基于无缝隙政府理论的我国紧急医学救援体系研究

发布时间：2018-05-01 16:37

本文选题：突发事件 + 紧急医学救援　；参考：《华中科技大学》2015年博士论文

【摘要】：[目的] 本研究旨在运用无缝隙政府理论,对照目前我国紧急医学救援工作的现状,并借鉴国外紧急医学救援体系的经验,进一步完善我国紧急医学救援体系,消除我国紧急医学救援体系系统内外部的“缝隙”,使其更加“流畅”、“连贯”、“灵活”,进一步完善功能、优化流程、整合机制,建立一个高质量、高效率和适应性强的紧急医学救援体系,兼顾质量和效率,最大程度满足突发事件紧急医学救援工作的需要。 [方法] (一)系统综述法和比较分析法：通过系统综述和比较分析,提炼、总结了无缝隙政府理论,并分析了该理论在紧急医学救援领域的适用性,并借鉴该理论,提出“无缝隙”紧急医学救援体系建设中的核心要素。运用多输入优序图法确定了“无缝隙”紧急医学救援体系的核心要素的优先顺序。通过文献研究和系统分析法,梳理了美国、日本、德国、俄罗斯等八个发达国家紧急医学救援工作开展情况,并对其进行了系统分析和比较,总结其特征,提炼出国外紧急医学救援体系“无缝隙”的核心内容。借鉴凯萨医疗机构灾害易损性分析模型,建立了紧急医疗救援的脆弱性分析模型。 (二)调查法和统计学方法：通过调查,收集到全国承担紧急医学救援任务的4960家二级以上综合性医院紧急医学救援能力的数据。重点对全国主要承担紧急医学救援任务的省级和地市级医院进行了典型调查,收集到386家医疗机构紧急医学救援核心能力要素数据。通过统计学方法对收集到的数据加以分析。使用描述性系统综述的方法,结合对相关行政官员、医疗机构工作人员、专家学者进行的访谈,从工作组织体系和运行体系两方面全面总结了我国紧急医学救援工作的组织和运行现状。在数据分析和系统综述的基础上,结合无缝隙政府理论,提出并分析了我国紧急医学救援工作中的“缝隙点”。 (三)专家咨询法贯穿于整个研究之中。 [结果] (一)无缝隙政府理论的有关特性和紧急医学救援工作的特点相互契合,可用于分析、指导紧急医学救援工作。 (二)“无缝隙”紧急医学救援体系包括机构“建设无缝隙”、“机构职能无缝隙”等11个“无缝隙”核心要素,其中最重要的两个要素是“后勤保障无缝隙”和“机构能力无缝隙”。 (三)发达国家紧急医学救援体系相对较为成熟,其“无缝隙”的核心内容对我国紧急医学救援体系建设具有一定的借鉴意义。发达国家紧急医学救援体系特征对我国的启示主要有：设置有统一协调机构：拥有多重医学救援力量和专门医疗救治机构；装备先进、配置齐全；具有快速反应系统；信息传递及时、快速、流畅；物资储备充足、费用解决渠道多；工作以属地为主、分级负责；各种救援力量充足、工作连续、职责清晰；专业技术人员能力强、水平高。 (四)目前,我国紧急医学救援工作还存在很大的“缝隙”,主要表现在： 1.组织机构：全国有11.6%的医疗机构没有成立卫生应急工作领导小组,有9.8%的医疗机构还没有组建紧急医学救援专业队伍。 2.机构职能：在突发事件紧急医学救援工作中,不同机构和部门之间还存在条块分割、各自为战的现象：分属不同系统和行业的医疗救援力量缺少统一的协调,伤员救援工作不连续,缺少对伤员救治情况的总体掌控和安排；尚未有一部专门的法律和法规对突发事件紧急医学救援工作进行系统的规定。 3.机构能力：全国有11.3%的医疗机构无用于应急处置的床位；三级医院和东部地区可用于紧急医学救援的床位所占总床位的比例还比较低,分别为3.77%和4.86%：平均每家医疗机构只有3.2辆普通救护车和0.2辆负压救护车；烧伤悬浮床和烧伤翻身床全国总体拥有数量还是很低；有16.0%的地市级医疗机构和28.3%的省级医疗机构没有扩增病床的条件,有17.4%的医疗机构有扩增病床条件但无扩增方案。 4.管理制度；全国有1.6%的医疗机构尚未制定紧急医学救援预案和工作方案：有22.3%的医疗机构没有腾空床位的制度和流程；有近10%的医疗机构在一年内没有举办过各类型医学救援演练,医疗机构一年中举办跨部门的演练比例只有8.1%。 5.人员职权职责：在突发事件紧急医学救援工作中,部分指挥决策还缺少科学依据,存在盲目指挥和凭经验指挥。 6.人员技术技能：医疗机构参与紧急医学救援队伍高级职称医务人员数量平均为9.9人／家；紧急医学救援队伍中高级职称医务人员所占比例仅为26.1%。 7.专业人员内部满意情况：全国只有22.2%的医疗机构购买了人身意外伤害保险,为参与紧急医学救援的医务人员提供人身安全保障；32.6%的医疗机构为参加紧急医学救援的专业人员发放高风险补助。 8.救援流程：我国紧急医学救援工作还存在流程不明晰,多头指挥,程序纷繁复杂等情况。 9.信息传递：目前我国紧急医学救援信息传递时效性、准确性、连贯性普遍不好。 10.后勤保障：全国有18.1%的医疗机构没有设置二次检伤分类的场所；有10.9%的医疗机构没有物资储备,有37.2%医疗机构有物资储备但无分装配送能力；有5.4%的医疗机构没有用于紧急医学救援培训的场地；只有13.0%的医疗机构拥有停机坪,60.1%的医疗机构有远程会诊联通能力。 11.运行管理体制：紧急医学救援资源分布严重不均衡,东部地区集中分布,西部地区严重匮乏,大中城市资源丰富,基层资源相对短缺。 [结论] 目前,我国突发事件紧急医学救援工作主要存在“医疗机构内部紧急医学救援组织、协调机构建设不足”；“紧急医学救援队伍建设欠缺”等20个“缝隙点”,严重制约了我国突发事件紧急医学救援工作的开展。我国紧急医学体系建设的目标是建成一个突发事件发生后,能提供连续性医疗照顾服务,致力于最大限度恢复伤员生理和心理功能、最大限度减少因突发事件造成的健康损害的,方便、流畅、高效、高质量的医疗救援服务体系。紧急医学救援脆弱性分析模型包括风险可能性、损害严重性和应对准备三个一级维度以及七个二级维度,涵盖了自然灾害、事故灾难等6类28个风险因素,通过四个评分等级,可确定医疗机构紧急医学救援工作在不同风险因素下的脆弱性。在完善和发展我国紧急医学救援体系时,应通过加强紧急医学救援主体机构建设、加强参与紧急医学救援工作的人员能力建设以及促进紧急医学救援机构规范化运行三个方面,实施11项具体举措来弥合缝隙,建成“无缝隙”紧急医学救援体系。 [创新与不足] 本研究主要创新点： (一)通过对全国承担紧急医学救援任务的二级以上综合性医疗机构进行普查,共收集到全国4960家医疗机构的数据,可供全面、系统的分析我国紧急医学救援工作能力现状。 (二)在国内首次应用“无缝隙政府理论”指导医疗卫生服务体系建设,并提出“无缝隙”紧急医学救援体系建设的核心要素。 (三)提出紧急医学救援脆弱性分析模型,医疗机构可运用该模型分析本机构紧急医学救援工作在不同风险因素下的脆弱性。本研究局限性：国内、外尚缺乏具体、完善、具有操作性的紧急医学救援体系评价标准,研究结论还有待理论和现实的进一步检验。
[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 .

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R459.7

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