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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (09) : 821 -827. doi: 10.3877/cma.j.issn.1674-0785.2022.09.001

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大规模突发性公共卫生事件的紧急医学救援实践
敬勇1, 李鑫2, 付晶3, 常莉3, 肖宁4, 马黎2, 乐磊2, 黄雷2, 王学杰5, 尹立雪6, 陈康2, 吕传柱3, 刘于嵩7,()   
  1. 1. 610072 四川成都,电子科技大学附属医院四川省人民医院心血管超声及心功能科;610072 四川成都,国家(四川)紧急医学救援队
    2. 610072 四川成都,电子科技大学附属医院四川省人民医院急救中心;610072 四川成都,国家(四川)紧急医学救援队
    3. 610072 四川成都,电子科技大学附属医院四川省人民医院急救中心
    4. 610072 四川成都,电子科技大学附属医院四川省人民医院健康管理中心;610072 四川成都,国家(四川)紧急医学救援队
    5. 610072 四川成都,电子科技大学附属医院四川省人民医院后勤保障部;610072 四川成都,国家(四川)紧急医学救援队
    6. 610072 四川成都,电子科技大学附属医院四川省人民医院心血管超声及心功能科
    7. 610072 四川成都,电子科技大学附属医院四川省人民医院临床医学检验中心;610072 四川成都,国家(四川)紧急医学救援队
  • 收稿日期:2022-07-01 出版日期:2022-09-15
  • 通信作者: 刘于嵩
  • 基金资助:
    四川省科技厅资助项目(2022YFS0602); 四川省科技厅资助项目(2021YFS0187)

Practice of emergency medical rescue in large-scale public health emergencies

Yong Jing1, Xin Li2, Jin Fu3, Li Chang3, Ning Xiao4, Li Ma2, Lei Yue2, Lei Huang2, Xuejie Wang5, Lixue Yin6, Kang Chen2, Chuanzhu Lv3, Yusong Liu7,()   

  1. 1. Department of Cardiovascular Ultrasound and Cardiac Function, Sichuan Provincial People's Hospital, Chengdu 610072, China; National (Sichuan) Emergency Medical Rescue Team, Chengdu 610072, China
    2. Emergency Medical Center, Sichuan Provincial People's Hospital, Chengdu 610072, China; National (Sichuan) Emergency Medical Rescue Team, Chengdu 610072, China
    3. Emergency Medical Center, Sichuan Provincial People's Hospital, Chengdu 610072, China
    4. Health Management Center, Sichuan Provincial People's Hospital, Chengdu 610072, China; National (Sichuan) Emergency Medical Rescue Team, Chengdu 610072, China
    5. Logistics Support Department, Sichuan Provincial People's Hospital, Chengdu 610072, China; National (Sichuan) Emergency Medical Rescue Team, Chengdu 610072, China
    6. Department of Cardiovascular Ultrasound and Cardiac Function, Sichuan Provincial People's Hospital, Chengdu 610072, China
    7. Clinical Laboratory Center, Sichuan Provincial People's Hospital, Chengdu 610072, China; National (Sichuan) Emergency Medical Rescue Team, Chengdu 610072, China
  • Received:2022-07-01 Published:2022-09-15
  • Corresponding author: Yusong Liu
引用本文:

敬勇, 李鑫, 付晶, 常莉, 肖宁, 马黎, 乐磊, 黄雷, 王学杰, 尹立雪, 陈康, 吕传柱, 刘于嵩. 大规模突发性公共卫生事件的紧急医学救援实践[J]. 中华临床医师杂志(电子版), 2022, 16(09): 821-827.

Yong Jing, Xin Li, Jin Fu, Li Chang, Ning Xiao, Li Ma, Lei Yue, Lei Huang, Xuejie Wang, Lixue Yin, Kang Chen, Chuanzhu Lv, Yusong Liu. Practice of emergency medical rescue in large-scale public health emergencies[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(09): 821-827.

以2019年爆发的新型冠状病毒肺炎(COVID-19)为代表的大规模传染病事件,属于全球性重大公共卫生事件,给全人类的生命健康、经济发展带来了极大的冲击,也对我国社会治理体系和治理管理能力带来了重大挑战。面对突发性大规模传染病事件,能否根据需求及时、准确的有效提供医疗救治服务,是应对疫情防控的关键。在此次应对COVID-19的过程中,全球面对的考验主要集中在以下两点:一是基础医疗系统与应急医疗救援系统的协调性,二是面对井喷式大规模群体感染的确诊病例需要大量的救治空间和场所,其救治难度远远超出所有国家常态化医疗设施的负荷。为减轻基础医疗设施的压力,保证医疗正常秩序,怎样及时有效地展开应急医学救援,做到防控、救治同时并举至关重要,本研究探讨方舱医院的创设及临床-医技-信息技术多学科整合救援模式、疗愈景观理念,建立和运行“点面管理”(重症和批量轻症、无症状感染者的医护协同分类照护)、“流径管理”(重症和批量轻症、无症状感染者的医护协同分类照护)、“载量管理”(统筹筛查、批量周转的先期处置)、“筛网管理”(根据病情分级和病 程分时的梯级分流)、“全域管理”(全环境、全人员、全流程、全路径的感染控制)工作模式,将为全球公共卫生危机下的应急医疗资源提供思路。

The outbreak of coronavirus disease 2019 (COVID-19) is a major global public health event, which has brought great impact on people's lives and health and economic development around the world, and has also brought major challenges to China's social governance system and governance management capacity. In the face of sudden large-scale infectious disease events, whether medical treatment services can be provided in a timely, accurate, and effective manner according to demand is the key to epidemic prevention and control. In the process of responding to COVID-19, the main challenges are the coordination of the basic medical system and the emergency medical rescue system, and the requirement of a large number of spaces and places for the treatment of confirmed cases that far exceed the load of normal medical facilities in all countries. In order to help reduce the pressure on basic medical facilities, ensure normal order, carry out emergency medical rescue in a timely and effective manner, and coordinate the prevention, control, and treatment at the same time, this study discusses the establishment of makeshift hospitals, the rescue mode of integrating clinical, medical, and information technology, the concept of healing landscape, and the models of "point management" (coordinated and classified care for patients with severe and mild cases and asymptomatic infections in batches), "flow path management" (coordinated and classified care for patients with severe and mild cases and asymptomatic infections in batches), "load management" (operations prior to patient screening and transportation), "screen management" (triage according to the illness and disease course), " whole domain management" (infection control in terms of the whole environment, all staff, the whole process, and the full path), with an aim to provide ideas for rational utilization of emergency medical resources in global public health crises.

图1 2020年武汉救援期间22支国家紧急医学救援队学科专业分布
图2 国家(四川)紧急医学救援队学科构成
图3 分级、分程、分区管理
表1 2022方舱患者分级管理标准
图4 感防控组织体系
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