Galante Joseph M, Jacoby Robert C, Anderson John T
Department of Surgery, University of California Davis Medical Center, Sacramento, 95817, USA.
J Surg Res. 2006 May;132(1):85-91. doi: 10.1016/j.jss.2005.07.031. Epub 2005 Nov 14.
We hypothesized that resident education is inadequate with respect to management of mass casualty incidents that may involve chemical, biological, and nuclear exposures.
Chief level residents in surgery (n = 10), emergency medicine (n = 10), and anesthesia (n = 8) were asked to complete a survey questionnaire. Responses were tabulated and statistically analyzed with Mann-Whitney Rank Sum, Student's t test, and Kruskal-Wallis one-way analysis of variance.
All of the residents were similar with respect to age, sex, and intended setting of clinical practice. Only a single resident reported military experience. Two residents (7.1%) had administered medical care while wearing a protective suit. Compared with emergency medicine residents, surgical residents reported significantly less formal teaching in mass casual incidents (P = 0.02), trauma triage (P = 0.01), and nuclear, biological, chemical agents (P = 0.002). When surgical residents were compared with anesthesia residents, there was significantly less training for surgical residents in nuclear, chemical, and biological agents (P = 0.02). Multiple/mass casualty incident experience did not differ between residents. However, the most common incident involved only three to five patients with blunt trauma. Emergency medicine residents were significantly more comfortable in treating patients with exposure to anthrax (P = 0.01), sarin (P = 0.04), and nuclear exposure (P = 0.01).
Surgical residents have significantly less formal training in mass casualties, triage, and chemical, biological, and nuclear exposures than residents in other specialties. Therefore, surgical residents are less comfortable treating these types of patients. Because surgeons often are expected to take leadership roles in mass casualty incidents, surgical education should be modified to match or exceed that of other specialties.
我们推测住院医师在可能涉及化学、生物和核暴露的大规模伤亡事件管理方面的教育不足。
要求外科（n = 10）、急诊医学（n = 10）和麻醉科（n = 8）的主任级住院医师完成一份调查问卷。对回答进行列表整理，并采用曼-惠特尼秩和检验、学生t检验和克鲁斯卡尔-沃利斯单向方差分析进行统计分析。
所有住院医师在年龄、性别和预期临床实践环境方面相似。只有一名住院医师报告有军事经验。两名住院医师（7.1%）曾穿着防护服提供医疗护理。与急诊医学住院医师相比，外科住院医师报告在大规模伤亡事件（P = 0.02）、创伤分诊（P = 0.01）以及核、生物、化学制剂方面接受的正规教学显著较少（P = 0.002）。将外科住院医师与麻醉科住院医师相比，外科住院医师在核、化学和生物制剂方面接受的培训显著较少（P = 0.02）。住院医师之间在多重/大规模伤亡事件经验方面没有差异。然而，最常见的事件仅涉及三到五名钝性创伤患者。急诊医学住院医师在治疗接触炭疽（P = 0.01）、沙林（P = 0.04）和核暴露患者时明显更自在（P = 0.01）。
与其他专科的住院医师相比，外科住院医师在大规模伤亡、分诊以及化学、生物和核暴露方面接受的正规培训显著较少。因此，外科住院医师在治疗这类患者时不太自在。由于在大规模伤亡事件中通常期望外科医生发挥领导作用，应调整外科教育以使其与其他专科相当或超过其他专科。
