汶川地震后华西医院调整急救空间的实践分析

Practice of and experience in adjustment of space for emergency treatment in West China Hospital after the Wenchuan Earthquake

汶川地震后3周内，2621例伤员陆续直接从现场送到华西医院。在院领导的支持下配合形势的变化对急诊空间进行调整。优化急诊空间，在急诊空间规划时预留空间。震后12h内，伤员主要来源于成都市区及周边区域，以皮肤软组织伤和肢体骨折居多。在急诊科的就诊大厅由护士迅速分诊，再由医生在抢救室，清创间以及普通诊断室按常规流程进行诊治。接着，大量重伤员从重灾区运来。医院增设等待分流区。伤员初诊后，接受影像学和实验室检查后送至等待区接受另一批医生的诊治，从而使大量伤员得到及时分流。生命体征不平稳者在抢救室立即实施抢救。12h后，灾区伤者收治量剧增，伤情更为复杂。急诊科迅速将分检区扩大至医院停车场，由医师检伤后再将病员分流至诊疗区处理。3d后伤口感染的伤员增加。急诊科将伤者分为开放性和闭合性损伤两类，前者分流至半污染区，伤口分泌物快速涂片排除感染后再进入普通等待区，有感染性伤口的伤者进入感染区诊治。在平常的停车场一侧不与非感染诊疗区相通的区域搭棚设立感染区，伤者在此隔离，工作人员进出也要进行严格消毒，从而避免交叉感染和院内感染。与交通警察合作，对急诊科前的停车场实施交通管制，开辟单向循环快速抢救通道。清理乱停乱放车辆，人流车流完全分开。

Within 3 weeks after the May 12 Wenchuan Earthquake, 2,631 wounded persons were transferred in succession to the West China Hospital. The problems of space shortage and bad management were highlighted soon. With the support of the hospital administration the emergency space was re-arranged, optimized, and re-dispatched in response to the changes of situation. Necessary room was reserved too. Within 12 hours after the quake the wounded persons were sent to the hospital mainly form the urban areas of Chengdu and nearby areas, most with soft tissue injuries and fractures. They underwent triage by the nurses in the hall of the Department of Emergency and then sent to the counsnlting rooms to be treated by the physicians according to the routine schedule. Those with unstable vital signs were treated in the rescue room. Then severe traumatic patients arrived from the areas seriously stricken by earthquake group by group. A waiting area was set up. After triage and first consultation the wounded that had underwent supplementary diagnostic examinations, such as CT, MRI, laboratory examination etc, waited here for the treatment by other physicians, thus the patients were diverted in time. Twelve hours after the quake, more and more patients severely and complicatedly wounded kept arriving. The Department of Emergency expanded the triage area to the yard in front of the hospital building immediately where the physicians practiced triage and then the patients were diverted to the special diagnosis, and treatment area. Three days later, the percentage of patients with infected wound increased greatly. The wounded patients were diverted according to the characteristics of the wound. Those with open wound were diverted to the semi-contamination area to undergo wound smear examination, and then those confirmed to be without infection were led to the ordinary waiting area, and those with infection to the infection area. A shed was put up at one side of the former parking lot to be used as infection area where the wounded patients with infection were isolated and the medical professionals had to abide by the rules of sterilization and isolation too so as to avoid cross infection and nosocomial infection. Helped by the traffic police, traffic control was exerted in the parking lot and a one-way rescue passage was established. Illegally parked vehicles were cleared. Stream of people and traffic flow were separated completely.