灾难准备应是日常创伤系统的强化，但我们做好准备了吗？
Disaster preparedness should represent an augmentation of the everyday trauma system, but are we prepared?
作者信息
Jørgensen Jørgen Joakim, Monrad-Hansen Peter Wiel, Gaarder Christine, Næss Paal Aksel
机构信息
Departments of Traumatology and Vascular Surgery, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
Trauma Surg Acute Care Open. 2021 Jul 7;6(1):e000760. doi: 10.1136/tsaco-2021-000760. eCollection 2021.
BACKGROUND
The increased frequency, geographical spread and the heterogenicity in mass casualty incidents (MCIs) challenge healthcare systems worldwide. Trauma systems constitute the base for disaster preparedness. Norway is sparsely populated, with four regional trauma centers (TCs) and 35 hospitals treating trauma (non-trauma centers (NTCs)). We wanted to assess whether hospitals fill the national trauma system requirements for competence and the degree of awareness of MCI plans.
METHODS
We conducted a cross-sectional survey of on-call trauma teams in all 39 hospitals during two time periods: July-August (holiday season (HS)) and September-June (non-holiday season (NHS)). A standardized questionnaire was used to evaluate the MCI preparedness.
RESULTS
A total of 347 trauma team members participated (HS: 173 and NHS: 174). Over 95% of the team members were aware of the MCI plan; half had read the plan during the last 6 months, whereas 63% at the TCs and 74% at NTCs were confident with their MCI role. Trauma team exercises were conducted regularly and 86% had ever participated. Only 63% at the TCs and 53% at the NTCs had participated in an MCI exercise. The proportion of resident surgeons and anesthetists with >4 years' clinical experience was significantly higher in TCs (88% and 63%) than in NTCs (27% and 17%). All the on-call consultant surgeons were at home, leaving interns in charge at several of the hospitals. All resident surgeons at the TCs were ATLS providers compared with 64% at the NTCs, and almost 90% of the consultant surgeons had participated in advanced trauma surgical courses.
DISCUSSION
Despite increased national focus on disaster preparedness, we identified limited compliance with trauma system requirements concerning competency and training. Strict guidelines to secure immediate notification and early presence of consultants whenever a situation that might turn into an MCI occurs should be a prerequisite.
LEVEL OF EVIDENCE
Level IV. Study type: cross- sectional.
背景
大规模伤亡事件（MCI）发生频率的增加、地域范围的扩大以及事件的异质性对全球医疗系统构成了挑战。创伤系统是灾难准备工作的基础。挪威人口稀少，有四个区域创伤中心（TCs）和35家治疗创伤的医院（非创伤中心（NTCs））。我们想评估医院是否满足国家创伤系统对能力的要求以及对MCI计划的知晓程度。
方法
我们在两个时间段对所有39家医院的创伤应急小组进行了横断面调查：7月至8月（假期（HS））和9月至6月（非假期（NHS））。使用标准化问卷评估MCI准备情况。
结果
共有347名创伤小组成员参与（HS：173名，NHS：174名）。超过95%的小组成员知晓MCI计划；一半的人在过去6个月内阅读过该计划，而TCs中有63%、NTCs中有74%的人对自己在MCI中的角色有信心。创伤小组演练定期进行，86%的人曾参与过。只有TCs中的63%和NTCs中的53%参与过MCI演练。TCs中临床经验超过4年的住院外科医生和麻醉师的比例（分别为88%和63%）显著高于NTCs（分别为27%和17%）。所有值班的顾问外科医生都在家中，几家医院由实习医生负责。TCs的所有住院外科医生都是高级创伤生命支持（ATLS）提供者，而NTCs中这一比例为64%，近90%的顾问外科医生参加过高级创伤外科课程。
讨论
尽管国家对灾难准备的关注度有所提高，但我们发现医院在能力和培训方面对创伤系统要求的遵守情况有限。当可能演变为MCI的情况发生时，确保顾问能立即接到通知并尽早到场的严格指导方针应成为先决条件。
证据级别
四级。研究类型：横断面研究。
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