医院接诊灾后批量伤员的流程和模式探讨
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摘要
目的探讨地震灾害后伤员成批后送转诊过程中后方医院的接诊流程和模式。方法对汶川地震灾害后本院3次成批接诊139例伤员转运和初步收治的流程及模式进行回顾性分析。结果139例转院伤员中,入院时危重患者37例(26.6%),中至重度患者98例(70.6%),轻症患者4例(2.8%);感染观察病房收治病例23例(16.5%);入院当天急诊手术9例(6.5%);所有患者均根据病情轻重和分类得到及时有效的救治,无1例发生转运和收治途中死亡,无院内感染发生。结论建立地震灾害后后方医院成批伤员接诊模式有利于伤员的及时有效救治。建立模式的关键是:及时评估,确定应对等级;明确职责,合理组织人力资源;各环把关,强化院内感染控制和规范流程,保证处置及时。
Objective To explore the admission model of batch transferred wounded from Wenchuan seismic area in rear-area hospital.Methods We retrospectively analyzed the transportation and admission procedures of three batch of patients(139),from Wenchuan seismic area.Results All of the wounded were triaged by traumatic severity and infection conditions,all of them received therapy timely and anti-nosocomial infection actively;none of the death and the in-hospital infection was observed during the transferring and reception process;there were 37 cases(26.6%)classified as critical wounded,98 cases(70.6%)severe to moderate and 4 cases(2.8%)mild injured.On admission,23 cases were admitted to the infection observation ward;there were 6 emergency operation preformed shortly after admission,including 3 cases fracture fixation,2 cases of thoracic closed drainage,1 cases of tracheotomy.Conclusion It is important to establish the admission model of batch transferred wounded in rear-area hospital after seismic.To do these,there are four basic elements needing our attention:timely evaluation to chose the response level appropriately,identify staffs abilities to organize human resource more effectively,pay attention to every details to prevent in-hospital infection actively,and standardize the admission procedures to insure the therapy more comprehensively.
Objective To explore the admission model of batch transferred wounded from Wenchuan seismic area in rear-area hospital.Methods We retrospectively analyzed the transportation and admission procedures of three batch of patients(139),from Wenchuan seismic area.Results All of the wounded were triaged by traumatic severity and infection conditions,all of them received therapy timely and anti-nosocomial infection actively;none of the death and the in-hospital infection was observed during the transferring and reception process;there were 37 cases(26.6%)classified as critical wounded,98 cases(70.6%)severe to moderate and 4 cases(2.8%)mild injured.On admission,23 cases were admitted to the infection observation ward;there were 6 emergency operation preformed shortly after admission,including 3 cases fracture fixation,2 cases of thoracic closed drainage,1 cases of tracheotomy.Conclusion It is important to establish the admission model of batch transferred wounded in rear-area hospital after seismic.To do these,there are four basic elements needing our attention:timely evaluation to chose the response level appropriately,identify staffs abilities to organize human resource more effectively,pay attention to every details to prevent in-hospital infection actively,and standardize the admission procedures to insure the therapy more comprehensively.
引文
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[2]卫生部.四川汶川大地震灾区医院感染预防与控制指南[J].中国护理管理,2008,8(6):4.
[3]杨顺秋.现代实用护理管理[M].第4版.北京:军事医学科学出版社,2003:335.
[4]Rinnert KJ,Vligginton JG,Pepe PE.管兴志译.灾难的时代错误-灾害医学的过去、现在和将来[J].中国急救复苏与灾害医学杂志,2006,1(1):14.
[5]孙志刚,李宏立.地震伤员分类的原则和方法[J].灾害学,2001,16(1):61.
[6]Ful mer F,Portelli I,Foltin GF,et al.Organization-based incident management:developing a disaster volunteer role on a university campus[J].Disaster Manage Response,2008,5(3):74.
[7]Cox E,Briggs S.Disaster nursing:newfrontiers for criti-cal care[J].Crit Care Nurse,2004,24:16.
[8]Ligon BL.Infectious diseases that pose specific challenges after natural disasters:a review[J].Semin Pediatr Infect Dis,2006,17(1):36.
[9]Uckay I,Sax H,Harbarth S,et al.Multi-resistant infec-tions in repatriated patients after natural disasters:lessons learned fromthe2004tsunami for hospital infection con-trol[J].J Hosp Infect,2008,68(1):1.
[10]林正介,陈维恭,郭宪文,等.灾难发生后灾区医疗应变模式与人力支援系统之建立以及相关灾难医疗研究之连结与整合[CP/DK].[2003-01-17]http://www.ncdr.nat.gov.tw/91conf/cd/J/JR10.pdf.
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