摘要:目的: 了解綿竹市社區衛生服務系統震后現狀,同時分析社區醫療震后居民滿意度和社區衛生服務機構震后災害干預能力,以期為社區衛生服務體系地震應急恢復和重建提供參考意見。 方法 :采用隨機抽樣的方法,抽取綿竹市劍南社區衛生服務中心和天河社區衛生服務中心進行訪談,采取方便抽樣的方法,抽取24‰的綿竹城區居民采用面對面訪談的方式用自制問卷進行調查,并用Epidata30 進行數據錄入、SPSS130進行統計分析。 結果 :共發放問卷240份,收回有效問卷229份(有效回收率954%)。當地社區衛生服務系統在地震中受損嚴重。社區衛生服務系統災后工作居民滿意度為454%,社區衛生服務機構對居民進行抗災/防災知識教育的比例為336%,災后是否有持續而足夠的常見病藥品供應及是否有持續而足夠的慢性病藥品供應是影響當地居民對當地社區衛生服務體系災害應急工作的滿意度的影響因素(P 值分別是0033,0001)。 結論 :震后社區衛生服務居民滿意度較低,服務體系地震災害干預能力不足。居民在在災前接受抗災教育的比例較低,加強藥品儲備能提高社區衛生機構災害應急工作的效果。在社區衛生服務體系重建的過程中,應注重社區醫療基礎工作的恢復,基礎設施的重建和健全社區急救體系。Abstract: Objective: To investigate the reality of community health service system after earthquake in Mianzhu, the satisfaction of community residents to the community health service as well as the postdisaster emergency response capability of community hospital in order to provide decisionmaking suggestions on better reconstruction of community health service system. Methods : Jiannan and Tianhe community hospital were randomly selected for visiting and 24‰ of community residents in the city zone of Mianzhu were selected by convenience sampling for a facetoface interview using a questionnaire. Data entry and statistically analysis were completed by Epidata30 and SPSS130 respectively. Results :A total of 240 questionnaires were conducted to facetoface interviews, and 229 questionnaires were returned (response rate 954%).The community health service system was badly injured. Residents’ satisfactory degree of the community health service after earthquake was 454%. The proportions of disaster / disaster prevention education was 336%,medicine supply for familiar diseases and the chronic were the main factors which influenced judgements of residents to the emergency response capabilities of community hospitals(〖WTBX〗P =0033,P=0001,respectively). Conclusion :The community health services after earthquake had not been widely satisfied and the emergency response capability of community hospital was far from enough. The proportions of disaster / disaster prevention education were far from enough. The effectiveness of emergency response work of community hospitals can be enhanced by reinforcing medicine preparation.In the course of the reconstruction, community health service system should pay attention to the resumance of basic community health service,reconstruction of basic establishment and construction of firstaid system.
The Wenchuan Earthquake caused severe injuries and deaths as well as subsequent serious potential risks to public health and hygiene in the worst-hit areas. There were 16 casualties in the Mianyang CDC system and the township amp; county CDC networks were destroyed in the worst-hit counties after the earthquake. The Mianyang CDC quickly launched its emergency response plan for major natural disasters within two hours after the earthquake, prepared and improved the technical guide for disease prevention after the earthquake and rapidly sent out quick response team. With the help of CDC aid teams across the country, Mianyang CDC successfully disinfected and buried 6,767,568 corpses, and disposed of millions of animal carcasses.They also disinfected and sterilised an area of 932.595 million square metres, eradicating 3,514,166 fly and mosquito breeding places and treating 5,254,228 cesspit times. By June 30, they had examined 11,092 water supply units and carried out disinfection of 319.7997 million cubic metres of drinking water. Besides, dynamic monitoring for water quality in the four worst-hit areas in Mianyang urban areas. They organised hygienic enforcement supervisors to develop food safety inspection, regulated catering services of the centralised settlements, destroyed spoiled and expired food and vegetables. The authorities prevented the masses from eating dead poultry or meat from carcasses to ensure no occurrence of food poisoning after the earthquake. Standard administration of the 170 settlements of the earthquake-afflicted people and 132 settlements of evacuated people was carried out in accordance with the rules of "Six Provisions and Four Reinforcements" and this would ensure no recurrence of public health events in the settlements. On Day 3 (May 15) after the earthquake, they established a real-time monitoring and report network of the epidemic situation after the earthquake and monitored diseases and symptoms of the people in the resettled region to ensure no occurrence of major epidemic cases. The monitoring results showed that the number of infectious disease cases was comparable to that in the previous years. Moreover, they carried out intensive vaccination with hepatitis A vaccine in children 41196 person times, stored 100,000 person oral cholera vaccine and monitoring for new sexually transmitted diseases. A total of 10.1265 million copies of publicity materials were organised printed and distributed. They developed large-scale health education and a massive patriotic health campaign by means of the media and organised the masses to engage in sanitation and hygiene as well as controlling flies, mosquitoes and rats in the temporary earthquake-proof places. Under the unified command of the Mianyang emergency response headquarters, the centers for health and epidemic control and prevention at various levels of disaster relief continued to dispose of carcasses and disinfect and bury corpses as well as monitor water quality, so as to ensure the secondary disasters could be prevented in advance.
To investigate the method of using vacuum seal ing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic effect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 woundson the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or flap transposition was used to repair the wounds. Results In 21 cases (40.4%), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia col i, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or flap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stabil ity of condition. Conclusion VSD treatment can cover the wound promptly, el iminate contamination, prevent secondary infection and benefit late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can rel ieve the pain suffered by the injured and decrease theworkload of medical stuff, thus facil itating the rescue work.
After the Wenchuan Earthquake on May 12th, 2008, under the b leadership of the SichuanProvincial Party Committee, the People’s Government of Sichuan Province, and the Ministry of Health of the People’sRepublic of China, the Medical Security Team working at the Sichuan Provincial Headquarters for Wenchuan Earthquakeand Disaster Relief Work constructed a secure medical material distribution system through coordination and interactionamong and between regions, systems, and departments.
Objective To discuss the mode of triage patient in Emergency Department of West China Hospital of Sichuan University after the Wenchuan earthquake and the major experience during the process. Method The patients’ severity level of injury and waiting time for medical care in Emergency Department were analyzed after earthquake in 2 weeks. Result 375 patients were triaged into the severity level and get the treatment followed the triage systems gave the highest rate of survival and lowest rate of over triage and under triage. Conclusion In the calamity of Wenchuan earthquake with large number of casualties, Emergency Department automatically shifted into disaster mode and triage victims by the irregular triage systems. In this situation, medical staff do not just triage the patients to the Emergency Department or to see a doctor, but triage the victims to the medical care immediately and efficiently. By the new triage system, the West China Hospital saves more lives in less time.
During the medical rescue after the Wenchuan earthquake, in order to prevent hospital environmental pollution and cross infection, the nosocomial infection control committee of West China Hospital of Sichuan University immediately initiated the emergency response plan, improved the triage system, and organized multi-disciplinary infection control groups to improve the triage of the wounded and the infection control of the emergency department. At the same time, we regulated the individual behavior of healthcare professionals and took appropriate measures for personnel protection so as to ensure the safety of both the wounded and healthcare professionals.
Objective To study the medication usage in children with crush syndrome in Wenchuan Earthquake. Methods The information of the medications of 7 children with crush syndrome in West China Second University Hospital, Sichuan University was collected by medical history. The cases and times of medication, the total number of drugs, the drug cost per capita and the drug cost per day were calculated by Excel. Results A total of 113 drugs in 19 categories were appl ied to 7 children with crush syndrome. Most children used Vitamins and antibacterial agents. The cost of gamma globul in injection was the highest. Conclusions The rational ity valuation for children medication lacks international vulgate index and needs more basic research.
Objective To analyze the spinal injury in Wenchuan earthquake and to investigate its cl inical features. Methods Data of 146 patients in Wenchuan earthquake with spinal injuries (79 males, 67 females; aged 11-88 years old, average 51 years old) were collected and analyzed epidemiologically. Two patients under 16 years of age, 15 patients withthe fractures of spinous process, transverse process or vertebra lamina, 1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification, and 9 patients with upper cervical injuries were excluded. The remaining 119 patients were divided into two groups according to their age: group A in which 78 patients were under 60 years of age, including 40 males and 38 females aged 18-58 years old (average 41 years old), and group B in which 41 patients were 60 years of age or above, including 24 males and 17 females aged 60-88 years old (average 71 years old). Analyses for the two groups were compared. Results The leading causes of spinal injuries were fall from high places (27.40%) and crush by heavy objects (67.81%). According to Denis classification, the major types of spinal injuries were burst fracture (54.62%) and compression fracture (33.61%). Serious nerve injury, defined as grade A, B and C in ASIA neurological function assessment, occurred in 31.51% of patients. The most common injured site was in thoracic or lumbar vertebrae (78.77%), and 52.74% of patients had combined injuries, among which the fractures of l imb (30.14%) and rib (19.86%) were the most common. Multilevel spinal fractures happened to 22.60% of patients. Comparative analysis revealed the rate of injury caused by fall from high places in group A (34.62%) was much higher than that in group B (12.20%). The commonest type of fracture in group A was burst fracture (58.97%), and it was compression fracture in group B (48.78%). The rate of serious nerve injury in group B (24.39%) was much lower than that in group A (44.87%). The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%, respectively, which was much higher than that in group A (combined injury 43.59%; multilevel vertebral body injury 21.79%). There were significant differences between two groups in all the indicators derived from cl inical data (P lt; 0.05). Conclusion In Wenchuan earthquake, the leading causes of spinal injuries are fall from high places and crush by heavy objects, the major types of fracture are compression fracture and burst fracture, and the occurrence rates of spinal injury, combined injury and multilevel vertebral body injury are high.
Objective To retrospectively analyze the characteristics and death causes among the Wenchuan earthquake victims in The Third People’s Hospital of Chengdu so as to provide information for reducing mortality in future earthquake disasters. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, and the Emergency Room of the hospital through July 12. Microsoft EXCEL was used for data input and SPSS 13.0 was used for statistical analyses. Results Through July 12, 9 (1.57%) out of the 575 wounded patients died, comprising 3 males and 6 females. Of those, 5 died in the outpatient department. The death causes were all related to severe cerebral injuries. The other 4 died in the inpatient department and the death causes were related to severe underlying illnesses and infection. Conclusion Screening and early treatment for cerebral injuries is very important in the period directly following the earthquake. Later, more attention should be paid to the treatment of underlying illnesses as well as the prevention and control of infection.
Objective To investigate the rebuilding status of community health service (CHS) system after Wenchuan earthquake in Mianzhu, improve service ability and provide data for better reconstruction of CHS system after natural disaster. Methods The interview was conducted with local health system officials, and self-designed questionnaire for face-to-face interview was distributed to 508 community residents in Mianzhu who were selected by convenience sampling. Data entry and statistical analysis were completed using Microsoft Office Excel 2007 and SPSS 16.0 respectively. Results A total of 508 questionnaires were distributed, and then 486 questionnaires were retrieved effectively (response rate 95.7%). The analysis on 486 respondents in CHS after rebuilding showed the rate of respondents with health files rose from 20.1% to 43.8%, the rate of having regular health check-up rose from 7.4% to 46.7%, the rate of health education rose from 20.1% to 39.7%, the rate of chronic disease monitoring rose from 0.9% to 35.4%, the rate of knowing referral pattern rose from 15.7% to 51.2%, the rate of propaganda for disaster relief rose from 33.6% to 58.6%, and the rate of doing disaster emergency response exercise was 21.8% currently. 62.3% of residents chose CHS on the first visit. The satisfactory degree to CHS rose from 45.4% to 76.1% after earthquake. Both popularization of regular health check-up and propaganda for disaster relief were major factors with influence on residents’ satisfaction to CHS (Plt;0.001, P=0.010, respectively). Conclusion The residents’ satisfactory degree to the rebuilding status of CHS system is encouraging. It is necessary to strengthen the popularization of regular health check-up and propaganda for disaster relief in order to improve the quality of community health service.
