not meet government standards, a deficiency citation is issued. The deficiency citations (commonly called F-tags) for evacuation planning are F-517 and F-518. F-517 states, “The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather and missing residents.”4^(p32) F-518 states,

The facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.4^(p32)

In addition, incorporated into survey and certification regulations are Life Safety Code requirements (commonly called K-tags). These regulations focus mainly on fire safety but also include evacuation planning procedures, such as K-48 and K-50. K-48 states, “There is a written plan for the protection of all patients and for their evacuation in the event of an emergency.”5^(p42) K-50 states,

Fire drills are held at unexpected times under varying conditions, at least quarterly on each shift. Staff are familiar with procedures and aware that drills are an established routine. Responsibility for planning/conducting drills is assigned only to competent persons who are qualified to exercise leadership.5^(p42)

To my knowledge, the report from the Department of Health and Human Services is the only published document addressing evacuation plans used by nursing homes.1 The authors of the report interviewed 20 nursing home top managers involved with facility evacuation and examined deficiency citations given nationally in 2004 for having no plans or deficient plans for evacuation (codes F-517, F-518, K-48, and K-50). They found that nationwide, 94% of nursing homes met federal standards for emergency plans and 80% had sufficient emergency training. They also found substantial variation in the content of evaluation plans used by the 20 nursing homes examined.I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes (such as for-profit or nonprofit) that received deficiency citations for inadequate plans. My analysis extends the previous research by (1) examining evacuation plans from a large sample (n = 2134) of nursing homes and (2) analyzing longitudinal panel data (1997–2005) from nursing homes (n = 121 779) to determine the types of nursing homes that received deficiency citations for inadequate evacuation plans.     

高层医院建筑火灾人员营救与疏散

阐述了高层医院发生火灾后人员营救及疏散的难点和对策,并结合消防实战演练经验,有针对性的提出了必须即时修订火灾应急疏散预案,开展常态应急疏散演练,坚持＂救人第一＂原则,选择正确疏散方法等以确保人员安全的管理对策。     

便携式护士卫生包在卫生列车后送中的应用

目的：探讨特殊情况下护士卫生包在卫生列车后送工作中的应用。方法：自行研制新型便携式护士卫生包,配备给卫生列车上执行后送任务的护理人员,提供对伤员进行各种基本护理、治疗操作、病情观察、紧急救治的医疗物品。结果：护士卫生包在多次执行卫勤训练和特殊任务中发挥了重要作用。结论：护士卫生包轻便、小巧．具有较强的适用性、有效性和可操作性,是顺利完成卫生列车伤病员后送救治任务的重要装备。     

空运后送对多器官功能障碍（MODS）患者的影响分析及对策研 究

阐述了多器官功能障碍综合征（MODS）的概念及其发病机制，分析了空运后送时高空环境对机体的影响以及空运后送对MODS的影响，同时回顾了国内外对于MODS空运后送的医学研究现状，提出了开展MODS空运后送前瞻性研究的设想。