摘要
目的通过仿真创伤全流程早期救治模拟演练分析我国县域医院创伤救治能力现状。方法2018年7月—2022年7月在全国40家县域医院举办了中国创伤救治培训基层版(China trauma training basic,CTCT?-B),培训包括仿真的创伤早期全流程救治模拟演练。本研究对演练中创伤院前急救、院前院内信息联动、院内早期评估与处置、院内救治模式和流程、影响救治结局因素等进行归纳统计分析。结果40家县域医院,其中二级医院29家,三级医院11家;院前急救模式:依托型32家,指挥型6家,独立型2家;院前急救能力方面:院前规范处置31家,不规范处置7家,不处置2家;院前院内信息联动方面:电话/微信24家,院前急救系统8家,中国创伤联盟紫云系统6家,无信息交互2家;院内交接和早期评估:能够按照创伤救治规范化培训要求进行评估和处置23家,不规范17家;创伤救治模式方面:以急诊科为主导的多学科会诊模式34家,创伤科主导的创伤救治模式4家,专科主导多学科会诊模式2家;实体创伤病房6家,急诊病房23家,无病房11家;40名模拟创伤患者16人死亡,其余存活,死亡原因为早期评估和处置不规范,输血流程不合理、创伤相关核心技术缺乏,有效运行的创伤多学科团队缺乏。结论县域创伤救治过程中存在创伤早期评估和核心技术不足、缺乏院内高效的多学科救治团队、创伤集中收治模式尚未普及等问题,亟须重视解决。
Objective To investigate the current situation of trauma care skills in county-level hospitals in China via a whole-process early trauma rescue simulation:China Trauma Care Training-Basic(CTCT®-B).Methods From Jul.2018 to Jul.2022,the authors and team members organized CTCT®-B in 40 county-level hospitals.During each training,the whole-process early rescue of a simulated patient(SP)of severe trauma was conducted.The pre-hospital first aid,pre-and in-hospital information linkage,in-hospital early assessment and handling,in-hospital treatment mode and process,as well as the outcome influencing factors were analyzed.Results For the 40 investigated and trained county-level hospitals,the results were(1)hospital levels:29 secondary and 11 tertiary;(2)pre-hospital first aid mode:32 related departments-dependent,6 centralized command and 2 independent trauma centers;(3)pre-hospital first aid ability:31 standard care,7 simple treatment and 2 no treatment;(4)preand in-hospital information linkage:24 by telephone/WeChat,8 by pre-hospital emergency system,and 6 by Ziyun System of China Trauma Alliance,2 without information interaction;(5)early assessment and handling of the trauma patients:23 able to evaluate and handle trauma patients according to the standardized training requirements and 17 failed;(6)trauma treatment mode:34 by emergency department-led multidisciplinary consultation,4 by a trauma team with fixed members,and 2 by specialty-led multidisciplinary consultation;(7)trauma wards:4 had trauma wards,6 had emergency wards,and 11 had no wards;and(8)the severe trauma SP:24 survived and 16 died,for non-standard early assessment and handling,unreasonable blood infusion,lack of trauma rescue core skills,or a non-effective multidisciplinary team.Conclusion The county-level hospitals showed an unsatisfied rescue capacity for severe trauma patients,presenting as insufficient early trauma assessment and treatment skills,lack of high-quality teams,and limited mode of centralized trauma care.
出处
《创伤外科杂志》
2024年第1期26-30,共5页
Journal of Traumatic Surgery
基金
教育部产学合作协同育人项目(220400576285352)。
关键词
创伤和损伤
县域医院
模拟演练
创伤培训
Wounds and injuries
County-level hospitals
Simulation training
Trauma care training