Career risk of hepatitis C virus infection among U.S. emergency medical and public safety workers

OBJECTIVE: A probabilistic model was used to analyze the cumulative risk of occupational hepatitis C virus (HCV) infection among U.S. public safety workers. METHODS: A model for the career risk of HCV was developed using the frequency of parenteral exposures to blood, the population seroprevalence of HCV, and the risk of seroconversion after exposure. Estimates of key input variables were obtained from published studies. RESULTS: Calculated estimates of the 30-year risk of infection ranged from <0.1% for police, firefighters, and corrections officers to 1.9% among paramedics and emergency department personnel in high-risk communities. Infrequent exposure to high-risk blood seems to present a greater risk of infection than more frequent contact to low-risk populations. CONCLUSIONS: Use of a probabilistic risk assessment model using published data can assist in policy decisions designed to protect the health and safety of workers. Further efforts to document the frequency of occupationally acquired HCV are needed.     

应急医学救援分队医疗设备管理系统的设计

目的：设计一种针对特殊条件下医疗救治相关的智能化医疗设备管理系统,避免在特殊环境下设备物资账目混乱,提高医学救援分队医疗设备管理的现代化水平。方法：设计基于客户机和（或）服务器（C/S）架构,分别采用VBA、InfoPath、智能算法实现DBMS、数据汇总及维修知识库系统,建立基于ACCESS平台的数据中心。结果：本系统实现了救援分队医疗设备编码、日常维护、应急维修、特殊环境下日常维护规划及设备配件管理等功能,提高了特殊环境下设备管理的智能化。结论：本系统具有投资小、效率高的特点,为特殊条件下医疗设备的管理提供了现代化管理手段,为应急医学救援争取了宝贵的时间。     

The formation of the emergency medical services system

The evolution of the emergency medical services system in the United States accelerated rapidly between 1960 and 1973 as a result of a number of medical, historical, and social forces. Current emergency medical services researchers, policy advocates, and administrators must acknowledge these forces and their limitations and work to modify the system into one that provides uniformly high-quality acute care to all patients, improves the overall public health through injury control and disease prevention programs, participates as a full partner in disease surveillance, and is prepared to address new community needs of all types.     

Preventing tuberculosis among health workers in Malawi

OBJECTIVE: Following the introduction of guidelines for the control of tuberculosis (TB) infection in all hospitals in Malawi, a study was carried out to determine whether the guidelines were being implemented, the time between admission to hospital and the diagnosis of pulmonary TB had been reduced, and the annual case notification rates among health workers had fallen and were comparable to those of primary-school teachers. METHODS: The study involved 40 district and mission hospitals. Staff and patients were interviewed in order to determine whether the guidelines had been adopted. In four hospitals the diagnostic process in patients with smear-positive pulmonary TB was evaluated before and after the introduction of the guidelines, with the aid of case notes and TB registers. In all hospitals the proportion of health workers registered with TB before and after the guidelines were introduced, in 1996 and 1999, respectively, was determined by conducting interviews and consulting staff lists and TB registers. A similar method was used to determine the proportion of primary-school teachers who were registered with TB in 1999. FINDINGS: The guidelines were not uniformly implemented. Only one hospital introduced voluntary counselling and testing for its staff. Most hospitals stated that they used rapid systems to diagnose pulmonary TB. However, there was no significant change in the interval between admission and diagnosis or between admission and treatment of patients with smear-positive pulmonary TB. The TB case notification rate for 2979 health workers in 1999 was 3.2%; this did not differ significantly from the value of 3.7% for 2697 health workers in 1996 but was significantly higher than that of 1.8% for 4367 primary-school teachers in 1999. CONCLUSION: The introduction of guidelines for the control of TB infection is an important intervention for reducing nosocomial transmission of the disease, but rigorous monitoring and follow-up are needed in order to ensure that they are implemented.     

Planning for emergency medical services in Boston.

The results of a survey of 10,200 visits to 11 Boston hospital emergency rooms during a 9-day period in March 1972 are presented. The survey was designed to provide data on emergency room use to permit more informed planning by public agencies concerned with improving areawide emergency medical services. The 11 institutions surveyed provided virtually all of the emergency medical services in the city of Boston. A majority are teaching hospitals affiliated with one or more of the three medical schools in the area. Of the 11 hospitals, 3 accounted for 60% of all emergency room visits. Survey data were extracted from emergency room log sheets and hospital medical records of individual patients. Information collected included the residence pattern of patients within the geographic area, the patient mix by degree of urgency based on presenting complaints, mode of transportation to the hospital, and age and sex of the patients. Only 15 percent of the 10,200 visits were true emergencies. Fifty-seven percent were classified as urgant and 28% nonurgent. The mix among the 11 hospitals ranged from 7 to 22 percent in the emergency category, and 11 to 61 percent in the nonurgent classification. Trauma accounted for 19 percent of all admissions, with 3 percent attributed to fractures and 4 percent to head injuries. Fifty-six percent of the emergency cases required the services of an internist or pediatrician, 38 percent a surgeon, and 1 percent an obstetrician. The highest utilization rate--27 per 1,000 population--was recorded for the under 5 age group. Although the 65 and older age group had the lowest utilization rate of 6 per 1,000, this group had the highest rate of visits classified as emergencies. Children under 5 accounted for the highest proportion of nonurgent visits. The survey revealed that 30 percent of all hospital admissions were from the emergency room. One in four emergency patients lived outside the city of Boston. A neighborhood health center and a hospital general practice unit reduced hospital emergency room workloads appreciably, even when they were open only during daytime hours. Eighty-eight percent of all patients arranged for their own transportation, usually by private automobile. Of those arriving by ambulance, only 35 percent were classified as emergencies. The survey data reinforce the conclusion that major planning efforts should be concentrated on the management of the nonemergency patient. The data also emphasize the need for a single agency to be responsible for overall planning for emergency medical services on an area wide basis.     

医院急诊医疗信息管理系统的开发及应用

目的研发临床急诊医疗信息管理系统．满足临床抢救危重病实践需要。方法采用微软可视化编程工具Microsoft Visual Fox Pro．开发医院急诊医疗信息管理的计算机辅助系统。结果用急诊软件统计分析模块、急诊抢救质量控制模块、急诊抢救流程模块、各病种急诊抢救护理模块和抢救培训模块,实现对急诊临床的系统管理．并对急诊统计数据进行处理和分析。结论该系统实用性强．优化急救临床路径．能满足急诊临床抢救的需要。     

灾难应急医疗信息系统平台设计

目的:基于公众无线通信网络,设计开发一个开放式灾难应急医疗信息系统平台.方法:利用APP软件结构化设计方法,分析研究信息系统需求,对系统框架、数据流程、功能模块、系统重要字段进行设计.结果:当无线网络覆盖灾难区域时,该系统平台能及时准确地采集伤员信息,辅助首长机关决策力量部署、制定应急措施和科学救援方案.结论:该系统能在一定程度上提高伤员定位搜索效率,消除手工报袁漏报、误报、迟报、多头上报的弊端,减少决策机关统筹指挥一线力量的中间层级,对灾难应急环境下的伤员救援救活具有重要意义.     

广州市医务人员对公共卫生应急体系建设需求定性调查分析

目的 了解广州市医务人员对公共卫生应急体系的建设需求,旨为政府相关部门的决策提供科学依据。方法 采用小组专题访谈方法,对24家不同级别、类别和性质医疗机构的领导层和主要业务科室工作人员共220名医务人员召开24次专题组讨论;对记录的文字资料进行逻辑分类和分析。结果 83．7％医务人员因对SARS有所了解、个人防护措施得到了加强,不害怕SARS重来,11．2％医务人员主要担心SARS防控设施不符合规范或SARS影响经济收入;绝大部分医疗机构及医务人员（72．5％）对政府应对突发公共卫生事件有信心;公共卫生应急体系尚存在资金不足,信息流不畅通等方面不足,并提出加大防病经费投入、加强信息沟通及人才培养等需求。结论 应用专题访谈定性方法具有深入收集资料、观点及意见的优势。公共卫生应急体系建设应着重在专项经费投入、防疫网底巩固、信息整合及多方联合演练等方面加强整体配置和高效管理。     

我国空中医疗急救发展现状与体系构建建议

目的 探讨我国空中医疗急救发展现状及体系构建策略。方法 基于现有资料分析我国空中医疗急救发展现状、模式、问题与挑战。结果 近年来我国通航企业及飞行器数量发展迅速,但是存在总体不足、多数通航企业规模较小等问题。空中急救网络主要有航空公司主导、医院或急救中心主导、通航企业-医院联合和政府主导4种发展模式;各模式均为自由发展,距离国家规划的目标尚远;现有体系内要素分散、结构不完整,大范围的空中急救网络尚未形成。结论 我国地形复杂,建成覆盖面广、运行模式统一的空中医疗急救网络困难较大,建议全国范围内构建多个主体共同参与的多元化区域性空中急救体系,而在青藏高原及周边区域优先构建公益性空中医疗急救体系。     

新疆179家医院突发事件医疗应急救援管理体系现状调查

目的 评价新疆医院突发事件医疗应急救援管理体系建设现状,为提高突发事件医疗应急救援能力提供依据.方法 2019年3-5月,采取整群抽样的研究方法,对新疆二级及以上医院的应急管理现状、应急制度、应急预案、应急专家组、应急演练等情况进行调查,并对结果进行汇总分析.结果 共有179家医院参与调查并回收有效问卷,占新疆所有二级...     

A hybrid FLEET model for emergency medical service system design

Covering models have been used to locate emergency services such as ambulance and fire protection systems. As an example, in the late seventies, an analysis of the Baltimore, Maryland fire protection system was conducted with the development and use of a covering model called the Facility Location and Equipment Emplacement Technique (FLEET). The FLEET model combined the location of fire stations with the allocation of primary and special service equipment to the stations. Further, in a recent study of Austin, Texas the ambulance system was restructured based on the use of a covering model. Covering models have also been extended to handle some of the special circumstances involved in emergency service systems. One example is the maximal expected coverage problem (MEXCLP). This paper presents a new covering model which utilizes both the special coverage structure of the MEXCLP and the simultaneous station location and equipment allocation of the FLEET model. Optimal solutions are found using linear and integer programming. Results of the model applied to several planning data sets (including a form of the Austin, Texas planning problem) demonstrate that more concentrated ambulance allocation patterns exist which may lead to easier dispatching, reduced facility costs, and better crew load balancing with little or no loss of service coverage. Tradeoff curves are presented which show that significant reductions in the number of dispatching sites (keeping the number of ambulances constant) can be made without any major changes in service level.