本文選題：突發(fā)事件 + 緊急醫(yī)學(xué)救援��； 參考：《華中科技大學(xué)》2015年博士論文

【摘要】：[目的] 本研究旨在運(yùn)用無縫隙政府理論,對(duì)照目前我國緊急醫(yī)學(xué)救援工作的現(xiàn)狀,并借鑒國外緊急醫(yī)學(xué)救援體系的經(jīng)驗(yàn),進(jìn)一步完善我國緊急醫(yī)學(xué)救援體系,消除我國緊急醫(yī)學(xué)救援體系系統(tǒng)內(nèi)外部的“縫隙”,使其更加“流暢”、“連貫”、“靈活”,進(jìn)一步完善功能、優(yōu)化流程、整合機(jī)制,建立一個(gè)高質(zhì)量、高效率和適應(yīng)性強(qiáng)的緊急醫(yī)學(xué)救援體系,兼顧質(zhì)量和效率,最大程度滿足突發(fā)事件緊急醫(yī)學(xué)救援工作的需要。 [方法] (一)系統(tǒng)綜述法和比較分析法：通過系統(tǒng)綜述和比較分析,提煉、總結(jié)了無縫隙政府理論,并分析了該理論在緊急醫(yī)學(xué)救援領(lǐng)域的適用性,并借鑒該理論,提出“無縫隙”緊急醫(yī)學(xué)救援體系建設(shè)中的核心要素。運(yùn)用多輸入優(yōu)序圖法確定了“無縫隙”緊急醫(yī)學(xué)救援體系的核心要素的優(yōu)先順序。通過文獻(xiàn)研究和系統(tǒng)分析法,梳理了美國、日本、德國、俄羅斯等八個(gè)發(fā)達(dá)國家緊急醫(yī)學(xué)救援工作開展情況,并對(duì)其進(jìn)行了系統(tǒng)分析和比較,總結(jié)其特征,提煉出國外緊急醫(yī)學(xué)救援體系“無縫隙”的核心內(nèi)容。借鑒凱薩醫(yī)療機(jī)構(gòu)災(zāi)害易損性分析模型,建立了緊急醫(yī)療救援的脆弱性分析模型。 (二)調(diào)查法和統(tǒng)計(jì)學(xué)方法：通過調(diào)查,收集到全國承擔(dān)緊急醫(yī)學(xué)救援任務(wù)的4960家二級(jí)以上綜合性醫(yī)院緊急醫(yī)學(xué)救援能力的數(shù)據(jù)。重點(diǎn)對(duì)全國主要承擔(dān)緊急醫(yī)學(xué)救援任務(wù)的省級(jí)和地市級(jí)醫(yī)院進(jìn)行了典型調(diào)查,收集到386家醫(yī)療機(jī)構(gòu)緊急醫(yī)學(xué)救援核心能力要素?cái)?shù)據(jù)。通過統(tǒng)計(jì)學(xué)方法對(duì)收集到的數(shù)據(jù)加以分析。使用描述性系統(tǒng)綜述的方法,結(jié)合對(duì)相關(guān)行政官員、醫(yī)療機(jī)構(gòu)工作人員、專家學(xué)者進(jìn)行的訪談,從工作組織體系和運(yùn)行體系兩方面全面總結(jié)了我國緊急醫(yī)學(xué)救援工作的組織和運(yùn)行現(xiàn)狀。在數(shù)據(jù)分析和系統(tǒng)綜述的基礎(chǔ)上,結(jié)合無縫隙政府理論,提出并分析了我國緊急醫(yī)學(xué)救援工作中的“縫隙點(diǎn)”。 (三)專家咨詢法貫穿于整個(gè)研究之中。 [結(jié)果] (一)無縫隙政府理論的有關(guān)特性和緊急醫(yī)學(xué)救援工作的特點(diǎn)相互契合,可用于分析、指導(dǎo)緊急醫(yī)學(xué)救援工作。 (二)“無縫隙”緊急醫(yī)學(xué)救援體系包括機(jī)構(gòu)“建設(shè)無縫隙”、“機(jī)構(gòu)職能無縫隙”等11個(gè)“無縫隙”核心要素,其中最重要的兩個(gè)要素是“后勤保障無縫隙”和“機(jī)構(gòu)能力無縫隙”。 (三)發(fā)達(dá)國家緊急醫(yī)學(xué)救援體系相對(duì)較為成熟,其“無縫隙”的核心內(nèi)容對(duì)我國緊急醫(yī)學(xué)救援體系建設(shè)具有一定的借鑒意義。發(fā)達(dá)國家緊急醫(yī)學(xué)救援體系特征對(duì)我國的啟示主要有：設(shè)置有統(tǒng)一協(xié)調(diào)機(jī)構(gòu)：擁有多重醫(yī)學(xué)救援力量和專門醫(yī)療救治機(jī)構(gòu)；裝備先進(jìn)、配置齊全；具有快速反應(yīng)系統(tǒng)；信息傳遞及時(shí)、快速、流暢；物資儲(chǔ)備充足、費(fèi)用解決渠道多；工作以屬地為主、分級(jí)負(fù)責(zé)；各種救援力量充足、工作連續(xù)、職責(zé)清晰；專業(yè)技術(shù)人員能力強(qiáng)、水平高。 (四)目前,我國緊急醫(yī)學(xué)救援工作還存在很大的“縫隙”,主要表現(xiàn)在： 1.組織機(jī)構(gòu)：全國有11.6%的醫(yī)療機(jī)構(gòu)沒有成立衛(wèi)生應(yīng)急工作領(lǐng)導(dǎo)小組,有9.8%的醫(yī)療機(jī)構(gòu)還沒有組建緊急醫(yī)學(xué)救援專業(yè)隊(duì)伍。 2.機(jī)構(gòu)職能：在突發(fā)事件緊急醫(yī)學(xué)救援工作中,不同機(jī)構(gòu)和部門之間還存在條塊分割、各自為戰(zhàn)的現(xiàn)象：分屬不同系統(tǒng)和行業(yè)的醫(yī)療救援力量缺少統(tǒng)一的協(xié)調(diào),傷員救援工作不連續(xù),缺少對(duì)傷員救治情況的總體掌控和安排；尚未有一部專門的法律和法規(guī)對(duì)突發(fā)事件緊急醫(yī)學(xué)救援工作進(jìn)行系統(tǒng)的規(guī)定。 3.機(jī)構(gòu)能力：全國有11.3%的醫(yī)療機(jī)構(gòu)無用于應(yīng)急處置的床位；三級(jí)醫(yī)院和東部地區(qū)可用于緊急醫(yī)學(xué)救援的床位所占總床位的比例還比較低,分別為3.77%和4.86%：平均每家醫(yī)療機(jī)構(gòu)只有3.2輛普通救護(hù)車和0.2輛負(fù)壓救護(hù)車；燒傷懸浮床和燒傷翻身床全國總體擁有數(shù)量還是很低；有16.0%的地市級(jí)醫(yī)療機(jī)構(gòu)和28.3%的省級(jí)醫(yī)療機(jī)構(gòu)沒有擴(kuò)增病床的條件,有17.4%的醫(yī)療機(jī)構(gòu)有擴(kuò)增病床條件但無擴(kuò)增方案。 4.管理制度；全國有1.6%的醫(yī)療機(jī)構(gòu)尚未制定緊急醫(yī)學(xué)救援預(yù)案和工作方案：有22.3%的醫(yī)療機(jī)構(gòu)沒有騰空床位的制度和流程；有近10%的醫(yī)療機(jī)構(gòu)在一年內(nèi)沒有舉辦過各類型醫(yī)學(xué)救援演練,醫(yī)療機(jī)構(gòu)一年中舉辦跨部門的演練比例只有8.1%。 5.人員職權(quán)職責(zé)：在突發(fā)事件緊急醫(yī)學(xué)救援工作中,部分指揮決策還缺少科學(xué)依據(jù),存在盲目指揮和憑經(jīng)驗(yàn)指揮。 6.人員技術(shù)技能：醫(yī)療機(jī)構(gòu)參與緊急醫(yī)學(xué)救援隊(duì)伍高級(jí)職稱醫(yī)務(wù)人員數(shù)量平均為9.9人／家；緊急醫(yī)學(xué)救援隊(duì)伍中高級(jí)職稱醫(yī)務(wù)人員所占比例僅為26.1%。 7.專業(yè)人員內(nèi)部滿意情況：全國只有22.2%的醫(yī)療機(jī)構(gòu)購買了人身意外傷害保險(xiǎn),為參與緊急醫(yī)學(xué)救援的醫(yī)務(wù)人員提供人身安全保障；32.6%的醫(yī)療機(jī)構(gòu)為參加緊急醫(yī)學(xué)救援的專業(yè)人員發(fā)放高風(fēng)險(xiǎn)補(bǔ)助。 8.救援流程：我國緊急醫(yī)學(xué)救援工作還存在流程不明晰,多頭指揮,程序紛繁復(fù)雜等情況。 9.信息傳遞：目前我國緊急醫(yī)學(xué)救援信息傳遞時(shí)效性、準(zhǔn)確性、連貫性普遍不好。 10.后勤保障：全國有18.1%的醫(yī)療機(jī)構(gòu)沒有設(shè)置二次檢傷分類的場(chǎng)所；有10.9%的醫(yī)療機(jī)構(gòu)沒有物資儲(chǔ)備,有37.2%醫(yī)療機(jī)構(gòu)有物資儲(chǔ)備但無分裝配送能力；有5.4%的醫(yī)療機(jī)構(gòu)沒有用于緊急醫(yī)學(xué)救援培訓(xùn)的場(chǎng)地；只有13.0%的醫(yī)療機(jī)構(gòu)擁有停機(jī)坪,60.1%的醫(yī)療機(jī)構(gòu)有遠(yuǎn)程會(huì)診聯(lián)通能力。 11.運(yùn)行管理體制：緊急醫(yī)學(xué)救援資源分布嚴(yán)重不均衡,東部地區(qū)集中分布,西部地區(qū)嚴(yán)重匱乏,大中城市資源豐富,基層資源相對(duì)短缺。 [結(jié)論] 目前,我國突發(fā)事件緊急醫(yī)學(xué)救援工作主要存在“醫(yī)療機(jī)構(gòu)內(nèi)部緊急醫(yī)學(xué)救援組織、協(xié)調(diào)機(jī)構(gòu)建設(shè)不足”；“緊急醫(yī)學(xué)救援隊(duì)伍建設(shè)欠缺”等20個(gè)“縫隙點(diǎn)”,嚴(yán)重制約了我國突發(fā)事件緊急醫(yī)學(xué)救援工作的開展。 我國緊急醫(yī)學(xué)體系建設(shè)的目標(biāo)是建成一個(gè)突發(fā)事件發(fā)生后,能提供連續(xù)性醫(yī)療照顧服務(wù),致力于最大限度恢復(fù)傷員生理和心理功能、最大限度減少因突發(fā)事件造成的健康損害的,方便、流暢、高效、高質(zhì)量的醫(yī)療救援服務(wù)體系。 緊急醫(yī)學(xué)救援脆弱性分析模型包括風(fēng)險(xiǎn)可能性、損害嚴(yán)重性和應(yīng)對(duì)準(zhǔn)備三個(gè)一級(jí)維度以及七個(gè)二級(jí)維度,涵蓋了自然災(zāi)害、事故災(zāi)難等6類28個(gè)風(fēng)險(xiǎn)因素,通過四個(gè)評(píng)分等級(jí),可確定醫(yī)療機(jī)構(gòu)緊急醫(yī)學(xué)救援工作在不同風(fēng)險(xiǎn)因素下的脆弱性。 在完善和發(fā)展我國緊急醫(yī)學(xué)救援體系時(shí),應(yīng)通過加強(qiáng)緊急醫(yī)學(xué)救援主體機(jī)構(gòu)建設(shè)、加強(qiáng)參與緊急醫(yī)學(xué)救援工作的人員能力建設(shè)以及促進(jìn)緊急醫(yī)學(xué)救援機(jī)構(gòu)規(guī)范化運(yùn)行三個(gè)方面,實(shí)施11項(xiàng)具體舉措來彌合縫隙,建成“無縫隙”緊急醫(yī)學(xué)救援體系。 [創(chuàng)新與不足] 本研究主要?jiǎng)?chuàng)新點(diǎn)： (一)通過對(duì)全國承擔(dān)緊急醫(yī)學(xué)救援任務(wù)的二級(jí)以上綜合性醫(yī)療機(jī)構(gòu)進(jìn)行普查,共收集到全國4960家醫(yī)療機(jī)構(gòu)的數(shù)據(jù),可供全面、系統(tǒng)的分析我國緊急醫(yī)學(xué)救援工作能力現(xiàn)狀。 (二)在國內(nèi)首次應(yīng)用“無縫隙政府理論”指導(dǎo)醫(yī)療衛(wèi)生服務(wù)體系建設(shè),并提出“無縫隙”緊急醫(yī)學(xué)救援體系建設(shè)的核心要素。 (三)提出緊急醫(yī)學(xué)救援脆弱性分析模型,醫(yī)療機(jī)構(gòu)可運(yùn)用該模型分析本機(jī)構(gòu)緊急醫(yī)學(xué)救援工作在不同風(fēng)險(xiǎn)因素下的脆弱性。 本研究局限性： 國內(nèi)、外尚缺乏具體、完善、具有操作性的緊急醫(yī)學(xué)救援體系評(píng)價(jià)標(biāo)準(zhǔn),研究結(jié)論還有待理論和現(xiàn)實(shí)的進(jìn)一步檢驗(yàn)。
[Abstract]:Purpose of the project

The purpose of this study is to use the theory of non - gap government to control the current situation of emergency medical rescue work in our country , and to learn from the experience of foreign emergency medical rescue system , to further improve our country ' s emergency medical rescue system , to eliminate " gap " outside the system of emergency medical rescue system in our country , to make it more " smooth " , " coherent " , " flexible " , to further improve function , optimize process and integrate mechanism , establish a high - quality , high - efficiency and adaptable emergency medical rescue system , taking into account quality and efficiency , and meeting the need of emergency medical rescue work to the maximum extent .

Methodology

( 1 ) Systematic review and comparative analysis method : Through systematic review and comparative analysis and refinement , the paper summarizes the non - gap government theory , and analyzes the application of the theory in emergency medical rescue system . By means of literature research and systematic analysis , this paper analyzes and compares the emergency medical rescue work of eight developed countries , including USA , Japan , Germany and Russia .

Based on the data analysis and systematic review , this paper puts forward and analyzes the gap point in emergency medical rescue work in China .

( 3 ) The expert consultation method runs through the whole study .

The result is not valid .

( 1 ) The characteristics of the gap - free government theory and the characteristics of emergency medical rescue work coincide with each other , and can be used for analyzing and guiding emergency medical rescue work .

( 2 ) " No gap " emergency medical rescue system includes 11 " non - gap " core elements , such as " no gap " and " no gap " of " institutional function " , among which the most important two elements are " no gap " and " no gap between institutional capacity " .

( 3 ) The emergency medical rescue system developed in developed countries is relatively mature , and its " seamless " core content has certain reference significance to the construction of emergency medical rescue system in China .
Advanced equipment , complete configuration ;
having a rapid reaction system ;
the information transmission is timely , fast and smooth ;
The material reserve is sufficient , the cost is more than the channel ;
The job is subordinate to the ground and is responsible for the classification ;
All kinds of rescue forces are abundant , the work is continuous and the responsibilities are clear ;
Professional staff with strong ability and high level .

( 4 ) At present , there is a great gap between China ' s emergency medical rescue work , which is mainly manifested in :

1 . Organization : 11.6 % of the medical institutions in the country do not establish the health emergency leading group , and 9.8 % of the medical institutions have not formed emergency medical rescue teams .

2 . Institutional function : In the emergency medical and rescue work of emergency , there is also a division between different agencies and departments . The phenomenon of self - fighting is that the medical rescue forces of different systems and industries lack uniform coordination , the wounded rescue work is not continuous , and the overall control and arrangement of the rescue situation of the wounded is missing ;
There has not been a special law and regulation on the system of emergency medical and rescue work for emergencies .

3 . Institutional capacity : 11.3 % of medical institutions nationwide have no beds for emergency disposal ;
The proportion of beds available for emergency medical relief at the tertiary and eastern areas is also low , 3.77 % and 4.86 % , respectively : there are only 3.2 ordinary ambulances and 0.2 negative pressure ambulances on average .
The whole national ownership of the burn suspension bed and the burn - over bed is still very low ;
There were 16.0 per cent of municipal medical institutions and 28 . 3 per cent of provincial health institutions without the conditions for the expansion of beds , 17.4 per cent of which had conditions for amplification of the beds but no amplification protocol .

4 . Management system ;
1.6 % of medical institutions in the country have not yet developed emergency medical rescue plans and work programmes : 22.3 % of medical institutions have no system and process for emptying the beds ;
Nearly 10 % of the medical institutions did not hold medical rescue drills for each type within one year , and only 8.1 % of the cross - sectoral drills were held in the medical institutions for one year .

5 . The functions and functions of personnel : In the emergency medical rescue work of the emergency , part of the command decision is lack of scientific basis , and there are blind command and experience command .

6 . Technical skills of personnel : the average number of medical personnel participating in emergency medical rescue teams is 9.9 persons / home ;
The proportion of senior professional medical personnel in emergency medical rescue team is only 26.1 % .

7 . Internal satisfaction of professionals : Only 22.2 % of medical institutions nationwide purchased personal injury insurance and provided personal safety for medical personnel involved in emergency medical assistance ;
32.6 % of medical institutions provide high - risk subsidies for professionals involved in emergency medical assistance .

8 . Rescue procedure : The emergency medical rescue work in our country is not clear , multi - head command , procedure is complicated and so on .

9 . Information delivery : The timeliness , accuracy and consistency of emergency medical rescue information in our country are generally bad .

10 . Logistics guarantee : 18.1 % of medical institutions in the country do not have the place for secondary examination injury classification ;
10.9 % of the medical institutions have no material reserves , and there are 37.2 % of the medical institutions have the material reserve but have no distribution capacity ;
5.4 % of medical institutions are not available for emergency medical rescue training ;
Only 13.0 % of medical institutions have a helipad and 60.1 % have remote consultation and communication capabilities .

11 . Operation management system : the distribution of emergency medical rescue resources is seriously uneven , the concentrated distribution in the east region , severe shortage in the western region , abundant resources of large and medium - sized cities and relative shortage of grass - roots resources .

Conclusion

At present , the emergency medical rescue work in our country mainly exists in the " emergency medical rescue organization in the medical institution , insufficient coordination mechanism " ;
There are 20 " gap points " , such as " lack of construction of emergency medical rescue teams " , which severely restrict the development of emergency medical rescue work in China .

The goal of the construction of the emergency medical system in China is to provide continuous medical care services after an emergency occurs , and is committed to the maximum recovery of physical and psychological functions of the wounded , to minimize the health damage caused by the emergency , and to provide a convenient , smooth , efficient and high - quality medical rescue service system .

The emergency medical rescue vulnerability analysis model includes three primary dimensions and seven secondary dimensions , including the risk probability , the severity of the lesion and the preparation of the response , and seven secondary dimensions , covering the six categories of 28 risk factors , such as natural disasters , accident disasters , etc . The vulnerability of medical emergency medical rescue work under different risk factors can be determined through four scoring levels .

In order to improve and develop the emergency medical rescue system in China , 11 concrete measures should be implemented to bridge the gap and build a " seamless " emergency medical rescue system by strengthening the construction of emergency medical rescue main body , strengthening the capacity - building of personnel involved in emergency medical rescue work and promoting the normalization of emergency medical rescue institutions .

Innovation and Deficiency of Innovation

The main innovations of this study are as follows :

( 1 ) The data of 4960 medical institutions in the country are collected through a census of more than two comprehensive medical institutions undertaking emergency medical rescue missions nationwide , which can be used for comprehensive and systematic analysis of the present situation of emergency medical rescue work in China .

( 2 ) The first application of " No gap government theory " in China to guide the construction of medical and health service system , and put forward the core element of " No gap " emergency medical rescue system construction .

( 3 ) To put forward the analysis model of emergency medical rescue vulnerability , and the medical institution can use the model to analyze the vulnerability of emergency medical rescue work of the institution under different risk factors .

Limitations of this study :

At home , there is a lack of concrete , perfect , operational emergency medical rescue system evaluation standard , the research conclusion is still to be further tested in theory and reality .

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.7

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本文編號(hào)：1830237