Mendsaikhan Naranpurev, Gombo Davaa, Lundeg Ganbold, Schmittinger Christian, Dünser Martin W
Intensive Care and Anesthesiology Department, Intermed Hospital, Chinggis Avenue 41, Duureg 15, Ulaanbaatar, 17040, Mongolia.
Public Health School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
BMC Emerg Med. 2017 May 8;17(1):15. doi: 10.1186/s12873-017-0127-4.
While the capacities to care for and epidemiology of emergency and critically ill patients have been reported for secondary and tertiary level hospitals in Mongolia, no data exist for Mongolian primary level hospitals.
In this prospective, observational multicenter study, 74 primary level hospitals of Mongolia were included. We determined the capacities of these hospitals to manage medical emergencies. Furthermore, characteristics of patients presenting with potentially life-threatening emergencies to these hospitals were evaluated during a 6 month period.
An emergency/resuscitation room was available in 62.2% of hospitals. One third of the study hospitals had an operation theatre (32.4%). No hospital ran an intensive care unit or had trained emergency/critical care physicians or nurses available. Diagnostic resources were inconsistently available (sonography, 59.5%; echocardiography, 0%). Basic emergency procedures (wound care, 97.3%; foreign body removal, 86.5%; oxygen application, 85.2%) were commonly but advanced procedures (advanced cardiac life support, 10.8%; airway management, 13.5%; mechanical ventilation, 0%; renal replacement therapy, 0%) rarely available. During 6 months, 14,545 patients were hospitalized in the 74 study hospitals, of which 8.7% [n = 1267; median age, 34 (IQR 18-53) years; male gender, 54.4%] were included in the study. Trauma (excl. brain trauma) (20.4%), acute abdomen (16.9%) and heart failure (9.6%) were the most common conditions. Five-hundred-thirty patients (41.8%) were transferred to a secondary level hospital. The hospital mortality of patients not transferred was 3.2%.
Capacities of Mongolian primary level hospitals to manage life-threatening emergencies are highly limited. Trauma, surgical and medical conditions make up the most common emergencies. In view of the fact that almost half of the patients with a potentially life-threatening emergency were transferred to secondary level hospitals and the mortality of those hospitalized in primary level hospitals was 3.2%, room for improvement is clearly evident. Based on our findings, improvements could be obtained by strengthening inter-hospital transfer systems, training staff in emergency/critical care skills and by making mechanical ventilation and advanced life support techniques available at the emergency rooms of primary level hospitals.
虽然蒙古国二级和三级医院在急诊和危重症患者护理能力及流行病学方面已有报道，但蒙古国基层医院尚无相关数据。
在这项前瞻性观察性多中心研究中，纳入了蒙古国的74家基层医院。我们确定了这些医院处理医疗紧急情况的能力。此外，在6个月期间对这些医院收治的有潜在生命危险的急诊患者的特征进行了评估。
62.2%的医院设有急诊/复苏室。三分之一的研究医院有手术室（32.4%）。没有医院设有重症监护病房，也没有经过培训的急诊/重症护理医生或护士。诊断资源供应不一（超声检查，59.5%；超声心动图检查，0%）。基本急救程序（伤口护理，97.3%；异物取出，86.5%；吸氧，85.2%）普遍具备，但高级程序（高级心脏生命支持，10.8%；气道管理，13.5%；机械通气，0%；肾脏替代治疗，0%）很少具备。在6个月期间，74家研究医院共收治14545例患者，其中8.7%[n = 1267；中位年龄34（四分位间距18 - 53）岁；男性占54.4%]纳入研究。创伤（不包括脑外伤）（20.4%）、急腹症（16.9%）和心力衰竭（9.6%）是最常见的病症。530例患者（41.8%）被转至二级医院。未转诊患者的院内死亡率为3.2%。
蒙古国基层医院处理危及生命的急诊情况的能力非常有限。创伤、外科和内科病症构成最常见的急诊情况。鉴于几乎一半有潜在生命危险的急诊患者被转至二级医院，且基层医院住院患者的死亡率为3.2%，改进空间明显。根据我们的研究结果，可通过加强医院间转运系统、培训工作人员的急诊/重症护理技能以及在基层医院急诊室配备机械通气和高级生命支持技术来实现改进。
