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2019冠状病毒病与全球重症监护培训的必要性。为何仅靠呼吸机无法解决问题。

COVID-19 and the Need for Global Critical Care Training. Why Ventilators Alone Are Not the Answer.

作者信息

Brotherton B Jason, Mbugua Evelyn, Halestrap Pete, Lee Burton W

机构信息

Department of Critical Care.

Department of Internal Medicine, and.

出版信息

ATS Sch. 2020 Oct 23;2(1):13-18. doi: 10.34197/ats-scholar.2020-0060PS.

Abstract

The current coronavirus disease (COVID-19) pandemic has unearthed many weaknesses in healthcare systems worldwide. In doing so, it has caused high-income countries to deal with the uncomfortable situation of resource allocation that has long been a daily occurrence in low- and middle-income countries. The shortage of equipment continues to be a major problem in low- and middle-income countries, but there is an even greater shortage of human resources in the form of trained individuals capable of caring for critically ill patients. With physicians being in short supply in many areas throughout Africa, the question becomes where do these human resources come from? In Kenya, clinical officers are the frontline workers and backbone of care in many healthcare settings and outnumber physicians four to one. AIC Kijabe Hospital, located in rural Kenya, recognized this need and identified this cohort of clinicians as a means of ramping up local emergency and critical care. In doing so, the Emergency and Critical Care Clinical Officer training program was created in 2015. Since its inception, the Emergency and Critical Care Clinical Officer program has been training nonphysician clinicians to care for critically ill patients with physician support. In this perspective piece, we outline our attempt at capitalizing on this pool of human resources to advance the care of critically ill patients, describe lessons learned along the way, and try to highlight the utility of their unique skill set in the setting of a pandemic.

摘要

当前的冠状病毒病(COVID-19)大流行暴露了全球医疗系统的许多弱点。在此过程中,它使高收入国家面临资源分配这一在低收入和中等收入国家长期以来每日都在发生的令人不安的情况。设备短缺在低收入和中等收入国家仍然是一个主要问题,但以能够护理重症患者的受过培训人员形式存在的人力资源短缺更为严重。由于非洲许多地区医生供应短缺,问题就变成了这些人力资源从何而来?在肯尼亚,临床干事是许多医疗环境中的一线工作者和护理骨干,其人数是医生的四倍。位于肯尼亚农村的艾维奇贾贝医院认识到了这一需求,并将这群临床医生确定为加强当地急诊和重症护理的一种方式。在此过程中,2015年创建了急诊和重症护理临床干事培训项目。自成立以来,急诊和重症护理临床干事项目一直在培训非医生临床医生,以便在医生的支持下护理重症患者。在这篇观点文章中,我们概述了我们利用这一人力资源库来推进重症患者护理的尝试,描述了在此过程中吸取的经验教训,并试图强调他们独特技能组合在大流行背景下的效用。

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