南方某市地铁车站空气PM2.5中重金属特征及健康风险评估

目的对南方某市地铁车站空气PM_(2.5)中重金属特征及健康风险进行分析和评估。方法以南方某城市的1个地铁车站作为研究对象,在车站地面外环境设置1个采样点、车站内设置2个采样点,共设置3个采样点。每天24 h采集空气PM_(2.5)样品,连续采样3 d。分析PM_(2.5)样品中10种重金属As、Cr、Cd、Ni、Hg、Pb、Mn、Sb、Se、Cu的浓度。采用美国环境保护局推荐的健康风险评价模型对重金属通过呼吸途径引起的人群健康风险进行评估。结果地铁车站空气PM_(2.5)中的10种重金属浓度范围从0.06 ng/m~3～49.22 ng/m~3。地铁车站空气PM_(2.5)中Mn、Cr、Ni的浓度分别是外环境空气PM_(2.5)中相应浓度的3.75倍、2.23倍、2.12倍。地铁乘客人群当每日在地铁内暴露时间达到5 h以上,重金属Cr对于人群可能存在致癌风险(10~(-6));当每日在地铁内暴露时间达到8 h以上,重金属As对于成年男性人群可能存在致癌风险(10~(-6))。地铁车站空气PM_(2.5)中Mn、Cu、Pb、Se、Hg和Sb对人群的非致癌健康风险较小。结论地铁车站空气中颗粒物已成为人群重金属暴露的重要来源之一。应进一步关注地铁车站空气PM_(2.5)中重金属对于长时间暴露人群可能存在的健康风险。     

安全疏散设施设计备忘录

医院建筑一旦发生火灾,怎样确保建筑内的人员在最快的时间内逃生呢?从消防专业的角度看,安全疏散设施的设计举足轻重. 这是因为,医院建筑功能复杂,人员多元且集中,大多数患者自主疏散能力弱或者完全缺乏,个别患者遇到火灾威胁,只能靠他人担抬、背身进行疏散,这些都无疑增加了医院在遭遇火灾时疏散人员的难度.     

行动障碍人员在火灾中的行为研究

多年来,我们一直在进行“行动障碍人员在火灾中的行为研究“,特别关注医院建筑领域中的行动障碍人员设计的场所,例如:在综合医院和老人医院里,火灾似乎格外留有情面.这些场所的特殊设计和经过专门培训的工作人员,都能将行动障碍人员从火灾现场成功疏散.一项针对医疗卫生单位火灾发生时的人员行为调查显示,即使病人身处在危机情况之下,经过训练的护理人员也能够将他们从火灾中成功救助出来.……     

广州地铁二、八号线车站氡浓度水平调查

目的了解广州地铁二、八号线车站氡浓度水平及所致工作人员有效剂量。方法采用CR39氡探测杯对16座车站~(222)Rn累积浓度进行了测量分析,计算了所致工作人员年有效剂量当量。结果 16座车站~(222)Rn浓度均值为40.7 Bq/m~3。~(222)Rn子体所致工作人员的年有效剂量当为0.293 mSv/a。结论广州地铁地铁二、八号线16座车站氡及其子体未给地铁工作人员带来额外的放射性剂量负担。     

高层民用建筑设计防火规范

6.1.8 为保障高层建筑内发生火灾时人员的疏散安全，本条对房间面积和开门的数量作了规定。只规定疏散走道和楼梯的宽度，而不考虑房间开门的数量，即使门的总宽度能满足安全疏散的使用要求，也会延长疏散时间。假如面积较大而人员数量又比较多的房间，只有一个出口，发生火灾时，较多的人势必拥向一个出口，这会延长疏散时间，甚至还会造成人员伤亡等意外事故。因此本条规定房间面积不超过60m^2时，允许设一个门，门的净宽不应小于0.90m。     

高层民用建筑设计防火规范

六、大多数火灾案例表明,人员死亡绝大部分都是由于吸入有毒烟气而窒息死亡的。因此,对这类场所做出了防排烟要求。七、疏散指示标志的合理设置,对人员安全疏散具有重要作用,国内外实际应用表明,在疏散走道和主要疏散路线的地面上或靠近地面上设置发光疏散指示标志,对安全疏散起到很好的作     

上海市地铁地下车站室内微生物气溶胶分布特征分析

目的 了解上海市地铁车站室内空气中微生物分布状况。 方法 对地铁车站站台环境和室外环境中的细菌、真菌进行采样检测,并对数据进行统计学分析。 结果 车站内细菌菌落数低于室外对照点,真菌菌落数则高于室外,差异均有统计学意义(P<0.05)。地铁车站内颗粒粒径在4.70 μm以上的微生物数量低于室外对照点,差异有统计学意义(P<0.05)。地铁车站空气中微生物主要附着于0.65~4.70 μm粒径的颗粒物上。 结论 由于5.00 μm以下的颗粒可以进入到人体下呼吸道,富含致病微生物的颗粒物会对人体健康带来危害。地铁车站内粒径在5.00 μm以下的微生物气溶胶应成为重点监控对象。     

火灾情境下公交车自动破窗装置的研究

针对当前公共汽车火灾事故多发的现状,为方便人员迅速逃生,通过车窗玻璃应力、弹簧动力、人员疏散模型的验证,设计出一套火灾情境下的公交车自动破窗装置。该装置具备两种启动方式,其一为发生火灾或其他紧急情况时,温度感应装置感应环境温度达到设定阈值,接通自动控制电路,电磁铁吸引控制插销复位,弹簧储存的能量瞬间转化为撞击钢针的动能释放出来而击破车窗玻璃,达到破窗逃生的目的。其二为人工控制,由司机通过控制按钮接通电路,使装置直接实现破窗目的。装置运用于公交车,能有效节约火灾等紧急情况下的人员疏散时间。     

新加坡地铁安全管理的做法与经验

据报道,新加坡地铁是世界上最安全的地铁之一。新加坡地铁设备设施配置、遇到火警后逃生路线设置、乘客疏散到火灾救援以及管理方面非常值得我国借鉴。     

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。     

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.     

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。     

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。     

地铁化学恐怖袭击突发事件应急处置研究

地铁深入地下，空间狭小，人员密集，发生化学恐怖袭击突发事件易造成人员大量伤亡，神经性毒剂和全身中毒性毒剂隐蔽性强、毒性大，成为袭击地铁化学毒剂的首选。处置此类事件应防治结合，宅善结构设计，加强训练和宣传，提高综合指挥能力，实时监删，增强消防部队侦检、防护及快速应变等处置能力：     

移动式生命支持系统——一种快速院前处置和途中连续救治装备

目的：设计一种移动式生命支持系统,能适应突发灾害事故或未来局部战争中伤员现场救护和后送的需要。方法：分析突发灾害事故或未来局部战争伤痛员的特点和勤务救治要求,结合内嵌设备结构及急救器材与药品的配置,采用先进的计算机辅助设计软件,对系统框架整体结构、设备安放位置、固定方法、干涉情况、操作性能等进行仿真设计。结果：设计的系统能推、能抬,能加载在多种运载工具上,进而快速投放至急救现场展开急救．使危重病现场救治规则、卫勤保障原则更趋于合理,提高抢救成功率。结论：设计的系统结构新颖,布局合理,功能齐全,操作方便,为突发灾害事故或未来局部战争中伤病员现场抢救．以及伤病员长距离转移过程中不间断急救复苏．提供了一种新型的综合急救装备。     

地铁站勤务人员个体噪声暴露的监测与分析

目的 采用个体噪声暴露测量方法,了解地铁站勤务人员噪声暴露的水平和特点,为地铁站勤务人员的噪声职业危害控制提供依据。方法 以城市地铁某线路6个站点的4类岗位勤务人员为对象,用记录式噪声个体计量仪对地铁运行时间段内各岗位勤务人员进行个体噪声暴露测量。结果 城市地铁站的现场复杂,噪声源数量多、不稳定。在受检的48名勤务人员中,车站机房岗位的工作班内加权平均等效A声级（LAeq）水平最高为（81．8±2．5）dB（A）,车站控制岗位班内加权平均LAeq最低为（68．7±1．8）dB（A）;车站厅巡岗位班内加权平均LAeq水平极差最大为8．1dB（A）,车站控制岗位班内加权平均IAeq水平极差最小为4．0dB（A）。结论 地铁站勤务人员个体噪声暴露极不均一,用个体噪声暴露测量方法能较灵敏、完整地反映地铁站勤务人员的复杂噪声暴露状况。     

我院门急诊信息系统的构建

目的研制开发符合医院实际的门急诊信息系统。方法利用网络技术、数据库技术和实用开发工具,在现代医院管理理念的指导下研制开发门急诊信息系统。结果研制开发了包括急诊医生工作站、急诊护士工作站、门急诊综合查询系统等20余个功能模块,基本满足了我院门急诊医疗、护理工作的需要。结论门急诊信息系统优化了门急诊工作流程.改善了门诊"三长一短"现象,提高了医生工作效率、医疗护理质量和医院管理水平。     

疗养院总服务台工作常见问题

本院自联勤后,疗养院总服务台工作性质、工作内容及人员结构都发生了变化,业务工作和人员素质面临一些新的问题;本文在分析这些常见问题的基础上,提出加强培训、规范管理、及时引导、和谐处事的有关对策。     

我院急诊外科就诊病种分析

目的研究近三年来我院急诊外科就诊患者的病种分布规律。方法选取2009年1月1日至2011年12月31日来我院急诊外科就诊的共计60244例患者资料,对其年龄、性别、时间分布、病种排序等进行回顾性分析。结果就诊病例中男性患者为36164例,多于女性患者24080例,性别比为1.5:1,以21～40岁组的中青年为多,60岁以上的老年患者有明显增多的趋势,7～9月份为外科急诊病人就诊的高峰期,17:00～19:00为每天就诊时段分布的最高峰,创伤病人仍多于非创伤病人,但有减少趋势。结论应重视急诊外科就诊病种的变化规律,把握急诊外科工作重点和发展方向,加强医务人员及设备的合理配置,开展针对性的创伤救治技能培训,完善应急预案。