救护车担架隔振系统结构参数优化设计

为了提高救护车担架的乘卧舒适性，根据卧位人体振动响应的特点和汽车悬架系统的振动特性，对救护车担架隔振系统的结构参数进行了优化设计。经过优化设计后的新型担架隔振系统具有更好的减振和隔振效果，其振动加速度均方值明显下降。     

福州市院前急救2341例呼救与应急处理情况的分析

目的　研究福州市“12 0”院前急救系统的呼救原因、呼救时间、反应时间、处理时间与患者年龄等各项指标间的相互关系 ,为制定急救对策提供依据。　方法　从福州市“12 0”院前急救调度室约 1.5万例呼救信息资料中 ,以 15 %比例单纯随机抽样 2 34 1例 ,对相关指标进行相应的χ2 、秩和检验。　结果　 (1)前 3位呼叫原因为交通意外 (Traf)、心血管疾病 (CVD)和挫裂挤压伤 (L ac)。 (2 )交通意外 /挫裂挤压伤 (Traf/ L ac)和心血管疾病 /脑血管意外 (CVD/ CVA)呼救高峰时间段均为上夜。 (3) Traf/ L ac多见于 30～ 5 9岁 ,CVD/ CVA多见于 6 0岁以上患者。 (4)夜间呼叫多 ,夏秋季为忙季。 (5 )院前急救人员出诊平均反应时间为 5 .74m in,平均处理时间为 2 4.90 min。　结论　“12 0”呼救规律的分析对于制定相关急救措施、妥善处理有重要的指导意义。     

Use of a pulse oximeter for determination of systolic blood pressure in a helicopter air ambulance

INTRODUCTION: Traditional methods of determining blood pressure may be unreliable (auscultation or palpation) or unavailable (direct arterial cannulation) in the air medical environment. The authors investigated the combination of a pulse oximeter with a standard sphygmomanometer (blood pressure) cuff as an alternative method. METHOD: The pulse oximeter is applied to a finger on the same upper extremity on which a standard blood pressure cuff had been applied. A baseline blood pressure was obtained by palpation or an automated blood pressure device. One minute later, the systolic blood pressure (SBP) was determined by inflating the blood pressure cuff until the pulsatile display on the pulse oximeter was obliterated. This was taken as the systolic blood pressure. RESULTS: Complete data were obtained on 116 patients, with 223 data pairs. The SBP as obtained by the baseline method was strongly correlated with the SBP obtained by the pulse oximeter display obliteration method (r = 0.90, p < 0.001). CONCLUSION: The obliteration of the wave form display on a pulse oximeter is an accurate, convenient, inexpensive and readily available alternative method of determining SBP.     

基于救护车车载氧气瓶柜的优化安装设计

目的：设计一种全新的车载氧气瓶柜安装方式，对救护车医疗舱的空间资源进行重新整合，以增加抢救设备的安装空间，避免更换氧气瓶时的倾倒、坠落而导致的人员受伤甚至是爆炸事故的发生，提高安全性。方法：用可开关的合页将旋转式氧气瓶柜固定于救护车尾部的垂直上车扶手的下部、上车担架的对侧。结果：旋转式车载氧气瓶柜避免了先前更换氧气瓶的种种安全隐患，大大降低了医务工作者的劳动强度。结论：旋转式车载氧气瓶柜将成为未来救护车主流改装趋势。     

Effects of Emergency Medical Services Agency Ownership Status on Patient Transport

Objectives: Medical insurers have clearly defined which ambulance services will be reimbursed and which will not. Thus, ambulance agencies that provide emergency 9-1-1 services must be highly cognizant of their organization's revenue needs. This presents a distinction between publicly funded and privately funded organizations. This study seeks to identify any differences in the transport decision among agency ownership types. Methods: This retrospective study captured all 9-1-1 ambulance requests in the state of Virginia for the years 2009 through 2013. Each request was answered by either a publicly funded ambulance service or a privately funded ambulance service. The outcome variable of interest was patient disposition and the key explanatory variable was organizational ownership type. Multivariate logistic regression was utilized for data analysis. Results: Of the 4.6 million 9-1-1 requests, approximately 30% were attended to by a private ambulance service. After controlling for potential confounders, ownership type was found to have a statistically significant effect on the transport decision. Private for-profit ambulance services were 4.5 times more likely to transport a patient than were their publicly funded counterparts (OR: 4.56, 95% CI: 4.47–4.65). Private non-profit organizations were twice as likely to engage in patient transport (OR: 2.12, 95% CI: 2.09–2.14). Private for-profit ambulance organizations were also found to be less likely to allow for patient refusal (OR: 0.54, 95% CI: 0.53–0.55) or to medically treat on-scene without subsequent transport (OR: 0.48, 95% CI: 0.45–0.50). Conclusions: Given the reimbursement practices of medical insurers, private ambulance services are incentivized towards patient transport. Operational revenue for these services is not generated through public budgeting processes but through user fees. Thus, private agencies are more reliant on billable services than are their publicly funded counterparts.     

Les syndromes parkinsoniens : de l’analyse sémiologique au diagnostic nosologique

Parkinsonism may include atypical clinical manifestations, which are warning signs for the clinicians and motivate further investigations to identify an etiology other than idiopathic Parkinson's disease. The dismemberment of pathological entities, the advances of morphological and functional imaging of the brain, and new insights into molecular biology have successively led to more precise clinical phenotype and mechanisms. Except for etiologies with specific treatment, such as Wilson's disease or Parkinsonism secondary to a lesion of basal ganglia, or the discontinuation of a culprit drug, the treatment of Parkinsonian syndrome is mainly based on a multidisciplinary approach, involving occupational therapist, physiotherapist, speech therapist, psychologist and social worker. L-Dopa may be tried but it is less effective in atypical Parkinsonian syndrome than in Parkinson's disease. Formal diagnosis, only achievable post-mortem, is not available during the lifetime of the patient. Although some additional tests provide undeniable assistance, the clinical approach remains an essential and critical step to avoid costly and unnecessary investigations.     

浅谈北京急救中心救护车的选型

在救护车选型的工作中,根据北京市的地理情况、城市的功能、经济的发展、百姓的需要和急救中心所承担的任务,借鉴世界发达国家救护车发展的趋势,根据国家卫生行业标准,着力提高对突发意外事故现场的救援能力,提高院前医疗急救水平,选择适合北京地区的医疗救护车,以造福百姓。