Kun Luis
Homeland Security at the IRM College of the National Defense University, Fort McNair, Washington DC, 20319, USA.
Stud Health Technol Inform. 2007;127:18-27.
On June 14, 2006 three reports were published by the Institute of Medicine (IOM) in regards to "THE FUTURE OF EMERGENCY CARE IN THE UNITED STATES HEALTH SYSTEM". The three combined reports: Hospital-Based Emergency Care at the Breaking Point, Emergency Medical Services at the Crossroads and Emergency Care for Children Growing Pains, are a clear reflection of the state we currently face, even without a major disaster. Some key findings drawn from all three reports showed that the emergency care system is ill-prepared to handle a major one. For example, many of the 41 million citizens who do not have medical insurance end up using the Emergency Departments (ED) as their source of "regular" care and many of these EDs are at or over capacity, there is little surge capacity for a major event, whether it takes the form of a natural disaster, disease outbreak, or terrorist attack. If we had during the major disaster event, a "contagion" element, i.e. pandemic flu, then the problem would be even more complicated, since the "regular" hospital patient population would need to be isolated from these patients. If we add to this equation the length of time involved in the "current" process of vaccine creation and production (i.e. the volume of vaccines that would be required to be provided to the citizens of the world), the scenario does not look to promising. A new model is needed then to address these requirements. In the developed world we have a number of devices (e.g., radio, TV, Computers, telephones, mobile devices, etc.) and infrastructure (e.g., cable, wireless networks, etc.) that are already supplying the homes and the individuals with a large number of independent applications and different types of information. These stovepipes or independently developed family that include: tele-banking, Telehealth, tele-education, e-commerce, entertainment on demand, etc. when "connected" as an integrated set, may provide an ideal environment, where families may stay at home for a long period of time (quarantine) and would have all the mechanisms in place for getting food and water from supermarkets, drugs from the pharmacy, the children would be able to go to school from home (in turn their school grounds may become temporary hospitals), adults could telecommute to work and minor conditions could be consulted and treated through these systems (with the help of a Telehealth platform that would include electronic health records), etc.
2006年6月14日，美国医学研究所（IOM）发表了三份关于“美国医疗体系中急诊护理的未来”的报告。这三份综合报告：《处于危机边缘的医院急诊护理》《十字路口的紧急医疗服务》以及《儿童成长疼痛的急诊护理》，清晰地反映了我们当前面临的状况，即便没有重大灾难。从这三份报告中得出的一些关键发现表明，急诊护理系统对应对重大灾难准备不足。例如，4100万没有医疗保险的公民中，许多人最终将急诊室（ED）作为他们“常规”护理的来源，而且许多急诊室已满负荷或超负荷运转，对于重大事件几乎没有应对能力，无论是自然灾害、疾病爆发还是恐怖袭击形式。如果在重大灾难事件中有“传染”因素，即大流行性流感，那么问题会更加复杂，因为“常规”医院患者群体需要与这些患者隔离。如果再考虑到“当前”疫苗研发和生产过程所需的时间（即需要向世界各国公民提供的疫苗数量），情况就不容乐观。因此需要一种新的模式来满足这些需求。在发达国家，我们有许多设备（如收音机、电视、电脑、电话、移动设备等）和基础设施（如有线、无线网络等），它们已经为家庭和个人提供了大量独立应用和不同类型的信息。这些独立发展的系统或自成一体的体系包括：电话银行、远程医疗、远程教育、电子商务、按需娱乐等，当它们作为一个集成集“连接”起来时，可能会提供一个理想的环境，家庭可以长时间居家（隔离），并且具备从超市获取食物和水、从药店获取药品的所有机制，孩子们可以在家上学（反过来他们的校园可能会变成临时医院），成年人可以远程办公，轻微病症可以通过这些系统（借助包含电子健康记录的远程医疗平台）进行咨询和治疗等。
