芦山地震后1月应急医学救援的绩效评价
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摘要
目的评价芦山地震后1月应急医学救援绩效,验证和完善汶川经验,为全球地震应急医学救援降低死亡率和伤残率提供有益参考。方法收集整理"4.20"芦山地震后1月的官方信息通报、公开文件资料、新闻发布、网站信息及四川大学华西医院收治伤员情况等资料,同时检索"5.12"汶川地震等国内外地震医学救援相关文献,进行比较分析。结果①此次芦山地震和5年前的汶川地震分别位于龙门山断裂带的南西段和中北段,两者主震区相距87 km。震级虽仅相差1级,但汶川地震时的受灾面积、受灾人口、死亡人数、失踪人数、受伤人数、重伤人数和迁徙人口分别是芦山地震的40、23、353、853、27、14和51倍。②借鉴汶川经验,芦山地震人力调度更快速,在黄金72小时内,医疗卫生人力峰值集结87.62%,远高于汶川地震时的56.06%。③物资调度更合理:准确信息指导下按需调配,物资使用率明显提高。④医疗救治更科学":四集中"救治危重症;抢救生命与恢复功能同步;医疗救治与身心康复同步;救治与证据生产、转化同步。⑤医疗机构和服务恢复更及时:震后26天,21个受灾县96.7%的原公办县乡医疗机构(440/455家)在原址恢复诊疗业务。结论充分借鉴汶川经验,芦山地震实现了准确信息指导下的医学救援,准确需求指导下的物资调度,准确伤情评估下的危重症治疗和早期身心康复。因而震后1月医学救援更快速,更科学,更有效:震后20天危重症集中治疗实现零死亡,早期介入身心康复加快功能重建,促进其回归社会,从而丰富和完善了汶川经验,为地震应急医学救援积累了新鲜经验。
Objective To evaluate the performance of emergency medical rescue(EMR) within 1 month after Lushan earthquake,and to prove and enrich the experience from Wenchuan earthquake,so as to provide useful references for global earthquake EMR with regard to decreasing death and disability rates.MethodsAll the following date published within 1 month after 4.20 Lushan earthquake were collected and analyzed,including official information,public documents,news release,relevant information from websites and victims' medical records in the West China Hospital,then the relevant domestic and foreign literature about EMR(including EMR of Wenchuan earthquake).And then comparative analysis was conducted to evaluate the performance of EMR in Lushan earthquake.Resultsa) Being 87 km apart from each other,the main seismic zones of Lushan and Wenchuan located in the south west and middle north of Longmenshan fault zone,respectively.Although only 1 earthquake magnitude differed between them,the disaster area,and the number of affected population,deaths,disappearances,injured,severe injured and migration population in Wenchuan earthquake were 40,23,353,853,27,14 and 51 times higher than those in Lushan earthquake,respectively.b) Learned from Wenchuan experience,the manpower scheduling in Lushan earthquake was quicker: the assembled medical personnel peak of Lushan vs.Wenchuan was 87.62% vs.56.06 % in golden 72 hours post-quake.c) Supplies scheduling was more rational: the utilization rate was higher under the guidance of accurate information of demand.d) Medical treatment was more rational and efficient: the critical injured were treated following "Four concentration treatment principles";saving life and restoring function at the same time;treatment and physical-mental rehabilitation at the same time;treatment and evidence production and implementation at the same time.e) Medical institutions and service returned to normal in time: 96.7%(440/455) of government owned township medical institutions in 21 affected towns returned to normal and provided medical services at their original sites.ConclusionBy learning form Wenchuan experience,the following performance is implemented in Lushan earthquake: medical rescue guided by the accurate information;supplies scheduling guided by the accurate demand;both critical injured treatment,and physical-mental rehabilitation guided by the accurate assessment of injuries.So the medical rescue within 1 month after Lushan earthquake is quicker,more rational and efficient.After 20 days post quake zero death of critical injured was achieved.The early physical-mental rehabilitation fastens the functional reconstruction of the injured and helps them return to the society.So it suggests that the Lushan EMR enriches and develops the reference value of EMR experience of Wenchuan earthquake.
Objective To evaluate the performance of emergency medical rescue(EMR) within 1 month after Lushan earthquake,and to prove and enrich the experience from Wenchuan earthquake,so as to provide useful references for global earthquake EMR with regard to decreasing death and disability rates.MethodsAll the following date published within 1 month after 4.20 Lushan earthquake were collected and analyzed,including official information,public documents,news release,relevant information from websites and victims' medical records in the West China Hospital,then the relevant domestic and foreign literature about EMR(including EMR of Wenchuan earthquake).And then comparative analysis was conducted to evaluate the performance of EMR in Lushan earthquake.Resultsa) Being 87 km apart from each other,the main seismic zones of Lushan and Wenchuan located in the south west and middle north of Longmenshan fault zone,respectively.Although only 1 earthquake magnitude differed between them,the disaster area,and the number of affected population,deaths,disappearances,injured,severe injured and migration population in Wenchuan earthquake were 40,23,353,853,27,14 and 51 times higher than those in Lushan earthquake,respectively.b) Learned from Wenchuan experience,the manpower scheduling in Lushan earthquake was quicker: the assembled medical personnel peak of Lushan vs.Wenchuan was 87.62% vs.56.06 % in golden 72 hours post-quake.c) Supplies scheduling was more rational: the utilization rate was higher under the guidance of accurate information of demand.d) Medical treatment was more rational and efficient: the critical injured were treated following "Four concentration treatment principles";saving life and restoring function at the same time;treatment and physical-mental rehabilitation at the same time;treatment and evidence production and implementation at the same time.e) Medical institutions and service returned to normal in time: 96.7%(440/455) of government owned township medical institutions in 21 affected towns returned to normal and provided medical services at their original sites.ConclusionBy learning form Wenchuan experience,the following performance is implemented in Lushan earthquake: medical rescue guided by the accurate information;supplies scheduling guided by the accurate demand;both critical injured treatment,and physical-mental rehabilitation guided by the accurate assessment of injuries.So the medical rescue within 1 month after Lushan earthquake is quicker,more rational and efficient.After 20 days post quake zero death of critical injured was achieved.The early physical-mental rehabilitation fastens the functional reconstruction of the injured and helps them return to the society.So it suggests that the Lushan EMR enriches and develops the reference value of EMR experience of Wenchuan earthquake.
引文
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2沈骥,康均行,石应康,等.特大地震应急医学救援:来自汶川的经验.中国循证医学杂志,2012,12(4):383-392.
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6 Jiang J,Li Y,Huang X,et al.Lessons learnt from the Wenchuanearthquake:performance evaluation of treatment of critical injuriesin hardest-hit areas.J Evid Based Med,2012,5(3):114-123.
7卫生与计划生育委员会网站.雅安抗震救灾医学救援工作动态(4月20日—5月3日).
8四川省卫生厅网站.紧急响应迅速行动——四川省“4.20”芦山7.0级地震医疗卫生救援情况(1-30期).
9汶川震后重建公共建筑经住芦山强震考验.北京青年报.[2013-05-08].
10守望相助爱满芦山(芦山抗震救灾述评).人民网-人民日报.[2013-04-28].11四川发布芦山地震震后首份经济形势分析报告.中国经济导报网.[2013-05-27].http://www.ceh.com.cn/fgwxx/2013/05/203738.shtml.
2沈骥,康均行,石应康,等.特大地震应急医学救援:来自汶川的经验.中国循证医学杂志,2012,12(4):383-392.
3 Auerbach PS,Norris RL,Menon AS,et al.Civil-military collabora-tion in the initial medical response to the earthquake in Haiti.NEngl J Med,2010,362(10):e32.
4 Cranmer HH.Volunteer Work—Logistics First.N Engl J Med,2005,13:1541-1543.
5徐健康,邓兴广,李华,等.汶川地震四川省医用物资保障工作情况——2008年5月12日至9月15日.中国循证医学杂志,2008,8(11):905-912.
6 Jiang J,Li Y,Huang X,et al.Lessons learnt from the Wenchuanearthquake:performance evaluation of treatment of critical injuriesin hardest-hit areas.J Evid Based Med,2012,5(3):114-123.
7卫生与计划生育委员会网站.雅安抗震救灾医学救援工作动态(4月20日—5月3日).
8四川省卫生厅网站.紧急响应迅速行动——四川省“4.20”芦山7.0级地震医疗卫生救援情况(1-30期).
9汶川震后重建公共建筑经住芦山强震考验.北京青年报.[2013-05-08].
10守望相助爱满芦山(芦山抗震救灾述评).人民网-人民日报.[2013-04-28].11四川发布芦山地震震后首份经济形势分析报告.中国经济导报网.[2013-05-27].http://www.ceh.com.cn/fgwxx/2013/05/203738.shtml.
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