【作者】 刘蓉蓉；

【导师】 秦银河；

【作者基本信息】 第三军医大学 ， 后方勤务学， 2012， 博士

【摘要】 地震是自然灾害之首恶，中国是地震多发的国家。破坏性地震一旦发生，往往会在极短的时间内造成大量人员伤亡和重大财产损失，因此迫切需要加强地震的应急医疗救援。从近年来我国的抗震救灾实践看，应急医疗分队在挽救地震伤员生命、降低伤残率的医疗救援活动中发挥了重要作用，但亦存在医疗分队人员和药材配置不合理、救治措施不规范的现象。本课题从地震早期伤病发生特点研究入手，适应黄金救治时机的需要，对地震应急医疗队的建设模式进行了系统研究，以期为各种医疗机构进行平时的卫生战备训练提供参考。本课题首先分析了目前我国地震应急医疗救援的现状。在此基础上，主要进行了以下几个方面的研究：(1)以2008年汶川大地震医疗救援资料为主要参考依据，结合1976年唐山大地震、2010年玉树大地震的相关数据资料，确立了地震早期伤病谱，并采用ABC管理法，对地震早期伤病实施分类管理，为后续研究奠定了基础。(2)采用文献调研和专家咨询法，构建了地震应急医疗队适宜技术筛选指标体系，包括有效性、公平性、保障性3个I级指标和效果性、紧迫性等8个II级指标，确定了各指标权重及评分标准。参照地震早期伤病谱研究结果，从33种应急医疗技术中，筛选出包括通气术、紧急气管切开术、抗休克技术等25种适宜技术。(3)根据地震早期伤病谱及适宜技术筛选结果，从军队医院抽组，借鉴军队机动卫勤分队和俄军特种医疗队的建设模式，确定了地震应急医疗队的编组模式和人员配置方案。(4)通过专家咨询，构建了地震早期主要伤病的分级救治方案，按照ABC管理法，以地震早期发生率最高的骨折伤为基准，对地震应急医疗队的救援能力进行了科学的测算。(5)以军队相关药材保障标准为基本依据，借鉴单病种病例管理方法，建立了单项适宜技术的药材配置方案。根据地震应急医疗队的救治范围和救援能力研究结果，按照黄金救治时间，确定了包括十大类共87种药材的应急药材配置方案。本课题研究的特色与创新之处主要有：(1)首次采用专家咨询、文献调研及层次分析法对地震应急医疗救援技术进行了适宜性评价，有利于规范应急医疗队的救治范围和措施，指导平时技术训练，提高救援质量和效率。(2)将时效救治理论、卫生技术评估方法等引入灾害医学救援研究，较好地实现了勤务与技术的有效结合。(3)运用科学方法对地震应急医疗队的技术、人员、药材等资源配置以及救治范围和能力进行了系统、定量研究，为地震应急医疗分队的建设和抗震救灾卫勤组织提供了可借鉴的模式，研究成果具有较强的实用性和较好的应用前景。更多还原

【Abstract】 Earthquakes are devastating natural disasters, and China is an earthquake-pronecountry. A devastating earthquake often causes a large number of casualties andsignificant property losses within a very short time. Therefore, there is an urgent need tostrengthen the emergency medical relief in response to earthquakes. In recent years,China’s earthquake relief practice has shown that various emergency medical teamsplayed an important role in the medical relief activities to save lives and reduce disabilityrates of the wounded. Nevertheless, there were also such issues as inappropriate medicalteam staffing and medical supplies, treatment measures being not standardized, etc. Inthis study, we analyzed the characteristics of early injuries and illnesses from theearthquake first, to fit the need of treating at the prime time, then discussed the modes ofemergency medical team building for earthquakes, so as to provide a reference for avariety of medical institutions to the usual health readiness training.In this study, we first analyzed the current status of China’s emergency medicalrescue for earthquakes. Then, the following work was carried out:(1) Primarily based onthe medical relief data of the2008Wenchuan earthquake, and also with reference to thedata of the1976Tangshan earthquake and the2010Yushu earthquake, the spectrum ofdiseases early after the earthquake was established, and was categorized according to theABC management method. This was the base of the subsequent study.(2) Based onliterature research and expert consultation, an index system for screening appropriatetechniques for the earthquake emergency medical teams was established, and the systemincludes three class I indexes, i.e., validity, fairness, and protection, and effects, andeight class II indexes, e.g., effectiveness and urgency. Then, the weight and scoringcriteria of each index were determined. According to the spectrum of diseases early afterthe earthquake, finally25emergency medical techniques, including ventilation, emergency tracheotomy and anti-shock measures were chosen from33emergencymedical rescue techniques as the appropriate techniques for the emergency medical team.(3) According to the appropriate techniques screened, relevant medical professionalswere selected from the army hospital. With reference to the team building mode of thearmy contingency medical units and the Russian special medical teams, the teambuilding and staffing programs were determined for the earthquake emergency medicalteam.(4) The classified treatment programs were established for early injuries andillnesses after the earthquake through expert consultation. According to the ABCmanagement method, bone fractures, the major injuries from earthquakes, were used asthe standard to estimate scientifically the emergency rescue capabilities of the medicalteam.(5) On the basis of the military medical supplies standards, and with reference to asingle disease case management, the medical supplies configuration for individualappropriate techniques was determined. According to the treatment range and rescuecapability of an earthquake emergency medical team, in light of the prime time for rescueand preservation, an emergency program of medical supplies comprising ten categoriesand87kinds of medical supplies was established.Features and innovations of this research are:(1) the appropriateness of emergencymedical rescue techniques was evaluated for the first time, which will help standardizethe scope and measures of treatment for various emergency medical teams.(2) theintroduction of the time window concept and health technology assessment methods willhelp achieve the effective combination of service and technology in disaster medicine.(3)this study investigated systematically the norms of medical team staffing, techniques,and medical supplies preparation, which provides a reference model for the building ofearthquake emergency medical teams. Therefore, the present study is highly practical.更多还原