Bostick Nathan A, Subbarao Italo, Burkle Frederick M, Hsu Edbert B, Armstrong John H, James James J
Center forPublic Health Preparedness and Disaster Response, American Medical Association, Chicago, IL 60610, USA.
Disaster Med Public Health Prep. 2008 Sep;2 Suppl 1:S35-9. doi: 10.1097/DMP.0b013e3181825a2b.
Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable.
大规模灾难性事件通常会导致基本医疗资源短缺，因此有必要实施分诊管理政策，以尽量减少可预防的发病率和死亡率。要实现这一目标，需要将分诊重新概念化为一个基于人群的系统过程，该过程整合患者与医疗保健系统之间所有互动点的护理。该系统至少确定4个接触层级：一级，社区；二级，院前；三级，医疗机构；四级，区域层面。采用这种方法将确保以全面的方式开展灾害应对活动，在随后的每个干预层级将患者护理负担降至最低，并减少总体护理资源分配需求。通过卫生应急行动中心协调，在这种基于系统的特定灾害分诊模型中无缝整合所有干预层级，可确保以有效、公正和公平的方式采取灾害应对措施。
