Peleg Kobi, Michaelson Moshe, Shapira Shmuel C, Aharonson-Daniel Limor
Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
Adv Ren Replace Ther. 2003 Apr;10(2):117-21. doi: 10.1053/jarr.2003.50019.
The organizational and medical conduct in disaster situations is complex and presents a challenge to every manager in the prehospital setting. The handling of such situations is characterized by the need to make decisions under uncertainty in real time, with deficient medical and support forces. The approach used in mass casualty incident situations is cycles of treatment, commonly known as the "butterfly system." There are serious logistic problems involved, both industrial and structural, physical obstacles that may interfere with rescue treatment and evacuation, disruption in communications, and many other difficulties. On top of these, there are other obstacles such as interruption with the cooperation and coordination of different force, enforcement and rescue teams, the press, inquisitive people, and others. However, the most serious problem of all is the tendency in complex situations to attempt to work with fixed preformed guidelines or protocols for operation. One disaster differs from another, regarding location, number of casualties, distribution, severity, type of injury and the nature of injury, size of available rescue teams, time and equipment needs, damage to roads, distance from hospital, and other variables. One of the most important lessons learned from the management of such incidents is do not set fixed protocols but rather principles only. By applying principles adapted to the situation, managers will be able to perform better.
灾难情况下的组织与医疗行动十分复杂，给院前环境中的每位管理者都带来了挑战。处理此类情况的特点是需要在不确定性下实时做出决策，且医疗和支援力量不足。在大规模伤亡事件中采用的方法是治疗循环，通常称为“蝴蝶系统”。其中涉及严重的后勤问题，包括工业和结构方面的问题、可能干扰救援治疗和疏散的物理障碍、通信中断以及许多其他困难。除此之外，还有其他障碍，比如不同部队、执法和救援队伍、媒体、好奇的民众等之间合作与协调的中断。然而，最严重的问题是在复杂情况下倾向于按照固定的预先制定的操作指南或规程行事。一场灾难与另一场灾难在地点、伤亡人数、分布、严重程度、损伤类型和性质、可用救援队伍的规模、时间和设备需求、道路损坏情况、与医院的距离以及其他变量等方面都有所不同。从这类事件的管理中学到的最重要的经验之一是不要设定固定的规程，而只设定原则。通过应用适应具体情况的原则，管理者将能够表现得更好。
