西藏阿里地区院前急救时空分布特征及对策探索

Spatial and temporal distribution characteristics of pre-hospital first aid in Ali region and its counter measures

目的通过分析西藏自治区阿里地区目前院前急救的特点及面临的问题,提出可能的改进措施。方法收集2015年9月至2019年8月西藏阿里地区人民医院急诊科院前急救相关数据,进行流行病学统计,并分析院前急救数量周期规律及交通伤在不同时间段所占院前急救量比例。绘制等时线图,比较不同时长地面紧急医疗服务及直升机紧急医疗服务所覆盖的居民点、旅游景点及主要道路情况。结果西藏阿里地区院前急救的流行病学以中、青年患者居多,占80.35%。创伤患者在外来人员和本地居民中均常见,其中交通伤导致的创伤占创伤总量的66.43%。除外创伤,本地居民中以神经系统急症最为常见(24.65%),外来人员中以高原反应最为常见(19.14%)。每年4至12月阿里地区急救量会出现周期性增高的现象,7至9月间达到峰值。在排除周期性影响因素后,阿里地区院前急救量随时间仍呈逐渐增长的趋势,回归方程Y=15.7+0.27X,F=36.809,P<0.05,R2=0.444。每年4至12月期间,交通伤导致的院前急救数量明显增加,χ2=10.819,P<0.05。地面紧急医疗服务15 min内,能够覆盖阿里地区所有镇所在区域,以及急救点所在区域及个别距离急救点近的村落,共计49个村(居);1 h内能够覆盖75个村(居)及4处旅游景点所在地,与15 min覆盖区域相比,χ2=10.813,P<0.05,覆盖主要道路约788 km。如地面紧急医疗服务及直升机紧急医疗服务相配合,院前资源能够覆盖116个村(居)及5处旅游景点所在地,与单纯地面急救1 h所能覆盖相比,χ2=19.447,P<0.05;覆盖主要道路约1234 km,与目前急救资源1 h所能覆盖区域相比,χ2=349.532,P<0.05。结论采用直升机紧急医疗服务配合地面紧急医疗服务可能是从根本上解决目前阿里地区急救网点覆盖范围较小的解决办法。

Objective To put forward possible improvement measures through analyzing characteristics of pre-hospital first aid in Ali region and the problems confronted.Methods The relevant data of pre-hospital first aid in the Emergency Department of Ali People's Hospital of Tibet from September 2015 to August 2019 were collected,and the epidemiological statistics were made.In addition,the number and cycle rule of pre-hospital first aid and the proportion of traffic injuries in pre-hospital first aid in different time periods were analyzed.The isochronous maps were drawn,and the residential areas,tourist attractions and main roads covered by the ground emergency medical service(GEMS)and helicopter emergency medical services(HEMS)at different periods were compared.Results The epidemiology of pre-hospital first aid was mainly in middle-aged and young patients,accounting for 80.35%.Trauma patients were the most common in both non-native population(45.72%)and local residents,of which traffic injuries accounted for 66.43%of total trauma.Neurological emergency was the second most common among local residents(24.65%),and high altitude reaction was the second most common among non-native population(19.14%).From April to December every year,the amont of emergency treatment in Ali region increased periodically,and reached the peak from July to September.After eliminating the periodic influencing factors,the amount of pre-hospital first aid in Ali region showed a gradual increase over time.The regression equation was Y=15.7+0.27X,F=36.809,P<0.05,R2=0.444.From April to December every year,the amount of pre-hospital first aid caused by traffic injuries increased significantly(χ2=10.819,P<0.05).Within 15 min,GEMS could cover all the towns in Ali region,as well as the area where the first aid point was located and some villages that were pretty close to the first aid point,with a total of 49 villages(residences);Compared with 15 min,the pre-hospital resources could cover 75 villages(residences)and 4 tourist attractions within 1 h(χ2=10.813,P<0.05),and the main roads could cover about 788 km.If combined GEMS and HEMS,compared with the coverage of only one hour of ground emergency,the pre-hospital resources could cover 116 villages(residences)and 5 tourist attractions(χ2=19.447,P<0.05),and the main roads could cover about 1234 km(χ2=349.532,P<0.05).Conclusions HEMS combined with GEMS might fundamentally solve problem of comparatively small coverage of the emergency network in Ali region at present.