Griffiths Jane L, Estipona Aurora, Waterson James A
University of Western Sydney, Sydney, Australia.
Am J Disaster Med. 2011 Jan-Feb;6(1):39-46.
Delineation of the problem of physician role during disaster activations both for disaster responders and for general physicians in a Middle East state facility.
The hospital described has 500 medical-surgical beds, 59 intensive care unit beds, eight operating rooms (ORs), and 60 emergency room (ER) beds. Its ER sees 150,000 presentations per year and between 11 and 26 multitrauma cases per day. Most casualties are the result of industrial accidents (50.5 percent) and road traffic accidents (34 percent). It is the principle trauma center for Dubai, UAE. The hospital is also the designated primary regional responder for medical, chemical, and biological events. Its disaster plan has been activated 10 times in the past 3 years and it is consistently over its bed capacity.
A review of the activity of physicians during disaster activations revealed problems of role identification, conflict, and lack of training. Interventions included training nonacute teams in reverse triaging and responder teams in coordinated emergency care. Both actions were fostered and controlled by a Disaster Control Centre and its Committee.
Clear identification of medical leadership in disaster situations, introduction of a process of reverse triage to meet surge based on an ethical framework, and improvement of flow through the ER and OR.
Reverse triage can be made to work in the Middle East despite its lack of primary healthcare infrastructure. Lessons from the restructuring of responder teams may be applicable to the deployment to prehospital environments of hospital teams, and further development of audit tools is required to measure improvement in these areas.
明确在中东某国家机构中，灾难应对期间灾难救援人员和普通医生的医生角色问题。
所描述的医院拥有500张内科-外科病床、59张重症监护病床、8间手术室和60张急诊室病床。其急诊室每年接待150000人次就诊，每天有11至26例多发伤病例。大多数伤亡是工业事故（50.5%）和道路交通事故（34%）造成的。它是阿联酋迪拜的主要创伤中心。该医院也是指定的医疗、化学和生物事件的主要区域响应机构。其灾难预案在过去3年中已启动10次，且一直床位超编。
对灾难启动期间医生的活动进行审查发现了角色识别、冲突和缺乏培训等问题。干预措施包括对非急症团队进行反向分诊培训，对响应团队进行协调急救培训。这两项行动均由灾难控制中心及其委员会推动和管控。
明确了灾难情况下的医疗领导地位，引入了基于伦理框架的反向分诊流程以应对激增情况，并改善了急诊室和手术室的流程。
尽管中东缺乏初级医疗保健基础设施，但反向分诊仍可发挥作用。响应团队重组的经验教训可能适用于医院团队在院前环境的部署，并且需要进一步开发审计工具来衡量这些领域的改进情况。
