nghiên cứu mô hình thu dung, cứu chữa nạn nhân hàng loạt do thảm họa tại bệnh viện tuyến cuối quân khu (tóm tắt tiếng anh)

1 BACKGROUND In recent years, the disaster situation has changed complicatedly, containing many uncertain factors. The fact that disasters occurs without warning, occurs very suddenly increased the number of victims should be cured, transportation always exceeds the capacity of the health sector response. To restrict to a minimum the loss of life and material caused by the disaster, the need for coordinated action of many forces, media synchronization, in which modern health sector had an important role. The military zone hospital (MZH) was a general hospital had specialist (type B), located on the strategic areas of the country, performing tasks of treatment for soldiers and people in the area. There is particularly important role in emergency medical response when disaster strikes. But so far, there was no unified model, RRVMD by the military zone hospitals was difficult. Therefore, we conducted this research subject to the following objectives: 1. Status of receiving, rescue victims of mass disasters from military zone hospitals in the period of 2007-2012. 2. Modeling, deployment experimental exercises and evaluate results of model organization RRVMD in Hospital 4, Military Zone 4, in 2012-2013. * New contributions on the practical science of the thesis: - Has been described real operating condition, capacity of RRVMD of military zone hospitals (MZH): There was adequate staffing organization by decision; There are facilities, fully equipped, convenient infrastructure for RRMVD; Have established the Steering Committee, annually implemented plan RRMVD; In 6 years (2007-2012) the hospital had 1-2 times receiving, rescue mass victims; Capable of sorting from 50-100 victims/hour, receiving treatment from 30-60 victims/hour, maximum deployment 4-10 surgical teams, often held 5- 6 mobile health groups available assignment of a task; Ability to rescue specialist early for the victims of disaster and responsive, effective for the second disaster. - Has been developed and successfully tested model RRMVD of MZH: Depending on the size, characteristics and extent of each type of disaster can be implemented in one of two solutions: + Option 1: deployment of mobile military medical team to the field; Organization the clinical patients in order to be ready to rescue victims. 2 + Option 2: deployment of mobile military medical team to the field; establishment of field hospitals; Forces remaining on duty regularly. + After 2 rehearsals empirical model was considered reasonable, realistic, feasible high. 90.9% - 92.9% of experts rated on organization, staffing, use of force in 2 alternatives was reasonable. 100% expert opinion evaluation with the model was built, MZH capable of completing tasks in similar situations. The layout of the thesis: The thesis consists of 132 pages include: Background 2 pages; Chapter 1-Overview: 34 pages; Chapter 2- Objects and research methods: 21 pages; Chapter 3-Results: 41 pages; Chapter 4-Discussion: 31 pages; Conclusion: 2 pages; Recommendations: 1; 44 tables; 11 schemes; 2 appendix ; 136 references (79 Vietnamese, 51 English, 6 Russian documents). Chapter 1 OVERVIEW 1.1. Situation disaster, losses from disasters around the world and in Vietnam 1.1.1. The concept of disaster According to the World Health Organization: "The disaster is the phenomenon caused the damage, the economic upside, the loss of life, human health, damage to health facilities with a large extent, requires the mobilization of relief especially from outside to the disaster area. " According to the Ministry Health and National Defense "Disaster is the risk or unexpected event occurs, causing great loss of life and material." 1.1.2. Classification disaster - According causes: natural disasters, human disasters - As the number of victims: from 3-4 degree - As request of medical interventions: immediate loss, lasting consequences - In time of disaster: long, short, acute, chronic - Geographically, regions, geography, population 1.1.3. Disaster situation in the world and Vietnam 1.1.3.1. Disaster situation in the world Catastrophic events in the world were coming complicated and growing rapidly. In 10 years (2002-2011), there are 3.942 worldwide natural disasters, including floods accounted for 1.793 cases, whirlwind accounted for 1.022 3 cases The disaster caused by people common as: fire, terrorism, war, industrial accidents, traffic accidents In 10 years (2002-2011), there were 2.622 disasters caused by humans, killing 82.609 people and affected up to 152.900 people life, loss of 38.112 million dollars. 1.1.3.2. Disaster situation in Vietnam From 2003 - 2012, there were 103 big natural disasters killed 7.748 people and 6.740 people injured, the loss of material wealth estimated thousand billions. In Vietnam disaster caused by humans was diverse, complex and increasingly more serious. Many disasters cause huge losses of life and materials, only traffic accidents in 10 years (2003-2012) had 36.409 cases occurred, killing 9849 people and 38.064 people injured. 1.2. The work of emergency medical response to disasters - In the world: the system for emergency medical response in disasters was organized to two trends: There were separated organizations outside the health system or in health system sector. - In Vietnam: based on the medical establishment to civilian and military organize searching, rescue, treatment victims due to the line of treatment system. 1.3. Model of receiving, rescue victims of mass disasters in hospital 1.3.1. Situation of ability RRMVD in hospital Hospitals can deploy RRMVD, depending on the severity of the disaster as well as the number and structure of victim injury. However, hospitals have no standard and full model for deployment RRMVD effective and systematic. 1.3.2. RRMVD model of some hospitals through rehearsal - Rehearsal BV-06 of Hospital103: Hospital 103 in collaboration with the forces of the military unit organization and onsite RR practice for 300 victims of the fire disaster in the industrial area of Ha Dong District . Forces have been used as follows: At the field using 3 surgical teams performing total rescue task with emergency, sorting victims; Established receiver and additional emergency; Organizations RRV in the clinical. - Rehearsal CN-10 at BV4/QK4: From forces and tools available of a hospital, in coordination with other forces in the area, RR for 170 victims of the collapsed multi-storey buildings under construction in Vinh city. Organizations were 4 implemented as follows: One military medical force at the field; At the hospital detached a force to be arranged independently of the hospital campus with RRV duty. - Rehearsal BV-05 at Hospital175: Hospital in collaboration with the Ministry of Defense forces organization RR for about 450 victims of fire disaster caused by tall buildings, including victims of poisoning. Hospital organizations deploy: Area receiving, sorting; emergency zone and shock management; victims of severe treatment areas; Face identification and preservation of the body. Chapter 2 SUBJECTS AND METHODS 2.1. Subjects, materials, time and location of study 2.1.1. Research Subjects - Research subjects situation: the MZH (infrastructure, equipment, staffing organizations, professional activities ) - Subjects intervention: military zone hospitals participation in RRVMD. - Leadership, command hospital head of some department of the military zone hospital directly related to the work RRVM in disaster. - Officers and staff of the Hospital 4 - Military Zone 4 in the exercise RRMV experimental. - Specialist in medical, military medicine, military, political, logistical and technical, local rescue Steering committee. 2.1.2. Material Research - The legal documents relating to the care and protection of people's health, the combined military and civilian medical response to an emergency condition. - The document of the situation and the damage caused by the disaster in the world and in Vietnam, the period from 2002 - 2012 - The document summarizes the work RRVM disaster and the results of a number of hospitals. - The statistical reports on infrastructure, staffing organizations, media equipment, qualifications and professional competence of MZH. 2.1.3. Study sites At 7 military zone hospitals, organizations 2 experimental maneuvers (BMT-13 and NA-NĐ13) in the province of Nghe An. 5 2.1.5. Research time - Phase 1, describes the current status surveys: from 07 2011-06/2012. - Phase 2, experimental exercises: from 7/2012 - 12/2013. 2.2. Methodology 2.2.1. Study Design Research describes across, the retrospective study combined quantitative and qualitative research and intervention by experimental maneuvers. 2.2.2. Sample sizes and sampling studies 2.2.2.1. Sample sizes and sampling baseline study - All 7 military zone hospitals of the army - 84 leaders, commander of the military zone hospitals - 50 experts in: medicine, military medicine, military, logistics 2.2.2.2. Sample sizes and sampling intervention studies - Intervention model: choose intentionally Hospital 4 - Military Zone 4 - The entire staff of 110 employees in H4/MZ4 - 61 turns of experts selected for interviews, opinions (1 st rehearsal: 33 experts, 2 nd rehearsal: 28 experts). 2.2.3. The scope, content and index research 2.2.3.1. The scope, content and status research index - Task and organize forces, number of beds - Facilities and equipment of hospital - The situation properly and heal in 6 years (2007-2012) - Construction work plans and activities to meet the emergency medical - Ability to organize and implement a RRVMD. 2.2.3.2. The scope, content and intervention research index - Content RRVMD model in military zone hospitals: discipline of the model; Depending on the characteristics of the disaster can be implemented in one of two alternatives. - The results of the last two experimental rehearsals: Preparation; Results deployment model; Opinion, evaluation of expert. 2.2.4. Methods and tools to gather information * Methods, tools for data collection in a status research 6 - Research Methods: Secondary data analysis; Observations described; Direct interviews; Professional method. - Research tools: form number 1, form number 2, form number 3. * Method and tools of assessment intervention results - Method: Empirical exercises with 2 plans + Option 1: the type of disaster occurs near the hospital or in the hospital may receive direct victims. + Option 2: major disaster, away from the hospital, casualties, difficult transportation conditions. - Assessment tool: form number 4 and form number 5. 2.3. Errors and remedies - Form design research to ensure adequate information, unified - Conduct a pre-test, complete toolkit - Choose enumerators, supervisors are experienced staff - Organization of adequate training and close supervision 2.4. Methods of analysis and data processing - Clean form before accessing computer - Data processing using Excel 2007 software, SPSS 13.0. 2.5. Research organization - Investigate, analysis the situation in 7 hospitals under the form - Organizing two rehearsals corresponding to 2 plans were built. 2.6. Limitation of the thesis - No research on: equipment, drugs, facilities, materials - No evaluation of the ability of each forces participating in a specific way - Not given model for each type of disaster - No deep research on the treatment, ensure logistics 2.7. Ethical aspects of research - The study subjects entirely voluntary - The information only used for research purposes and to ensure security. 7 Chapter 3 RESEARCH RESULTS 3.1. Current status and operational capacity of RRVMD of MZH 3.1.1. The task, organization forces. - Hospitals type B, general hospitals with specialist; With a payroll of 270 employees, was organized into six departments, 7surgical, 7 Internal Departments and 6 Para clinical Departments. - MZH had 7 tasks, including: "Ready combat, combat service and meet emergency medical situations such as natural disasters, catastrophes" . 3.1.2. The number of employees(E) and number of beds(B) - The MZHs were staffed from 200-250 beds, actual deployment from 250- 574 B. Served ratio is lower than specified, ranging from 0,69 to 1,30 E/B. - Only from 2,0% -18,0% of the doctors in general level, the rest have been trained specialist. Pharmacists have university degrees from 18.0%-38.0%. Nurses have an intermediate level between 84.0% - 97.0%. Technicians had intermediate level from 64.0% to 100%. 3.1.3. Status of physical facilities and equipment of the hospital research Table 3.4: The infrastructure of the hospital in research Index H11 0 H10 9 H7 H4 H1 7 H7A H121 Campus area/bed (m 2 ) 59 788 - 113 18 36 79 Using area/bed (m 2 ) 18 60 - 30 12 19 25 Operating rooms Present (room) 5 4 4 4 7 3 3 More (room) 3 2 3 3 3 4 3 Total (room) 8 6 7 7 10 7 6 Empty ground of Hospital (m 2 ) 500 500 400 1500 800 500 1250 Extra beds (bed) 100 50 100 150 100 120 120 - Each hospital had from 3-7 operating rooms, when emergency medical response can deploy more from 2-4 operating rooms. Each hospital can deploy more from 50 – 150 B enough to properly cure the disaster 1 to level 2. 8 - The research hospitals were equipped with basically for examination, diagnosis and treatment of patients, but the number was small, some just a single type should not be a transfer available on mobile military medical team. - All research hospitals had mobile equipment and materials as artificial respiration apparatus, anesthetic machine, operating tables, mobile X-ray all type of cars to transport patients but not enough quantity to meet if disaster happened. - All hospitals were not equipped with the tools of preventing biological weapons, chemical, nuclear, such as sanitation treatment systems, test facilities and tools of personal protection, respirator protection, DDA car 3.1.4. The situation of receiving and rescue of hospitals in 6 years (2007-2012) - Number of hospital surgery was not the same, the difference between the hospitals quite large (2043-7981 cases per year). Individual hospitals have relatively stable, the next year always higher. - The targets were exceeded professional regulations: bed utilization rate reached 116.9% - 184.0%; The rate of illness from 68.2% - 82.8%; The number of examination/day highest from 190-1471 people/day; The number of emergency/day highest from 14-140 people/day. 3.1.5. Current status of the organization and the ability to deploy properly and heal victims of the mass Hospital Research Table 3:13: The receiving ready, rescue victims of mass in research hospitals Content H11 0 H10 9 H7 H4 H17 H7A H12 1 - Executive Steering Committee RRVMD All research hospitals had decision on established the Steering Committee. - Plan to mobilize forces, facilities, supplies and medical equipment in RRVMD All hospitals had annual research plan on RRVMD, mainly respond to floods, fires and explosions, traffic accident - Times of RRVM from 2007 to 2012 2 2 2 3 2 1 2 - The highest number of victims was received and rescued at a time 20 25 30 32 26 17 45 9 The hospitals had executive board on emergency medical response to disasters by the Director as its head; were planed, organized force ready to respond to an emergency medical condition but mainly in response to floods, fire, traffic accidents including content reserve facilities equipment, and medical supplies. The statistics in 2007 - 2012 showed that 100% of patients had at least one RRVMD time with highest number of victims from 17-45 victims. Table 3:18: Ability to organize RRVM of research hospitals Hospital Victims sort/hour (people) Operation (cases) Motivated surgical team (team) Victims RR/hour(peopl e) H110 50 10 5 50 H9 50 6 5 50 H7 100 8 5 50 H4 50 6 6 50 H17 100 6 5 60 H7A 50 4 5 30 H121 100 6 6 60 The hospital research can be classified from 50-100 victims/hour and received treatment from 30-60 victims/hour. Regularly held 5-6 emergency groups and can deploy 4-10 surgical team. - 56.5% - 66.7% opinions of experts and staff that MZH only meet a part mission of RRVMD, due to the lack of planning (53.6% - 57.5%); No RRVMD model (65.0% - 71.4%); lack of practical training RRVMD (67.5% - 81.0%). - Only 29.8% - 32.7% suggested that the practical ability of medical staff had good capability in rescue emergency victims of disaster. 3.2. Building RRVMD model in MZH 3.2.1. Basic on model building - Functions and tasks of military zone hospitals - The need for rescue victims - The system of legal documents related to the work TDCCNN - Reality RRVMD ability of the hospitals. 10 3.2.2. Content of RRVMD model in MZH * Principles RRVMD at military zone hospitals "Use the force, available tools of hospital implemented emergency RR properly and timely the basic wounds of the victim. Ready assist and come to emergency disaster place. Simultaneously, ensure regular tasks of the hospital. " Table 3:22: Comments of the research objects on model and principles RRVMD Assessment content Commanders(n = 84) Experts (n = 50) Quantity Rate (%) Quantity Rate (%) 1. The need to build the model: - Very necessary 82 97,6 48 96,0 - Necessary 2 2,4 2 4,0 - No need 0 - 0 - 2. Principles of RRVMD: - Reasonable 82 96,4 50 100 - No reasonable, additional 3 3,6 0 - - Other ideas 0 - 0 - Opinion of the leaders, commanders of hospitals and research experts that very necessary (96.0% - 97.6%) and necessary (2,4 - 4,0%) to build RRVMD models for the MZH. 96.4% of leaders, commanders of the research hospital and 100% of the experts believe that the RRVMD principle was reasonable, only 3.6% of respondents need additional contributions to be fully taking advantage of the MZH: there are professional and technical staff experienced in handling medical conditions, surgical field, high mobility, equipment diversity, richness and advanced modern science can treat most basic and specialist help RRVMD timely and limited mortality disabled. * Content model: Depending on the specific situation, organizations can deploy RRVMD model as the following options: [...]... decision The payroll from 260-400 people, with a scale from 200-250 beds, can deploy 400-500 beds - The hospital has a team of professional basic training, with nearly 85% of doctors trained specialists, in which over 50% is surgical doctor Do well the 23 treatment techniques as assigned In 6 years (2007-2012) targets were overachieved professional regulations - The hospital has facilities, fully equipped,... rehearsals in Hospital 4 - MZ4 3.2.3.1 Rehearsals BMT-12 on 7/2012 (In accordance with option 2) - Preparatory work; + Establish committees: a steering committee, organizing committee, building committee documents, assisting part, part to ensure + Component in the exercise forces: Forces in hospital staff and coordination + Prepare assumption victims: cases structure like a disaster have occurred, have... highly specialized + At the hospital: From the hospital's payroll detached a force to deploy HF for disaster response, 10-15 km far from the field, go after MMT Number of employees remaining hospitals do routine tasks, but narrowing the scope of the rescue MZH Hospital field (HF) The remaining forces of hospital Mobility Medical Team (MMT) Chart 3.4: The basic deployment diagram in hospital under option... field to search, sorting, transport and rescue victims to the back + Field hospital disaster response, deploying far disaster site by 10-15 km, to be the basic hospital for MMT + Force's remaining of MZH do routine tasks but to narrow the mission and scope of the rescue * Results after two rehearsals under two experimental options: 24 - The model was considered reasonable, realistic, feasible, easy to . Research - The legal documents relating to the care and protection of people's health, the combined military and civilian medical response to an emergency condition. - The document of the situation. by humans, killing 82.609 people and affected up to 152.900 people life, loss of 38.112 million dollars. 1.1.3.2. Disaster situation in Vietnam From 2003 - 2012, there were 103 big natural disasters. organization and onsite RR practice for 300 victims of the fire disaster in the industrial area of Ha Dong District . Forces have been used as follows: At the field using 3 surgical teams performing