Baker Michael S
Chairman, Department of Surgery, John Muir Medical Center, Walnut Creek, CA 94598, USA.
Mil Med. 2007 Mar;172(3):232-6. doi: 10.7205/milmed.172.3.232.
How do we train for the entire spectrum of potential emergency and crisis scenarios? Will we suddenly face large numbers of combat casualties, an earthquake, a plane crash, an industrial explosion, or a terrorist bombing? The daily routine can suddenly be complicated by large numbers of patients, exceeding the ability to treat in a routine fashion. Disaster events can result in patients with penetrating wounds, burns, blast injuries, chemical contamination, or all of these at once. Some events may disrupt infrastructure or result in loss of essential equipment or key personnel. The chaos of a catastrophic event impedes decision-making and effective treatment of patients. Disasters require a paradigm shift from the application of unlimited resources for the greatest good of each individual patient to the allocation of care, with limited resources, for the greatest good for the greatest number of patients. Training and preparation are essential to remain effective during crises and major catastrophic events. Disaster triage and crisis management represent a tactical art that incorporates clinical skills, didactic information, communication ability, leadership, and decision-making. Planning, rehearsing, and exercising various scenarios encourage the flexibility, adaptability, and innovation required in disaster settings. These skills can bring order to the chaos of overwhelming disaster events.
我们如何针对所有潜在的紧急情况和危机场景进行培训？我们会突然面临大量战斗伤员、地震、飞机坠毁、工业爆炸或恐怖爆炸吗？日常工作可能会因大量患者而突然变得复杂，超出常规治疗能力。灾难事件可能导致患者出现穿透伤、烧伤、爆炸伤、化学污染，或者这些情况同时出现。有些事件可能会破坏基础设施，或导致基本设备或关键人员的损失。灾难性事件的混乱局面阻碍了决策制定和对患者的有效治疗。灾难需要一种范式转变，从为每个患者的最大利益投入无限资源，转变为在资源有限的情况下，为最大数量的患者的最大利益分配医疗资源。培训和准备对于在危机和重大灾难性事件中保持有效性至关重要。灾难分诊和危机管理是一门战术艺术，它融合了临床技能、教学信息、沟通能力、领导力和决策能力。规划、演练和模拟各种场景有助于培养灾难环境所需的灵活性、适应性和创新能力。这些技能可以给压倒性灾难事件的混乱局面带来秩序。
