Center for Disaster Medicine, New York Medical College, SPH Bldg, 3rd Floor, Valhalla, NY 10595, USA.
Disaster Med Public Health Prep. 2010 Oct;4(3):226-31. doi: 10.1001/dmp.2010.30.
A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning.
We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data.
Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care.
Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.
在医院应急准备规划中，一个普遍的假设是，患者将通过基于受害者人数、接收医院的能力以及疾病或伤害的性质和严重程度的协调患者分配系统从灾难现场到达。尽管紧急医疗服务系统强大，但文献中的案例报告和重大事件事后报告表明，大多数在灾难或其他重大紧急情况后到医疗机构就诊的患者并非一定通过救护车到达。如果这些关于在没有组织的紧急医疗服务系统之外到达的患者的报告是准确的，那么医院应该为不受控制的大量患者涌入对医疗系统的影响制定不同的计划。医院在进行重大事件规划时，需要考虑患者转介的替代模式，包括自我转诊患者的大量集中。
我们对过去 25 年的已发表研究进行了回顾性分析，以确定描述患者在医院就诊期间到达方式的灾难或重大紧急事件患者护理报告。我们使用结构化机制对数据进行了汇总和分析。
收集了来自 25 年文献的 8303 名患者的详细数据。许多报告表明，只有少数在灾难后在急诊科接受治疗的患者通过救护车到达，特别是在事件的早期阶段。我们 25 年的汇总数据表明，只有 36%的灾难受害者通过救护车被送往医院，而 63%的人则通过其他方式寻求紧急医疗救助。
医院应评估其应急计划，以考虑在灾难期间患者替代转介模式的影响。在发生重大事件后，应额外考虑大规模分诊、现场安全以及去污的潜在需求。
