【作者】 邓军；

【导师】 罗长坤；

【作者基本信息】 第三军医大学 ， 社会医学与公共卫生事业管理， 2013， 博士

【摘要】 新时期我军的根本任务是“能打仗、打胜仗”。我国西部高原寒区（西藏、青海、新疆地区）人口稀少，幅员广阔，边防线长，道路崎岖，战略地位重要，对外反“蚕食”、对内反“分裂”斗争任务艰巨，是我军未来作战的主要方向。高技术条件下高原寒区作战有发起突然、时间急促、部队集结量大、保障范围广、保障难点多等特点，加之高原寒区环境气候恶劣，地方病、环境相关病、自然疫源性疾病突出，对高原寒区卫勤保障工作提出了更高的要求。然而，我军定点布局、对口保障、分级负责的卫勤保障模式，在作战中容易成为打击目标，医疗保障机构面临很大的生存威胁。同时，未来信息化条件下，高原寒区发生战役级及以上规模的高技术战争时，军队建制保障医疗资源数量不足，其他战区支援保障的医疗机构，面临难以适应环境、难以遂行保障、难以有效诊治等问题。因此，研究这一特殊地域作战的卫勤保障体系，加强地方医院的平时储备和战时动员，将作战方向战略后方支援区域内的地方医院纳入战时卫勤保障的后备力量，实施军民融合式发展，建立军民结合、平战结合、寓军于民的卫勤保障创新模式，探索行之有效的保障手段和方法，对提高战役卫勤保障能力，取得高原寒区作战胜利具有重要意义。本研究依据军队卫生勤务学、国防卫生动员、模块化理论及系统评估理论等相关学科理论，聚焦高原寒区作战地方医院平转战问题，采用文献荟萃、现场调研等方法，研究总结我国地方医院平转战所涉及的相关理论、国内外地方医院平转战的发展历程和探索实践，分析高原寒区作战地方医院平转战的基础和存在的问题。采用专家咨询、统计分析等方法，分析某区域高原寒区作战地方医院平转战的应急响应需求、卫生资源储备与战备训练等潜力情况，获得高原寒区作战地方医院平转战的现实卫勤需求。在此基础上，采用优化建模、模块化等方法，构建高原寒区作战地方医院平转战应急响应模型，优化应急响应体系与流程，探讨应急响应机制；解析高原寒区作战地方医院医疗分队模块结构，建立高原寒区作战地方医院医疗分队模块体系，阐明地方医院平战转换模块化机制；编制各类高原寒区作战地方医院平转战预案，形成高原寒区作战地方医院平转战预案体系，为高原寒区作战地方医院提供平战转换的理论与方法支持。进一步通过专家问卷，采用层次分析法，构建高原寒区作战地方医院平转战能力评估指标体系，为高原寒区作战地方医院平转战能力评估提供工具，从而提升地方医院参与高原寒区作战的卫勤保障能力。本课题研究共分七章，第1章主要分析了高原寒区的概况及对机体的影响，阐明了高原寒区作战卫勤保障的特点和要求，重点回答“意义性”的问题；第2~4章主要分析了地方医院平转战的发展历程、理论成果和实践经验，并围绕高原寒区作战地方医院平转战有无需求开展研究，回答“虽有意义，是否必要”的问题；第5~6章主要围绕高原寒区地方医院有无基础而开展潜力调查和分析，并依据调查结果，针对地方医院是否具备平转战能力开展评估指标体系研究，回答“既然必要，有无可能”的问题；第7章主要研究高原寒区作战地方医院平转战机制和预案体系构建，回答“既然可能，如何实践”的问题。基于这一思路，通过文献调研和专家咨询等研究，获得了以下研究结果：地方医院平转战发展历程和现况研究结果：（1）国内外国防卫生动员和地方医院平转战相关研究取得一系列理论成果和实践经验；本研究中的地方医院平转战，是指战时由地方抽组的医疗救护分队预编地方各级医院中，从接到动员命令后，完成抽组或整体转换并到指定区域集结待命的过程；目前，我国地方医院平转战主要存在潜力调查管理不足、平转战机制建设不健全、平转战预案体系和能力评估指标体系尚不健全、高原寒区作战地方医院平转战研究不足等四个方面的问题。（2）地方医院资源丰富，人才和技术密集，卫生动员潜力巨大，高效的国防卫生动员是实现高原寒区作战卫勤保障的重要补充。（3）高原寒区作战对卫勤保障提出了新要求，大批量伤员、伤情复杂严重，伤病员救治与后送困难，地方医院的快速平战转换成为高原寒区作战卫勤保障的重要方式之一。（4）从地方医院平战转换的理论和实践研究上入手，研究前后密切衔接、军地密切融合、任务密切协同的“军地一体保障体系”，是高原寒区作战卫勤保障研究的新路子。地方医院平转战需求研究结果：（1）高原寒区作战急性高原病发病率高、卫生防病任务重、伤病员后送困难、地方卫生资源缺乏、高原特需药材保障难度大，卫勤保障的需求突出。（2）高原寒区作战减员率高，卫生人员的需求大，肢体伤、多部位伤、轻度脑损伤发生率高，救治难度很高，急性高原适应不全症、冻伤和非战斗外伤发生率高，救治任务的艰巨。（3）深入分析某战略后方支援区域卫生资源的现状发现，某区域医院在卫生机构总数、卫生床位、卫生人力及卫生设备等方面资源充足，说明高原寒区作战地方医院平转战卫生资源的潜力储备充足。（4）地方医院建立了国防卫生动员与应急响应体系，但存在应急体系规范化程度不高、基础设施综合防范能力不强、应急处置救援能力不足、应急管理的社会参与程度不高等问题；应急响应体系主要以公共突发事件应急响应为主，与战时卫勤保障的应急响应存在差距，现有的体系还不能完全满足高原寒区作战卫勤保障任务需求。高原寒区作战地方医院平转战能力研究结果：（1）在高原寒区战略后方支援区域某城市地方医院动员潜力调查的基础上，通过两轮专家咨询，筛选确定高原寒区作战地方医院平转战能力评估指标。（2）确定了各评估指标的权重，制定了高原寒区作战地方医院平转战能力评估标准，形成了高原寒区作战地方医院平转战能力评估指标体系；经总体一致性检验，指标各项权重判断无逻辑错误，具有满意一致性，指标体系构建合理，能够较好评估高寒地区作战地方医院平转战能力。高原寒区作战地方医院平转战机制和预案构建研究结果：（1）围绕高原寒区作战地方医院平转战的快速“转”的问题，开展平转战应急响应机制研究，提出了地方医院应急响应程序，构建出平战转换模型，阐明了保障潜力向保障实力转化的机制。（2）围绕高原寒区作战地方医院平转战的高效“转”的问题，开展平转战模块化机制研究，明确了地方医院医疗分队模块化步骤和模块化测算方法，提出高原寒区作战地方医院医疗分队可作为野战医疗队、野战医疗所、“中心型”野战医院、途中医疗站、基地医院、专科手术队、前沿手术队等模式实施保障，解析构建了高原寒区作战地方野战医疗所和野战医疗队三级模块化体系，以野战医疗队为例，研究建立了高原寒区作战地方野战医疗队人员编组配置的标准化模块，明确了卫勤保障模块化的机制。（3）提出了高原寒区作战卫勤保障应急预案的分级、分类，依据军队卫勤保障预案研制的思路与方法，构建了高原寒区作战地方医院平转战预案体系，形成了高原寒区作战地方医院平转战预案案例，为地方医院平转战提供范例。下一步将在高原寒区作战地方医院平转战需求大规模调研、地方医疗分队模块化建设实战化、平转战能力评估体系现场验证等方面深入开展研究，为高寒地区作战地方医院平转战系统的优化调整提供更加符合实际的政策建议。更多还原

【Abstract】 The fundamental mission of PLA in the new era is the “capability for battle”. Thewestern cold plateau regions in China (Tibet, Qinghai and Xinjiang) cover a vast area withlong border lines and rugged roads and are sparsely populated, these regions arestrategically important to fight against encroachment and splittism, they are the majorbattlefields of the military. The high-tech war in cold plateau regions is characterized withsudden breakout, shortness of time, mass troops, large scale of medical support and manydifficulties in the process; the severe weather condition, endemic diseases, environmentaldiseases and natural focal diseases pose difficulties for medical support in cold plateauregions. The medical support pattern of designated planning, arranged support, and level tolevel responsibility can be easily targeted in the war and poses life threat to medicalpersonnel. At the same time, in the information context, when a high-tech war break out incold plateau regions, the medical support unit in other battle fields would face manyobstacles, such as having difficulty in adapting to the environment and providing medicalservice due to the insufficient medical support resources in the military. Thus, it is withgreat significance to study the medical support mechanism in this region to improve thepeacetime reserve and wartime mobilization, to include civilian hospitals of the backupregion into wartime medical support reserve, establish cooperation between military andcivilian hospitals, and develop a creative medical support mechanism and explore aneffective method to strengthen medical service capability in cold plateau regions.This research is based on theories related to military medical service, national healthdefense mobilization, modular theory and system evaluation theory; and lays emphasis oncivilian hospital mobilization in cold plateau regions, adopts methods as documentsreference and field research to discuss and summarize theories related to civilian hospitalmobilization and the development and practice of domestic and foreign civilian hospitalmobilization, to analyze the foundation and existing problems in civilian hospital mobilization in cold plateau regions. This research centers on the analysis of the need,medical resource reserve and readiness training of civilian hospitals in cold plateau regionsthrough expert consultation and statistical analysis to acquire the actual medical serviceneed in civilian hospital mobilization in cold plateau regions, based on which to build aemergence response pattern of civilian hospital mobilization through optimizing modelingand modularization to improve emergence response system and process, and discussemergence response mechanism; and to analyze the modular structure of medical serviceunit of civilian hospitals in cold plateau regions, construct modular system for medicalservice unit in civilian hospitals, and illustrate modular mechanism of civilian hospitalmobilization; and formulate preplans and form preplanning system for civilian hospitalmobilization in cold plateau regions to provide theory and method for civilian hospitalmobilization in cold plateau regions. This research provides index system and tool toevaluate the capability of civilian hospital mobilization in cold plateau regions to enhancethe medical support capability of civilian hospitals in battles in cold plateau regions.This paper is divided into seven chapters. The first chapter analyzes the generalcondition of cold plateau regions and its impact on organism, and illustrates the features andrequirements of medical service in cold plateau regions, and mainly explains the meaningand concept. The second, third and fourth chapters analyze the development, theoreticalachievements and practices of civilian hospital mobilization, and give answers to “is itnecessary?” based on the research on the need of civilian hospital mobilization in coldplateau regions. The fifth and sixth chapter conducts survey and analysis on the foundationof civilian hospitals in cold plateau regions, and conducts research on index system forevaluating the capability of civilian hospital mobilization based on the survey, and giveanswers to the question of “possibility”.Chapter seven discusses the construction of civilianhospital mobilization in cold plateau regions and preplanning system to solve practicalissues. The following results have been obtained through referring to literature andconsulting experts.The results of the research on the development and current situation of civilianhospital mobilization are:(1) a series of theoretical achievements and practical experiencesof health defense mobilization and civilian hospital mobilization from both domestic andabroad have been obtained. The civilian hospital mobilization in this paper refers to the process of gathering and preparation of medicals teams from civilian hospitals that areincluded in the civilian hospitals; currently, there are four major problems existing in thecivilian hospital mobilization, such as insufficient research and management, inadequatemechanism, preplan system and evaluation index system(2) civilian hospitals have hugepotential in heath mobilization due to their rich human and technological resources, and aneffective national health defense mobilization is an important supplement to medicalsupport in cold plateau regions.(3) Cold plateau regions pose new threat to medical servicein, such as large number of the wounded, complicated and severe wounds, and difficulty intreating and transporting, which make the prompt mobilization of civilian hospitals one ofthe important way of medical support in cold plateau regions.(4) To analyze the “militaryand civil integration support system” through civilian hospital mobilization theory andpractice is a new approach to study the medical support in cold plateau regions.The results of the research on the need of civilian hospital mobilization:(1) operationsin cold plateau regions face obstacles due to high incidence of acute high altitude sickness,heavy load of medical service, difficulty in wounded transportation, shortness of civilianmedical resources, lack of special medical supply for high altitude diseases, and specialmedical support is required in cold plateau regions.(2) There is a high rate of staff depletionin the operations in cold plateau areas; thus, large number of medical staff is needed. Apartfrom that, the high incidence of limb injury, multiple site damage, and mild brain injury,together with acute high altitude maladjustment, frostbite and non-battle injury posedifficulty to rescue and treatment.(3) the in-depth analysis to the medical resource of a rearbackup area shows the sufficient health agencies, beds, human and equipment resources inhospitals of certain areas, this manifests sufficient health resources reserve of civilianhospital mobilization in cold plateau regions.(4) Emergence response system and nationalhealth defense mobilization mechanism has been established in civilian hospitals, but thelevel of standardization, comprehensive capability of infrastructure, capability foremergency, and level of emergence management and social involvement is relatively low;there is a gap between the current emergence response system and the need of wartimemedical support, because it is mainly targeted public emergencies, and cannot meet thedemand of medical support in cold plateau regions.The research results of the capability of civilian hospital mobilization in cold plateau region are:(1) based on the study of the mobilization potential of an urban hospital in rearbackup region and2round of experts consultation, the index for evaluating the mobilizationcapability of civilian hospitals has been selected.(2) the weight of indexes has beenconfirmed, and the standard to evaluate the mobilization capability has been finalized, andan evaluation index system has been formed to evaluate the mobilization of civilianhospitals in cold plateau regions. The weight of indexes has been proved reasonable withoutlogic mistake after series of tests, it is capable to evaluate the mobilization capability ofcivilian hospitals in cold plateau regions.The results of the research on the mechanism of civilian hospital mobilization inpreplan construction in cold plateau regions:(1) the study on the mobilization of emergenceresponse mechanism has been carried out based on the “promptness” of civilian hospitalmobilization, and proposes an emergence response procedure of civilian hospitals, builds amodel of mobilization and illustrates the transition from support potential to supportstrength.(2) Study the modularization mechanism of mobilization based on the effectivemobilization of civilian hospitals in cold plateau regions to confirm the measuring methodfor modularization and the process of modularization for medical unit in civilian hospitals,and proposes the idea that the medical teams of civilian hospitals in rear region can providemedical support in the form of field medical corps, field medical stations,“centralized”field hospitals, medical stations, specialized surgery corps and frontline surgery corps,explains and constructs the3-level modular system of field medical station and fieldmedical teams in cold plateau regions, clarifies the modular mechanism of medical support.(3)Propose the classification, categorization of the emergence preplan of medical service incold plateau operation regions based on the theory and method for formulating medicalservice preplan, construct the preplan system for civilian hospital mobilization in coldplateau regions, and provide cases of civilian hospitals mobilization for civilian hospitalmobilization.Large scale of research will be carried out on the mobilization of civilian hospitals incold plateau regions, and the modular construction of civilian medical unit will be targetedto actual combat, and in-depth study will be conducted to the on-site test of mobilizationevaluation system to provide practical advice for the optimization of mobilization system incivilian hospitals of cold plateau regions.更多还原