Alpert Evan Avraham, Weiser Giora, Kobliner Deganit, Mashiach Eran, Bader Tarif, Tal-Or Eran, Merin Ofer
Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
Department of Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
J Emerg Med. 2018 Nov;55(5):682-687. doi: 10.1016/j.jemermed.2018.07.019. Epub 2018 Sep 1.
Medical response to world disasters has too often been poorly coordinated and nonprofessional. To improve this, several agencies, led by the World Health Organization (WHO), have developed guidelines to provide accreditation for Foreign Medical Teams (FMTs). There are three levels, with the highest known as FMT Type-3 providing outpatient as well as inpatient surgical emergency care in addition to inpatient referral care. In November 2016, the WHO certified the Israel Defense Forces Field Hospital as the first FMT Type-3.
The objectives of this article are to describe the challenges in implementing these international standards for the field hospital emergency department in a disaster zone.
There are general standards for all levels of FMTs, as well as specific requirements for the FMT-3. These include a mechanism of appropriate triage, two operating suites, 40 regular beds, four to six intensive care unit beds, radiology facilities, and various staff specialties. Despite the sophistication of the field hospital, there are many challenges. Logistical challenges include constructing the hospital in a disaster zone and equipment issues. There are staff challenges such as becoming oriented to a new and difficult environment. Patient challenges include cultural differences, language barriers, and issues of follow-up. There are often ethical challenges unique to the disaster zone.
By presenting the experience and challenges of the first FMT Type-3, we hope that more countries can join this initiative and improve disaster care throughout the world.
对全球灾难的医疗应对往往协调不力且不专业。为改善这一状况，由世界卫生组织（WHO）牵头的多个机构制定了相关指南，为外国医疗队（FMTs）提供认证。认证分为三个级别，最高级别的FMT-3除了提供住院转诊护理外，还提供门诊和住院手术急救护理。2016年11月，WHO认证以色列国防军野战医院为首个FMT-3。
本文旨在描述在灾区野战医院急诊科实施这些国际标准所面临的挑战。
FMTs各级别都有通用标准，FMT-3也有特定要求。这些要求包括适当的分诊机制、两个手术室、40张常规病床、四至六张重症监护病床、放射科设施以及各类专业工作人员。尽管野战医院设施先进，但仍面临诸多挑战。后勤方面的挑战包括在灾区搭建医院以及设备问题。人员方面的挑战如适应全新且困难的环境。患者方面的挑战包括文化差异、语言障碍以及后续跟进问题。灾区往往还存在独特的伦理挑战。
通过介绍首个FMT-3的经验和挑战，我们希望更多国家能够加入这一倡议，改善全球灾难护理水平。
