特大地震应急医学救援:来自汶川的经验
摘要
本文系统回顾分析汶川地震应急医学救援组织指挥、力量部署、医疗救治、卫生防疫、心理救援及对口支援等方面的经验教训,提出"完善‘国家-省-市-县’4级联动的应急机制、建立协同高效的多元化救援力量协同机制、制定科学有序的伤病员后送体系与康复计划、健全卫生防疫的快速评估、避免过度消毒杀虫灭害、发挥对口支援这一中国特色的制度工具的重要作用等"中国特大灾害应急医学救援发展建议,旨在为全球应对自然灾害,尤其是地震医学救援提供有益参考。
We systematically and retrospectively analyzed the experience and lessons from the command system,medical rescue force deployment,medical treatment,public health response for infectious disease control,and health counterpart assistance for emergency medical rescue after the 2008 earthquake in Wenchuan,Sichuan Province,China.We propose that emergency medical rescue after tremendous catastrophes in China link responses at the national,provincial,city,and county levels,to set up an effective and cooperative medical relief forces coordination system and an effective triage system and rehabilitation plan.In addition,infectious disease control should be planned and assessed more quickly,and developing vital functions of pairing-assistance as a means with Chinese characteristic.Our aim is to provide a useful reference for medical rescue after natural catastrophes worldwide,especially after earthquakes.
We systematically and retrospectively analyzed the experience and lessons from the command system,medical rescue force deployment,medical treatment,public health response for infectious disease control,and health counterpart assistance for emergency medical rescue after the 2008 earthquake in Wenchuan,Sichuan Province,China.We propose that emergency medical rescue after tremendous catastrophes in China link responses at the national,provincial,city,and county levels,to set up an effective and cooperative medical relief forces coordination system and an effective triage system and rehabilitation plan.In addition,infectious disease control should be planned and assessed more quickly,and developing vital functions of pairing-assistance as a means with Chinese characteristic.Our aim is to provide a useful reference for medical rescue after natural catastrophes worldwide,especially after earthquakes.
引文
1 Noji EK.e public health consequences of disasters.Prehosp Disas-ter Med,2000,15(4):147-157.
2 Tanaka H,Oda J,Iwai A,et al.Morbidity and mortality of hospital-ized patients a er the 1995 Hanshin-Awaji earthquake.Am J EmergMed,1999,17(2):186-191.
3 Li YP,Wen J,Du L,et al.A comparative study on earthquake-relat-ed Literature published in medical journals.J Evid Based Med,2009,2(4):252-257.
4林均岐.2004年12月26日印度尼西亚地震海啸灾害考察.地震工程与工程振动,2005,25(2):30-33.
5 Han Q,Chen L,Evans T,et al.China and global health.Lancet,2008,372(9648):1439-1441.
6胡世全.重大自然灾害中的“信息孤岛”现象研究——以5.12四川汶川特大地震为例.南昌高专学报,2008,5:163-165.
7民政部,国家发展改革委,财政部,国土资源部,中国地震局.关于印发汶川地震灾害范围评估结果的通知.民发(2008)105号.http://www.gov.cn/jrzg/2008-07/22/content_1053017.htm.
8 Edwards CL.Emergency response and recovery after the May 12,Wenchuan earthquake.Proceedings of the 2009 ASCE TechnicalCouncil on Earthquake Engineering,2009,357:1-7.
9苗崇刚,聂高众.地震应急指挥模式探讨.自然灾害学报,2004,13(5):48-54.
10谷运麒.“汶川大地震”紧急医疗救援的组织管理.中国急救复苏与灾害医学杂志,2008,3(6):334-335.
11四川省卫生厅.四川省抗震救灾指挥部医疗保障组文件汇编.
12姜洁,李幼平,邓绍林,等.玉树汶川震后3月医疗救援比较研究.中国循证医学杂志,2010,10(7):784-790.
13四川省卫生厅.抗震救灾医疗卫生救援工作专报.
14卫生部医疗防疫志编纂委员会.汶川特大地震抗震救灾志医疗防疫志.
15张雁灵.汶川特大地震医学救援行动及战略思考.解放军医学杂志,2009,34(1):1-6.
16 Auerbach PS,Norris RL,Menon AS,et al.Civil-military collabora-tion in the initial medical response to the earthquake in Haiti.NEngl J Med,2010,362(10):e32.
17 Cranmer HH.Hurricane Katrina.Volunteer work--logistics rst.NEngl J Med,2005,353(15):1541-1544.
18沈骥,苏林,李冰,等.汶川地震四川省卫生应急救援成效分析.中国循证医学杂志,2009,9(3):301-306.
19姚元章,张连阳,程晓斌,等.汶川地震伤员伤情特点及救治分析.中华创伤杂志,2008,24(10):852-854.
20代小舟,沈骥,赵万华,等.汶川大地震四川省医疗救治阶段工作纪实.中国循证医学杂志,2008,8(10):797-802.
21胡卫建,赵万华,李元峰,等.汶川地震伤员的紧急医疗分级救治分析.实用医院临床杂志,2010,7(1):20-24.
22卢世璧.汶川地震伤员救治分级处理的重要性.解放军医学杂志,2008,33(8):919-920.
23毕玉田,蔺武军,程晓斌.四川汶川地震伤员救治中院内医疗资源的配置.中国急救复苏与灾害医学杂志,2009,4(9):679-681.
24吴梅祥,钱东阳,白波,等.汶川地震后方医院救治的患者病情特点及治疗对策.中国医药导报,2009,6(16):207-209.
25汶川特大地震灾害第三十八场新闻发布会.http://www.sc.gov.cn/jrsc/200808/t20080818_306986.shtml.
26 Xie J,Du L,Xia T,et al.Analysis of 1856 inpatients and 33 deaths inthe West China Hospital of Sichuan University from the Wenchuanearthquake.J Evid Based Med,2008,1(1):20-26.
27 Qiu J,Liu GD,Wang SX,et al.Analysis of injuries and treatment of3,401 inpatients in 2008 Wenchuan earthquake--based on Chinese Trauma Databank.Chin J Traumatol,2010,13(5):297-303.
28 Roy N,Shah H,Patel V,Bagalkote H.Surgical and psychosocial out-comes in the rural injured--a follow-up study of the 2001 earthquake victims.Injury,2005,36(8):927-934.
29曾宪敏,王哓红,徐健,等.四川什邡地震灾后截肢、脊髓损伤、颅脑损伤伤员康复状况调查.中国康复医学杂志,2010,25(8):771-773.
30吴先萍,方刚,唐雪峰,等.汶川地震灾后四川省的卫生防病工作(2008.5.12～8.12).中国循证医学杂志,2008,8(10):803-809.
31陈根,南克祎,赵宗国,等.“5.12”地震对甘肃灾区人群常见卫生习惯、腹泻和儿童肠道蠕虫感染的影响.中国病原生物学杂志,2010,5(11):附页4.
32朱鸿斌,程娟,赵大余,等.四川省“5.12”地震灾区饮用水卫生情况分析.预防医学情报杂志,2008,24(11):849-852.
33程芳芳,董晓梅,王声湧.玉树地震应急管理对汶川经验的验证.循证医学,2010,10(3):157-162.
34王育兵,马静.汶川地震灾后疫病的特点与启示.实用预防医学,2010,17(9):1908-1910.
35李静,李小麟,王丹,等.汶川大地震受伤人员心理干预理论框架与初步实践.华西医学,2008,23(4):834-835.
36李小融,卢雄灾后心理援助非政府组织的协调分析.四川教育学院学报,2008,24(12):1-3.
37国务院.汶川地震灾后恢复重建总体规划.2008-09-19.
38国务院办公厅.汶川地震灾后恢复重建对口支援方案.2008-06-11.
39国务院办公厅关于印发汶川地震灾后恢复重建对口支援方案的通知.国办发[2008]353号.2008-06-11.
40陈啸宏.在汶川地震灾区医疗卫生恢复重建对口支援工作会上的讲话(2010.8.25).卫生政务通报,第22期.2010-09-10.
41 Currier M,King DS,Wo ord MR,et al.A Katrina experience:les-sons learned.Am J Med,2006,119(11):986-992.
42 Nates JL,Moyer VA.Lessons from Hurricane Katrina,tsunamis,and other disasters.Lancet,2005,366(9492):1144-1146.
43姜洁,李幼平,王觅也,等.玉树与汶川地震医疗救援比较研究.中国循证医学杂志,2010,10(5):550-554.
44 Deng SL,Zheng SW,Shi YK.Applying lessons from China’s Wen-chuan earthquake to medical rescue following the Yushu earth-quake.J Evid-based Med,2010,3(2):62-64.
45 Tahir H,Iqbal Z.Do doctors who volunteer their services in disas-ters overseas do more harm than good?BMJ,2006,332:244.
46 Owens PJ,Forgione A Jr,Briggs S.Challenges of international dis-aster relief:use of a deployable rapid assembly shelter and surgical hospital.Disaster Manag Response,2005,3(1):11-16.
47 Roces MC,White ME,Dayrit MM,et al.Risk factors for injuries due to the 1990 earthquake in Luzon,Philippines.Bull World Health Organ,1992,70(4):509-514.
48 Schultz CH,Koenig KL,Noji EK.A medical disaster response to reduce immediate mortality a er an earthquake.N Engl J Med,1996,334(7):438-444.
49 Pretto EA,Angus DC,Abrams JI,et al.An analysis of prehospital mortality in an earthquake.Disaster Reanimatology Study Group.Prehosp Disaster Med,1994,9(2):107-117.
50 Chan EY.The untold stories of the Sichuan earthquake.Lancet,2008,372(9636):359-362.
51 Lei BL,Zhou Y,Zhu Y,et al.Emergency response and medical res-cue in the worst hit Mianyang areas a er the Wenchuan earthquake.J Evid Based Med,2008,1(1):27-36.
52姬军生.地震批量伤员空运后送体系的构建.解放军医院管理杂志,2008,15(10):906-907.
53曾伟,鹿茸,魏咏兰,等.灾害及灾后公共卫生服务的社会评估.现代预防医学,2010,37(9):1679-1681.
54倪锋,张悦,于彤舟.汶川大地震对口支援初步研究.经济与管理研究,2009,7:55-62.
2 Tanaka H,Oda J,Iwai A,et al.Morbidity and mortality of hospital-ized patients a er the 1995 Hanshin-Awaji earthquake.Am J EmergMed,1999,17(2):186-191.
3 Li YP,Wen J,Du L,et al.A comparative study on earthquake-relat-ed Literature published in medical journals.J Evid Based Med,2009,2(4):252-257.
4林均岐.2004年12月26日印度尼西亚地震海啸灾害考察.地震工程与工程振动,2005,25(2):30-33.
5 Han Q,Chen L,Evans T,et al.China and global health.Lancet,2008,372(9648):1439-1441.
6胡世全.重大自然灾害中的“信息孤岛”现象研究——以5.12四川汶川特大地震为例.南昌高专学报,2008,5:163-165.
7民政部,国家发展改革委,财政部,国土资源部,中国地震局.关于印发汶川地震灾害范围评估结果的通知.民发(2008)105号.http://www.gov.cn/jrzg/2008-07/22/content_1053017.htm.
8 Edwards CL.Emergency response and recovery after the May 12,Wenchuan earthquake.Proceedings of the 2009 ASCE TechnicalCouncil on Earthquake Engineering,2009,357:1-7.
9苗崇刚,聂高众.地震应急指挥模式探讨.自然灾害学报,2004,13(5):48-54.
10谷运麒.“汶川大地震”紧急医疗救援的组织管理.中国急救复苏与灾害医学杂志,2008,3(6):334-335.
11四川省卫生厅.四川省抗震救灾指挥部医疗保障组文件汇编.
12姜洁,李幼平,邓绍林,等.玉树汶川震后3月医疗救援比较研究.中国循证医学杂志,2010,10(7):784-790.
13四川省卫生厅.抗震救灾医疗卫生救援工作专报.
14卫生部医疗防疫志编纂委员会.汶川特大地震抗震救灾志医疗防疫志.
15张雁灵.汶川特大地震医学救援行动及战略思考.解放军医学杂志,2009,34(1):1-6.
16 Auerbach PS,Norris RL,Menon AS,et al.Civil-military collabora-tion in the initial medical response to the earthquake in Haiti.NEngl J Med,2010,362(10):e32.
17 Cranmer HH.Hurricane Katrina.Volunteer work--logistics rst.NEngl J Med,2005,353(15):1541-1544.
18沈骥,苏林,李冰,等.汶川地震四川省卫生应急救援成效分析.中国循证医学杂志,2009,9(3):301-306.
19姚元章,张连阳,程晓斌,等.汶川地震伤员伤情特点及救治分析.中华创伤杂志,2008,24(10):852-854.
20代小舟,沈骥,赵万华,等.汶川大地震四川省医疗救治阶段工作纪实.中国循证医学杂志,2008,8(10):797-802.
21胡卫建,赵万华,李元峰,等.汶川地震伤员的紧急医疗分级救治分析.实用医院临床杂志,2010,7(1):20-24.
22卢世璧.汶川地震伤员救治分级处理的重要性.解放军医学杂志,2008,33(8):919-920.
23毕玉田,蔺武军,程晓斌.四川汶川地震伤员救治中院内医疗资源的配置.中国急救复苏与灾害医学杂志,2009,4(9):679-681.
24吴梅祥,钱东阳,白波,等.汶川地震后方医院救治的患者病情特点及治疗对策.中国医药导报,2009,6(16):207-209.
25汶川特大地震灾害第三十八场新闻发布会.http://www.sc.gov.cn/jrsc/200808/t20080818_306986.shtml.
26 Xie J,Du L,Xia T,et al.Analysis of 1856 inpatients and 33 deaths inthe West China Hospital of Sichuan University from the Wenchuanearthquake.J Evid Based Med,2008,1(1):20-26.
27 Qiu J,Liu GD,Wang SX,et al.Analysis of injuries and treatment of3,401 inpatients in 2008 Wenchuan earthquake--based on Chinese Trauma Databank.Chin J Traumatol,2010,13(5):297-303.
28 Roy N,Shah H,Patel V,Bagalkote H.Surgical and psychosocial out-comes in the rural injured--a follow-up study of the 2001 earthquake victims.Injury,2005,36(8):927-934.
29曾宪敏,王哓红,徐健,等.四川什邡地震灾后截肢、脊髓损伤、颅脑损伤伤员康复状况调查.中国康复医学杂志,2010,25(8):771-773.
30吴先萍,方刚,唐雪峰,等.汶川地震灾后四川省的卫生防病工作(2008.5.12～8.12).中国循证医学杂志,2008,8(10):803-809.
31陈根,南克祎,赵宗国,等.“5.12”地震对甘肃灾区人群常见卫生习惯、腹泻和儿童肠道蠕虫感染的影响.中国病原生物学杂志,2010,5(11):附页4.
32朱鸿斌,程娟,赵大余,等.四川省“5.12”地震灾区饮用水卫生情况分析.预防医学情报杂志,2008,24(11):849-852.
33程芳芳,董晓梅,王声湧.玉树地震应急管理对汶川经验的验证.循证医学,2010,10(3):157-162.
34王育兵,马静.汶川地震灾后疫病的特点与启示.实用预防医学,2010,17(9):1908-1910.
35李静,李小麟,王丹,等.汶川大地震受伤人员心理干预理论框架与初步实践.华西医学,2008,23(4):834-835.
36李小融,卢雄灾后心理援助非政府组织的协调分析.四川教育学院学报,2008,24(12):1-3.
37国务院.汶川地震灾后恢复重建总体规划.2008-09-19.
38国务院办公厅.汶川地震灾后恢复重建对口支援方案.2008-06-11.
39国务院办公厅关于印发汶川地震灾后恢复重建对口支援方案的通知.国办发[2008]353号.2008-06-11.
40陈啸宏.在汶川地震灾区医疗卫生恢复重建对口支援工作会上的讲话(2010.8.25).卫生政务通报,第22期.2010-09-10.
41 Currier M,King DS,Wo ord MR,et al.A Katrina experience:les-sons learned.Am J Med,2006,119(11):986-992.
42 Nates JL,Moyer VA.Lessons from Hurricane Katrina,tsunamis,and other disasters.Lancet,2005,366(9492):1144-1146.
43姜洁,李幼平,王觅也,等.玉树与汶川地震医疗救援比较研究.中国循证医学杂志,2010,10(5):550-554.
44 Deng SL,Zheng SW,Shi YK.Applying lessons from China’s Wen-chuan earthquake to medical rescue following the Yushu earth-quake.J Evid-based Med,2010,3(2):62-64.
45 Tahir H,Iqbal Z.Do doctors who volunteer their services in disas-ters overseas do more harm than good?BMJ,2006,332:244.
46 Owens PJ,Forgione A Jr,Briggs S.Challenges of international dis-aster relief:use of a deployable rapid assembly shelter and surgical hospital.Disaster Manag Response,2005,3(1):11-16.
47 Roces MC,White ME,Dayrit MM,et al.Risk factors for injuries due to the 1990 earthquake in Luzon,Philippines.Bull World Health Organ,1992,70(4):509-514.
48 Schultz CH,Koenig KL,Noji EK.A medical disaster response to reduce immediate mortality a er an earthquake.N Engl J Med,1996,334(7):438-444.
49 Pretto EA,Angus DC,Abrams JI,et al.An analysis of prehospital mortality in an earthquake.Disaster Reanimatology Study Group.Prehosp Disaster Med,1994,9(2):107-117.
50 Chan EY.The untold stories of the Sichuan earthquake.Lancet,2008,372(9636):359-362.
51 Lei BL,Zhou Y,Zhu Y,et al.Emergency response and medical res-cue in the worst hit Mianyang areas a er the Wenchuan earthquake.J Evid Based Med,2008,1(1):27-36.
52姬军生.地震批量伤员空运后送体系的构建.解放军医院管理杂志,2008,15(10):906-907.
53曾伟,鹿茸,魏咏兰,等.灾害及灾后公共卫生服务的社会评估.现代预防医学,2010,37(9):1679-1681.
54倪锋,张悦,于彤舟.汶川大地震对口支援初步研究.经济与管理研究,2009,7:55-62.
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