基层部队一线救治能力抽样调查分析

Sampling investigation and analysis on military medical doctors and medical solders rescue capability

目的 对我军部队一线救治能力情况进行摸底,为更好地了解一线卫勤战备能力。方法 前瞻性研究2021年7月—10月福建、浙江等地6个空军旅团级单位中任职的未参加医师规范化培训且毕业年限<3年的军医、卫生员及兼职卫生医疗战士为调查对象。由调查者现场发放纸质问卷并进行简单的填写说明,问卷现场收回,内容包括个人情况、卫勤基础、部队列装物资使用及熟悉程度和检伤评估能力等。剔除2份无效问卷(内容不全),共收到114份有效调查问卷。军医、卫生员及兼职卫生战士各占35.96%(41人)、64.04%(73人)。平均年龄分别30.6岁和25.1岁。问卷收集后由2名经培训的研究者进行问卷质量评价,根据排除标准剔除并将结果进行比较,当评价结果不一致时,则由双方协商或由第3位研究者协助裁决。问卷三类选项分别为熟悉且掌握记为3分、熟悉但操作陌生记为2分,不熟悉记为1分。统计学处理采用Epidata 3.1进行双人数据录入,SPSS 25.0软件进行数据分析。结果 军医群体中对伤情检测分类不掌握的比例65.85%(27人)。基本检查技术及结果判读、麻醉技术、防护与洗消、紧急外科处置、生命体征及器官功能监护、紧急内科重症处理、药物应用、急救处置平均分分别(1.91±0.63)分、(1.61±0.74)分、(1.41±0.62)分、(1.74±0.71)分、(2.13±0.65)分、(1.93±0.73)分、(1.92±0.75)分、(2.17±0.66)分。对战救技术训练模拟器材熟悉且掌握、熟悉但操作陌生及不熟悉占比分别为26.82%(11人)、36.59%(15人)、36.59%(15人)。卫生员或兼职卫生战士中对检伤分类熟悉且掌握占比46.58%(34人)。体表出血控制、防护与洗消、气道开放与呼吸维持、包扎固定与搬运、药物应用、急救处置平均分分别为(2.30±0.73)分、(1.61±0.62)分、(2.13±0.71)分、(2.24±0.65)分、(1.80±0.65)分、(2.26±0.73)分。结论 大部分军医、卫生员及兼职卫生战士的一线救治能力与我军《训练大纲》中要求的能力要求尚存在一定差距,尤其是对上级配装装备使用流程及操作不能完全熟练掌握的问题较为突出,对检伤分类不清楚、不了解,技能操作不掌握。横向比较,卫生员及兼职卫生战士对技能掌握情况普遍优于军医,可能与卫生员培养模式聚焦备战打仗有关。综上,进一步增强我军年轻且未经规范化培训的基层卫生医疗人员一线救治能力十分必要。各项战伤救治技术的应用培训能够有效地提高一线救治能力,其在战伤救治系统中具有不可或缺的地位。

Objective To investigate the rescue capability of military medical doctors and medical solders,so as to know the combat abilities of military doctors and medical soldiers.Methods Military doctors and medical soldiers serving in six Air Force brigade and regiment units in Fujian and Zhejiang who had not participated in standardized physician training and had graduated for less than three years were selected for a prospective study from Jul.to Oct.2021.Paper questionnaires were distributed by the investigators on site with simple instructions for completion,and the questionnaires were collected on site.The content included personal information,the foundation of health care,the use and familiarity of troop listed materials and the ability of injury detection and assessment.After the questionnaires were collected,two trained researchers evaluated the quality of the questionnaires,eliminated and compared the results according to the exclusion criteria,and when the evaluation results did not agree,then both parties negotiated or a third researcher assisted in the adjudication.The three types of options in the questionnaire were:being familiar and mastered were scored as 3 points,being familiar but unfamiliar with operation was scored as 2 points,and being unfamiliar was scored as 1 point.Statistical processing was performed using Epidata 3.1 for two-person data entry and SPSS 25.0 software for data analysis.Results Two invalid questionnaires(incomplete content)were excluded,and 114 valid questionnaires were received.Military doctors and medical soldiers accounted for 35.96%(41 people)and 64.04%(73 people),respectively.The average age was 30.6 and 25.1 years,respectively.The percentage of the military doctors that did not master the classification of injury detection was 65.85%(27 cases).The mean scores(points)of basic examination techniques and result interpretation,anesthesia techniques,protection and decontamination,emergency surgical disposition,vital signs and organ function monitoring,emergency medical intensive care,drug application,and first aid disposition were(1.91±0.63)points,(1.61±0.74)points,(1.41±0.62)points,(1.74±0.71)points,(2.13±0.65)points,(2.13±0.65)points,(1.93±0.73)points,(1.92±0.75)points,(2.17±0.66)points,respectively.The percentages of familiar and mastered,familiar but operationally unfamiliar and unfamiliar with combat rescue technique training simulation equipment were 26.82%(11 people),36.59%(15 people),and 36.59%(15 people),respectively,and 46.58%(34 people)of the medical soldiers were familiar and mastered with injury detection classification.The mean scores(points)of body surface bleeding control,protection and decontamination,airway opening and respiratory maintenance,dressing and fixation and handling,drug application,and first aid disposal were(2.30±0.73)points,(1.61±0.62)points,(2.13±0.71)points,(2.24±0.65)points,(1.80±0.65)points,and(2.26±0.73)points,respectively.Conclusion Most of the military doctors and medical soldiers’treatment ability and ability requirements still exist in a certain gap,especially the problem of not being fully proficient in the use process and operation of superior dispensing equipment is more prominent,and the classification of injury detection is not clear and not understood.Skill operation is not mastered.In a horizontal comparison,medical soldiers generally have a better grasp of skills than military doctors.It may be related to the training mode of those medical soldiers focusing on war preparation and fighting.In summary,it is necessary to further enhance the front-line treatment capability of our young and unregulated trained primary health care personnel.Training in the application of various combat wound treatment techniques can effectively improve the front-line treatment capability,which has an indispensable position in the combat wound treatment system.