移动式销毁日本遗弃化学武器的医学风险与防范措施

目前,我国已有10余个省发现侵华日军战败后遗弃的化学武器（JACW）[1-4],其中毒气弹累计已达200多万枚,化学毒剂至少100余吨。移动式（TSD）销毁JACW是一种新的、更为灵活和实用的化学武器销毁方法。通过采用TSD销毁我国南京某单位JACW的实践,我们对销毁JACW作业过程中的医学风险（主要是指化学毒剂泄漏及人员被化学毒剂沾染及致伤的风险）和防范措施进行了深入分析。现报告如下。     

日遗化武移动式销毁作业突发事件预测及应急救援策略的制定

目的预测南京日遗化武(JACW)移动式销毁作业中可能发生的突发事件,探讨其应急医学救援流程。方法调查JACW的种类、销毁作业流程,评估作业风险,据此预测突发事件中可能出现的伤情种类和伤员数量,配置医学救援力量,制定救治流程。结果在南京托管库保存的JACW化学战剂有二苯氰胂、二苯氯胂、苯氯乙酮、芥子气及路易气,以前两者数量居多;多数是毒气筒,少数是炮弹。预测单次销毁作业突发事件伤员数量达4~7人,重伤2~3人。预测伤情类型包括化学武器伤(毒剂伤)、烧伤、爆炸伤和混合伤。救治流程如下:根据化学战剂的种类和伤者特殊表现迅速判定患者的综合情况;根据化学战剂种类和损伤部位选择正确的洗消方法;救治伤员应按红卡(需立即救治)、黄卡(可稍后处理)、绿卡(可延期处理)及黑卡(濒死或死亡)分类并进行救治。结论预测JACW移动式销毁作业中可能发生的突发事件,根据调查结果科学配置应急救援力量,制定救治流程,可为其他同类作业提供重要参考。     

脑损伤患者康复阶段的护理风险管理

在我院接受脑损伤康复治疗的患者多数伤情重,伴随的并发症多,病情复杂,康复治疗手段多样,护理风险始终存在于康复训练、护理操作、病情观察、抢救配合等护理过程中,为规避护理风险,保障患者安全,从2010年2月起,我院将护理风险管理方法运用于脑损伤康复中心病区中,通过识别脑损伤康复阶段专科护理中所存在的风险因素,实施风险管理措施,取得了满意效果。     

原油运输作业对船员健康的影响

原油运输作业对船员健康的影响赵光美随着我国石油工业的发展，从事原油运输作业的工人日益增多，对石油运输过程中的劳动卫生问题也愈来愈为有关部门所重视。为了解其危害情况和为制订防护措施提供依据，我站自１９７８年至１９８４年调查了原油运输船２３艘共１００５人...     

医疗安全风险干预研究

目的：制订医疗安全风险预警的有效干预措施。方法：针对医疗服务存在的风险,通过系统追踪,结合循证和专家共识,从整个系统层面提出可行的干预措施。结果：根据医疗安全风险的规模、形式、强度及发展趋势,将医疗安全风险预警分为五级,采用时限管理的方式,特殊情况立即启动应急方案。结论：干预是医疗安全风险预警机制有效实现的关键。     

军队医院医疗风险管理的探讨

风险管理是通过风险识别、风险估测、风险评价等方式,对风险实施有效控制和妥善处理,以最小的成本获得最大安全目标的管理过程。医疗风险是指存在于整个诊疗过程中,可能会导致损失和伤残事件的不确定性或可能发生的一切不安全事件。加强医疗风险防范,对避免医疗事故、医疗差错、医疗意外,以及并发症的发生具有重要意义。     

ICU潜在护理风险分析及对策

护理风险是指医院内病人在护理过程中有可能发生的一切不安全事件。ICU是一种现代化的先进医疗护理组织形式,主要作用是应用现代化的仪器设备来监护患者,以便及时地发现潜在的危险（主要是心、肺、肝、肾方面）包括可危及生命的或可导致患者残废的严重变化。由于护士是与病人接触最密切的医务人员,因此风险事件大多发生在护理工作中,及时识别发现工作中潜在的风险事件,对提高护士风险防范意识,预警风险的发生,保障病人医疗、护理的安全,将起到积极作用。如何保证护理安全,发现护理潜在风险和降低护理风险系数是每个护理工作者的重要任务。本文结合我院综合性ICU护理中存在的或潜在性护理风险问题对ICU风险的防范探讨如下。     

军队医院抗震救灾卫勤保障的几点思考

笔者通过回顾2008年"5·12"汶川大地震的特点和我院执行抗震救灾卫勤保障工作的完成情况,针对军队医院抗震救灾卫勤保障在策划、准备、组织、协调、开展等方面的工作流程、任务标准,分析了当前医疗机构在抗震救灾卫勤保障实施过程中存在的难点与不足,同时结合问题提出一些策略和措施.     

刍议医院高风险患者的管理

高风险是指某件可能发生的事件所造成的损害超过预期水平和可控范围;高风险患者管理是指患者在整个就医过程中可能或已出现技术风险、服务风险、管理风险以及法律风险,且该风险超出患方或医方可承受的期望值,需要医方通过加强诊疗技术、提高服务质量、强化管理等手段来预防或消除医疗纠纷和事故的发生,     

舰艇编队出访卫勤保障应注意的问题

1995年以来 ,我处先后 4次组织了舰艇编队出访卫勤保障 ,由于使命特殊 ,人员编成复杂 ,航行距离远 ,卫勤保障的重点、难点多 ,我们重点注意抓好以下问题 ,有力地保障了出访任务的顺利完成。1　指导思想上要防止“偏”每次编队出访应根据航行距离、航行时间、航行海区、经历的季节和时区转换 ,以及被访国家的疫情状况等特点 ,在卫勤组织、任务区分、卫勤力量配备、药品器材筹措、卫生防病措施及危重症伤病员处置等方面要借鉴以往出访的经验 ,注意综合分析 ,统盘考虑 ,防止顾此失彼 ,要从最困难和可能出现的新情况出发 ,制订多种预案 ,做好多…     

北京市接收汶川地震转运伤员过程中的伤检与流程

目的 通过对四川汶川大地震中需要长途转运伤员病情的了解和生命体征的检测,探讨地震期间大规模伤员转运的伤检与流程特点. 方法 北京市卫生局赴四川抗震救灾救护转运队第二分队共接收转运伤员197例,其中男106例,女91例;年龄6～81岁,平均37.5岁.在整个转运过程中,行2次"两查四对一评分";并在转运途中保持各医疗小组间的密切合作. 结果 197例伤员中,194例安全转运,3例伤员在接收时因病情不稳定送回原医院继续治疗.转运的194例伤员中,181例病情平稳,未诉不适,7例骨折伤员在搬运及车辆行进中诉患肢疼痛,2例挤压综合征伤员诉胸闷、气短,2例胸部挤压伤的伤员因路途颠簸而加重胸部疼痛,另外2例伤员诉头晕,恶心.所有不适伤员均给予生命体征监测及对症治疗. 结论 在地震期间大规模转运伤员时,充分的准备、严格的伤检及良好的医护配合,是完成安全转运的保证.转运途中,各医疗小组间密切合作,对伤员伤情的详细了解,必要的监护及治疗,充分的医患交流及认真详尽的后期交接足伤员成功转运的关键.     

一批35例烧伤伤员远程转运组织工作的成功经验

目的 总结组织35例烧伤伤员一次性远程转运的成功经验.方法 2006年5月黑龙江某地35例不同程度烧伤伤员,通过航空转运至北京.对转运的组织、指挥工作中的成功经验进行分析、总结.结果 专家医疗组到达后,经20h充分做好转运前准备工作,经4h航空转运,全部伤员均安全、顺利到达接收地.结论 转运前迅速处理危及生命的并发症,稳定伤情,防治继发损伤;制定转运计划,安排转运工具、人员,备齐相关器材、药品,协调出发地、接收地的陆空、空陆衔接,尽量缩短转运时间;任务布置明确,落实确实,责任到人是保证本批伤员长途转运成功实施的关键.     

地震伤员转运救援影响因素分析

目的 分析汶川地震伤员转运医疗救援中的影响因素. 方法 借助第三军医大学附属西南医院院前急救预案配置协调指挥人员、受过心理专业培训的急救专科医护人员和后勤保障人员进行转运伤员以及途中早期施行全程心理疏导. 结果 汶川地震伤员转运救援中,我院救援队员借助院前急救预案、专用器材库支持、整体救援模式和对伤员施行心理疏导,成功转运162例伤员. 结论 本次转运救援模式运行与途中心理救援实践提示,后方医院应建立应对特大灾害伤员心理应激的救援体制,建立健全应对特大灾害远程前接转运救援预案,完善与稳定应对特人灾害批苗伤员远程救援的专业医疗队伍以及建立和完善远程转运的专用医疗物资器材库.     

休克期飞机转运成批严重烧伤病人的探讨

休克期长途转送严重烧伤病人危险性较大，以往对路程较远者多不主张长途转运，作者于2000年8月经过各方面的努力和认真准备，成功地用飞机在休克期长途转送了一批危重烧伤伤员，经过顺利，所有伤员经过积极的有效的后续治疗全部成活。因此作者认为只要处理好各个环节，加强转送途中伤员的病情观察和处理，可以在休克期用飞机长途转送危重烧伤伤员。此次转运为以后战时烧伤伤员转送积累了经验。     

63例特重烧伤休克期转运的体会

目的探讨特重烧伤休克期转运的可能性。方法收集分析近5年9批63例伤后48h内转运的特重伤员资料。结果全部伤员均成功平稳转运,除2例分别于伤后9、19天死于多脏器功能衰竭外,余61例全部治愈。结论特重烧伤原则上应就地抗休克后转运,当治疗条件太差时,应迅速补充血容量后在继续补液的同时用快速平稳的运输工具转运。     

Heat stress and carbon monoxide exposure during C-130 vehicle transportation

INTRODUCTION: Running gasoline engines in a confined space causes heat stress and carbon monoxide (CO) buildup. Loading the C-130 aircraft by driving the vehicles onto the platform may expose the C-130 cabin crew to these environmental hazards. This study was aimed at investigating heat stress and CO exposure in the C-130 cabin during vehicle airlift. METHODS: There were four summer flights (two two-vehicle, two three-vehicle; 2 d, 2 nights) studied. The cabin heat stress index (wet bulb globe temperature, WBGT) and CO levels before vehicle loading (control) were compared with those after vehicle loading. Furthermore, two- and three-vehicle transportations, as well as day and night transportations, were compared. RESULTS: Ground temperature ranged from 18.2 to 33.4 degrees C. Mean heat stress index was higher in vehicle transportation than control flights, the greatest difference being 5.9 degrees C (p < 0.001). The WBGT levels exceeded the recommended exposure limit in 28 of 38 measurements during day flights. The cabin heat stress increased sharply with vehicle loading, and continued to increase for a range of 60-140 min after loading. Elevated cabin CO levels were found in three-vehicle flights as compared with two, and in night flights as compared with day. CONCLUSIONS: In hot climates, C-130 vehicle transportation may exacerbate heat stress. The in-flight heat stress can be predicted by the ambient temperature, duration of the vehicle transportation, and number of transported vehicles. The cabin CO level is related to the number of transported vehicles. We recommend the use of effective environmental control systems during C-130 vehicle transportation in hot climates.     

The anesthesiological-resuscitation aspects and the medical problems of catastrophes

Anaesthesiological and resuscitation service is a special component of disaster medicine. It is of paramount importance in LSFA (life-supporting first aid) training of the lay public. Lack of knowledge and inadequate application of LSFA are estimated to increase the mortality rate of disaster victims by 40%. The paper discusses quantity and quality of anaesthesiological and resuscitation aid delivered immediately at the disaster scene, during triage before and after evacuation, during transportation. Much attention is devoted to pain management and infusion therapy performed at the disaster scene and during transportation.     

To pop a balloon: aeromedical evacuation in the 1870 siege of Paris

H. G. Armstrong, in the 3rd edition of his Principles and Practice of Aviation Medicine stated: "The first use of air transportation in support of medical activities occurred during the siege of Paris in 1870 when a total of 160 patients were removed from that city by means of an observation balloon." Careful review of the available literature and of reports during and subsequent to that time have offered no corroboration of this statement, whereas the names and missions of some 167 balloonists and passengers are amply documented. An extensive bibliography and footnotes, available upon request from the author, attest to the multiple uses to which this new form of transportation was put; unfortunately, aeromedical evacuation was not one of them.     

化生颗粒在人体微通道内悬浮运动的数值模拟研究

目的 研究化生颗粒(CBP)在人体微通道内悬浮运动特性,以提高化生防护技术水平.方法 应用耗散粒子动力学(DPD)方法研究人体微通道内CBP的运动特性.结果 通过在模型内施加压力梯度和采用无滑移边界条件等方法,可确保模型内流体达到理想的Poiseuille流动状态.除在通道壁面附近外,连续相颗粒速度和CBP速度均匹配较好.在受约束通道的近壁面区域,CBP趋向于聚集,其浓度有轻微的增加,最终这种约束会引起阻塞效应,从而产生颗粒聚集现象.结论 掌握了CBP在人体微通道内的悬浮运动特性,针对CBP的运动特点,可有针对性地研制CBP过滤防护装置,系统提升我军化生防护技术水平.     

One year's trauma mortality experience at Brooke Army Medical Center: is aeromedical transportation of trauma patients necessary?

The purpose of this study was to review whether air ambulance transportation of trauma patients to the Brooke Army Medical Center (BAMC) level I trauma center contributed to maintaining national mortality standards in the trauma care of these patients. Aeromedical transportation is considered a standard-of-care component of regional trauma systems throughout the United States. Pooled trauma database information from 792 consecutive ambulance-transported trauma patients received at BAMC during the fiscal year from October 1, 1995, to September 30, 1996, were reviewed. The 792 trauma patients were composed of 687 patients transported by ground ambulance and 105 patients who received helicopter aeromedical evacuation. Aeromedical evacuation was associated with increased levels of prehospital medical care and faster transportation than ground ambulance service. The mortality rates (immediate, early, and late deaths) of both ambulance groups were compared with national mortality standards using the internationally recognized Trauma and Injury Severity Score methodology, based on the Major Trauma Outcome Study in 1986 and validated in 1992. The Z test for independent populations demonstrated no statistically significant difference between BAMC trauma mortality rates for either ambulance group compared with national trauma mortality rates. The results suggest that aeromedical evacuation of the more severely injured patients farthest from the BAMC trauma center resulted in mortality rates that met national standards.