我国急诊/急救医疗的现状及对未来改进的思考兼论“大急诊”

The present state of emergency/emergency treatment in China and a ponderation over the future: a comment on “broad emergency medicine”

我国的院前急救知识和技术远未普及 ,譬如心脏骤停患者难以得到现场及时的CPR。院内急诊科的人员编制、技术水平、知识范围不能满足社会对急诊医疗的需求。迄今全国缺乏统一的急诊专科技术标准和职业准入制度。急诊医师技术职称评定制度落后于现实 ,制约了专业队伍的发展。急诊医学教育尚未纳入医学教育计划 ,其教育和培训处于自发的无序状态。为改善我国急诊医疗现状 ,应 :①整合医疗资源 ,建立完善的急诊医疗服务系统 ;②全民普及急救知识特别是CPR技术和知识 ;③制订“急救法”;④与国际接轨 ,实行“大急诊” ,即院内急诊不分科、院前急诊和院内急诊一体化的急诊医疗体制 ,从而保证有效、快捷地抢救生命 ,缓解症状 ,稳定病情 ,安全转诊。

The knowledge and technique of pre-hospital rescue are far from popularized in our country. Take for an example, patient with cardiac arrest can not get immediate and proper CPR on the scene. Furthermore, the staffs, skills and knowledge of emergency medicine of the staffs of the emergency departments, and the pre-hospital rescue teams are extremely inadequate to meet the need of the emergency medicine service for the whole society. Skill of emergency rescue and the admission system are not yet standardized to execute emergency medicine service. Because of the profession rank evaluation system for the emergency physicians lags far behind, and it is not applicable to the clinicians working in the emergency medicine service system (EMSS), including pre-hospital and in-hospital emergency systems, it is difficult to maintain a stable team of emergency physicians. The emergency medicine education has not yet been accommodated into the national medicine education program, and therefore its training course is not uniform and is self-generated. To improve the status of EMSS in our country, it is important to establish a perfect EMSS, to propagandize rescue knowledge with emphasis of CPR skill, and to enate laws for emergency rescue. The operation system of rescue and emergency should be in line with the international EMSS, and should establish “broad emergency system”. The emergency system in broad sense means that the emergency clinic should not be split into different specialties, and the emergency medicine should be looked upon as a specialty or discipline by itself, to include all the life-saving technology of all of the acute and urgent illnesses both outside and inside of the hospital, and the treatments should be integrated with that of all the related departments of the hospital.