制定医院火灾应急预案 确保患者灾时撤离安全

医院不同于其他场所,发生火灾时患者的撤离十分困难,有时撤离本身就可能给患者带来伤害。因此,医院必须制定切实可行的应急预案,将火灾时患者安全保障措施都预先制定出来,并通过反复培训演练,使每一位工作人员都熟练掌握。只有这样,火灾发生时才能最大程度地保障患者的生命安全。     

Freedom of choice: Medicaid, managed care, and California family planning clinics.

Access to out-of-plan family planning services for Medicaid beneficiaries enrolled in managed care plans in California has been limited by poor relationships between family planning clinics and contracting managed care plans. Plans either delay or fail to reimburse claims from non-network family planning agencies; family planning staff are unmotivated to identify managed care members through financial screening, to cover costs with other funds, or to refer members back to plan. In addition, plans and clinics fail to coordinate the care of managed care clients by sharing medical records. Based on findings from a pilot project, California will try to facilitate relationships between plans and family planning agencies rather than directly pay out-of-plan claims.     

Health and safety programs for art and theater schools

A wide variety of health and safety hazards exist in schools and colleges of art and theater due to a lack of formal health and safety programs and a failure to include health and safety concerns during planning of new facilities and renovation of existing facilities. This chapter discusses the elements of a health and safety program as well as safety-related structural and equipment needs that should be in the plans for any school of art or theater. These elements include curriculum content, ventilation, storage, housekeeping, waste management, fire and explosion prevention, machine and tool safety, electrical safety, noise, heat stress, and life safety and emergency procedures and equipment. Ideally, these elements should be incorporated into the plans for any new facilities, but ongoing programs can also benefit from a review of existing health and safety programs.     

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.     

Surgical fires: a patient safety perspective

A surgical fire is a fire that occurs on or in a surgical patient. Such fires are rare--they occur in only an extremely small percentage of surgical cases. Nevertheless, the actual number of incidents that occur each year may surprise many healthcare professionals. ECRI estimates that 50 to 100 or more surgical fires occur each year in the United States alone. And such fires can have devastating consequences, not only for the patient, but also for the surgical staff and for the healthcare facility. Fortunately, through awareness of the hazards-and with emphasis placed on following safe practices-virtually all surgical fires can be prevented. Thus, it's important that surgical fire safety be incorporated into formal patient safety initiatives. In this article, we describe a few surgical fire patient safety initiatives that have been instituted in recent years. In addition, we describe in detail the causes of surgical fires and the preventive measures that are available for healthcare personnel to follow. In addition, we review how staff should respond in the event of a surgical fire.     

Educational videos on surgical fires

ECRI has been investigating, reporting on, and teaching about surgical fires for about 30 years. Our experience has shown that most of these fires could have been avoided had the staff been adequately educated about the hazards. Educational videos are just one tool that hospitals can use to provide the fire-safety training that surgical staff require. In this Evaluation, we look at eight videos covering fire safety in the operating room (OR). Our examination focuses on how well these videos address surgical fires in particular, since these can be the most devastating type of OR fire. We rate each video on how effectively it meets the fire-safety training needs of today's healthcare workers. For an educational fire safety video to earn at least an Acceptable rating, it must clearly and correctly explain what surgical fires are, how they occur, how they can be avoided, and how staff should respond if a fire occurs. Only three of the videos meet those criteria. The rest either contain errors, are missing information, or make hazardous recommendations and are rated Not Recommended or Unacceptable.     

Perceived risk of home fire and escape plans in rural households

BACKGROUND: Homes in rural areas have a higher fire death rate. Although successful exit from a home fire could greatly reduce fire-related deaths and injuries, little is known about factors associated with behaviors of developing and practicing an escape plan. METHODS: Between July 2003 and June 2004, a baseline survey was administered, in person, to 691 rural households. Information collected included a history of previous home fire, perceived risk of home fire, existing smoke alarms and their working status, and home fire safety practices, as well as home and occupant characteristics. The association of residents' perceived risk of home fire and fire escape plans was assessed. RESULTS: Forty-two percent of rural households reported having a fire escape plan. Of the households with a plan, less than two thirds (56.9%) discussed or practiced the plan. Households with children were more likely to develop and practice a fire escape plan. Households with an elderly or disabled person were less likely to develop or practice the plan. Compared to respondents who perceived low or very low risk of home fire, those who perceived a high or very high risk had 3.5 times greater odds of having a fire escape plan and 5.5 times greater odds of discussion or practicing their plan. CONCLUSIONS: Increasing awareness of the potential risk of home fires may help occupants develop and practice home fire escape plans. In order to reduce fire deaths and injuries, different strategies need to be developed for those households in which the occupants lack the ability to escape.     

Medication safety issue brief. Change your culture forever. Series II,Part 3

What is it they say about the best-laid plans? They often go awry. It's the same with initiatives to make drug delivery in hospitals safer. An organization can analyze its procedures with the most sophisticated methods and squeeze out every possible chance for error, but the new design will mold with disuse if momentum is lost. There are many ways for an innovation to get derailed: lost enthusiasm, personnel changes, budget cuts. As they mature in the safety process, organizations have to be flexible but also stay firm in maintaining medication safety as a top priority. Keep safety initiatives alive by involving staff, "hardwiring" changes into the system and monitoring their progress well into the future.     

Is heart surgery in the Netherlands sufficiently safe?

Recently the media, including this journal, paid attention to some cases of true or alleged failure of open heart surgery, i.e. mortality due to heart valve replacement, poor outcome in paediatric heart surgery (the so-called Bristol affair), and a series of failed Bj?rk-Shiley mechanical heart valves, thereby questioning the safety of heart surgery. Viewed from a safety perspective, there is a need for criteria for safety assessment of health care services, initiatives aiming at staff exchange and transparency of performance data, and the role of safety committees and safety management plans. Medicolegal developments illustrate the increasing relevance of risk information for patients based on physician experience and hospital performance with respect to maintaining safety standards.     

Burning issue

Unions are blazing angry about the anomalies in hospital fire safety regulations which are putting patients and staff at risk. Phil Cohen investigates.     

Educational videos on surgical fires

One of the most frightening events for any surgical staff member, and one of the most devastating events for any surgical patient, is a fire that occurs on or in the patient during a procedure. Surgical fires, as these are called, are fortunately very rare--but they do occur. ECRI has been investigating, reporting on, and teaching about surgical fires for nearly 30 years. Our experience has shown that most of these fires could have been avoided had the staff been adequately educated about the hazards. Educational videos are just one tool that hospitals can use to provide the fire-safety training that surgical staff require. In this Evaluation, we look at five videos covering fire safety in the operating room (OR). Our examination focuses on how well these videos address surgical fires in particular, since these can be the most devastating type of OR fire. We rate each video on how effectively it meets the fire-safety training needs of today's healthcare workers. The videos run the gamut from excellent to unsafe. We rate one Preferred because it contains particularly detailed information, and we rate another Acceptable because it provides good information overall. Two other videos are Not Recommended--the information in one of them, while good, is incomplete, and the other focuses too broadly on OR fires, with not enough emphasis on surgical fires. The fifth video provides two dangerous recommendations and is therefore Unacceptable.     

Preventing surgical fires: who needs to be educated?

BACKGROUND AND CASE STUDY: Surgical fires are rare but preventable. During facial surgery for a 68-year-old man, a fire broke out, resulting in first- and second-degree burns after a nasal cannula ignited in an oxygen-rich environment because of improper draping and tenting. DISCUSSION: Operating room (OR) fires can be prevented if any component of the "fire triangle"-fuels, ignition sources, and oxidizers-is reduced or eliminated. The use of supplemental oxygen in the OR via nasal cannulae, nebulizers, and oxygen cylinders must always considered a potential source of fire. Deficits in knowledge among the surgical team with respect to the prevention and management of surgical fires were apparent. A plan was put into place to improve fire safety education, entailing an educational program that is included in intern and resident orientation. Surgical fire safety training was also put into place for anesthesia and surgical faculty. The anesthesia preoperative evaluation was modified to include an assessment of the patients' ability to tolerate short periods without oxygen. Posters and signs are now displayed in each OR suite. A complete policy review and update ensures that at least two fire drills are performed annually. CONCLUSION: Surgical fires can usually be prevented by educating staff about risk and prevention strategies. Such education should be part of all undergraduate medical, nursing, and other allied health profession education.     

Health and safety--4: don't play with fire

Continuing his autumn series of health and safety Mr A. Smith turns his attention to fire precautions. He talks about organisation and arrangements which exist in hospitals to ensure that all precautions are taken, that staff are trained and that the Health and Safety at work Act is observed.     

Prevalence of residential smoke alarms and fire escape plans in the U.S.: results from the Second Injury Control and Risk Survey (ICARIS-2)

OBJECTIVES: This study was conducted to estimate (1) the proportion of U.S. homes with installed smoke alarms and fire escape plans, and (2) the frequency of testing home smoke alarms and of practicing the fire escape plans. METHODS: The authors analyzed data on smoke alarms and fire escape plans from a national cross-sectional random-digit dialed telephone survey of 9,684 households. RESULTS: Ninety-five percent of surveyed households reported at least one installed smoke alarm and 52% had a fire escape plan. The prevalence of alarms varied by educational level, income, and the presence of a child in the home. Only 15% tested their alarms once a month and only 16% of homes with an escape plan reported practicing it every six months. CONCLUSION: While smoke alarm prevalence in U.S. homes is high, only half of homes have a fire escape plan. Additional emphasis is needed on testing of installed smoke alarms and on preparedness for fire escape plans.     

Agricultural safety efforts by county health departments in Wisconsin.

OBJECTIVE: The authors sought to improve the agriculture safety prevention efforts of county health departments in Wisconsin by examining current programs, staffs'' perceptions of the farm safety problem, and the need for new resources. METHODS: A survey instrument was completed by a professional staff member of the local health department in each of Wisconsin''s 69 counties. RESULTS: Usable responses were obtained from 84% of the counties. Forty-five percent of the responding staff members conducted some agricultural safety and health programs, most often health screenings or group meetings conducted collaboratively with county agricultural Extension agents. There were no major differences in county demographics or other service provision variables between staff members who conducted programs and those who did not. Staff members perceived the largest barriers to better safety as lack of staff time and difficulty getting farmers to attend safety programs. Most failed to place more emphasis on training agricultural workers to permanently correct hazards than on training them to work safely around hazards. However, the staff members ranked safety inspection checklists as the most needed new material and ranked Extension agents and farmers as the most appropriate people to conduct inspections using such checklists. CONCLUSION: County public health professionals want more staff time and new materials to increase the effectiveness of their agricultural safety efforts. Encouraging agricultural workers and family members to identify and correct hazards would be a more effective use of staff time than training people to work safely around hazards.     

Ifs,maybes and butts: factors influencing staff enforcement of pupil smoking restrictions

Levels of pupil smoking are reported to be associated with the extent to which school staff consistently enforce smoking restrictions. Little is known, however, about factors which might motivate or discourage staff from doing so. Following analysis of interviews conducted with 27 members of school personnel purposively selected from two Scottish secondary schools serving relatively deprived communities, this paper identifies various issues that hinder staff intervention when confronted with pupil smoking. Both schools had no-smoking policies. In each, staff assumed or understood that smoking within the buildings was forbidden, yet were unsure about how far the bans extended. While the risk of fire in the school buildings prompted staff to intervene when smoking was witnessed indoors, where this risk was absent, decisions were largely context dependent or motivated by personal and professional values. Concerns about staff-pupil relationships, attention to pupils' wider welfare, lack of authority and staff levels of discomfort were salient issues inhibiting intervention. Implications for smoking policies and their enforcement are discussed. The concept of the Health Promoting School is considered in the light of the findings and inherent tensions highlighted.     

Smoking policy in long-term care: a survey of administrators in San Francisco

Despite the fact that smoking is a ubiquitous yet potentially hazardous behavior in long-term care settings, little previous investigation has been made into the construction or implementation of policy to manage smoking by elderly residents. This survey of administrators in long-term care facilities in San Francisco city and county reveals that fire and safety issues were the prime forces motivating smoking policy, which operated through control of behavior rather than by other available means, such as the use of fire retardant aprons. Although all facilities permitted smoking, a hierarchy of limit setting strategies was adopted, strategies which successively and evermore intrusively overrode the resident's autonomy and turned smoking policy from beneficent philosophy into a coercive moral statement. Arranged in order of frequency of occurrence and increasing degree of restriction, these strategies were: (a) designating appropriate locations; (b) controlling smoking opportunities and materials; (c) requiring staff supervision or help; (d) limiting the availability of staff help; and (e) writing Doctor's orders. By acknowledging the tensions between ambivalent goals inherent in smoking in long-term care, administrators could devise policies and procedures that are both supportive of collective rights and less corrosive of individual ones.     

Checklist to meet ethical and legal obligations to critically ill patients at the end of life

Despite improvements in communication, errors in end-of-life care continue to be made. For example, healthcare professionals may take direction from the wrong substitute decision-maker, or from family members when the patient is capable; permit families to propose treatment plans; conflate values and beliefs with prior expressed wishes or fail to inquire about prior expressed wishes. Sometimes healthcare professionals know what prior expressed wishes are but do not respect them; others do not believe they have enough time to have an end-of-life discussion or lack the confidence, willingness and skills to manage one. As has been shown in initiatives to improve in surgical safety, the use of a checklist presents opportunities to potentially minimize common mistakes and errors. When engaging in end-of-life care, a checklist can help focus on what needs to be communicated rather than how it needs to be communicated. We propose a checklist to support healthcare professionals in meeting their ethical and legal obligations to patients at the end of life. The checklist should minimize common mistakes, and in situations where irreconcilable conflict is unavoidable, it will ensure that both healthcare teams and family members are informed and prepared.     

Web-based training course for evaluating radiological dose assessment in NRC's license termination process

As part of the requirement for terminating the licenses of nuclear power plants or other nuclear facilities, license termination plans or decommissioning plans are submitted by the licensee to the U.S. Nuclear Regulatory Commission (NRC) for review and approval. Decommissioning plans generally refer to the decommissioning of nonreactor facilities, while license termination plans specifically refer to the decommissioning of nuclear reactor facilities. To provide a uniform and consistent review of dose modeling aspects of these plans and to address NRC-wide knowledge management issues, the NRC, in 2006, commissioned Argonne National Laboratory to develop a Web-based training course on reviewing radiological dose assessments for license termination. The course, which had first been developed in 2005 to target specific aspects of the review processes for license termination plans and decommissioning plans, evolved from a live classroom course into a Web-based training course in 2006. The objective of the Web-based training course is to train NRC staff members (who have various relevant job functions and are located at headquarters, regional offices, and site locations) to conduct an effective review of dose modeling in accordance with the latest NRC guidance, including NUREG-1757, Volumes 1 and 2. The exact size of the staff population who will receive the training has not yet been accurately determined but will depend on various factors such as the decommissioning activities at the NRC. This Web-based training course is designed to give NRC staff members modern, flexible access to training. To this end, the course is divided into 16 modules: 9 core modules that deal with basic topics, and 7 advanced modules that deal with complex issues or job-specific topics. The core and advanced modules are tailored to various NRC staff members with different job functions. The Web-based system uses the commercially available software Articulate, which incorporates audio, video, and animation in slide presentations and has glossary, document search, and Internet connectivity features. The training course has been implemented on an NRC system that allows staff members to register, select courses, track records, and self-administer quizzes.     

新发展理念下新能源行业消防安全的主要风险与对策

本文旨在探讨新发展理念下新能源行业消防安全主要风险与对策.文章以能源使用发展的变化与趋势为切入点,立足"十四五"发展规划趋势,围绕新能源产业布局和基本特点,从消防安全角度分析研判新能源产业常见的风险与挑战,结合消防救援工作实际,提出规范消防安全管理、强化灭火救援准备和提升现场处置技战术水平的对策建议.