以医院船为节点的伤病员医疗后送优化配置研究

Optimization of Medical Evacuation for Casualties in Hospital Ship

目的:以医院船为节点,模拟海上伤病员医疗后送中的伤员流,以找出限制性的关键因素,进行路径优化和资源调整,辅助卫勤指挥者选择更好的应对方案,提高保障效率。方法:按照军队现行的海上医疗后送体制搭建框架,并根据现有的医院船条件和设施进行细化和修改,以GoldSim为建模平台,在计算机上搭建以医院船为节点的伤员流仿真模型,选取四种伤员分布作为模型运行的情景,采用蒙特卡洛方法进行模拟,依靠灵敏性分析处理不同因素之间的关联性。结果:在面对单峰型和增长型伤员流时,手术室的通过率占最主要地位;在面对峰值型伤员流时,伤病员分类速度成为了主要因素;在面对均衡型伤员流时,伤病员后送频率影响最大。结论:一是需要强调增加预测模式的重要性,军队用于减员预测的模式越丰富,战时应对不同需求的灵活性就越大;二是需要突出卫勤调配过程信息化的重要性,人员之间的协调,在战场环境下不能全部依靠单一的通讯方式,多种通信方式并存且将其条理化,可有效降低不良沟通带来的延时和误解;三是需要利用医院船功能模块化的优越性,在面对战场复杂多变的环境时,卫勤指挥人员随时根据当前情况迅速调整人员和物资配备,可有效增加资源使用效率、降低人员死亡率、提高保障效率。

Objective To build a model simulating the casualty-flow in medical evacuation at sea in order to help decision- makers to optimize casualty path and medical resource, and to find the key factors which affect the effectiveness. Methods According to the current medical evacuation system in the army and the equipment and staff in the newest hospital ship in China, the model was created with GoldSim software. Four casualty distributions of which the data had been obtained with Monte Carlo method were chosen as the input data to run the model. Sensitivity analysis method was used to find out the key factors. Rosults The adoption rate of casualties in operating room was proved to be the most important factor for unimodal and increasing distributions; classification rate of sick and wounded was the essential one for spike distribution; frequency of evacuation was most critical for uniform distribution. Conclusion More predictive models are needed for decision-makers to enhance the flexibility to variable demands; the importance of information should be much more realized in medical service deployment process; modularization of hospital-ship needs to be improved to effectively increase the efficiency of resource in use.