天津港“8·12”爆炸事故后某医院医疗需求激增分析  

A descriptive analysis of triage, surge, and medical resource use in a university affiliated hospital after 8 · 12 explosion and burn at Tianjin Port

作　　者：李国强[1,2] 于鑫[2] 盂祥涛 刘亮亮[2] 燕朋波[2] 田梦娜[2] 陈少雷[2] 韩慧娟[1] 

机构地区：[1]武警后勤学院附属医院救援医学研究所,天津300162 [2]武警后勤学院附属医院呼吸和重症医学科,天津300162

出　　处：《中华急诊医学杂志》2016年第9期1119-1125,共7页Chinese Journal of Emergency Medicine

基　　金：天津市自然科学基金（16JCYBJC27500）

摘　　要：目的2015年天津港特大危化品火灾爆炸事故导致群体伤亡事件，本研究旨在分析某医院对此事件反应过程，以期证实通过优化医疗资源使用来降低危重患者病死率。方法本研究回顾性研究某医院的创伤急救中心在本次事件中接诊、再分诊伤员的过程，分析危重患者病死率、损伤情况、医疗需求激增数据以及复苏室、手术室及ICU伤员流向和特殊检查情况。结果天津港特大危化品火灾爆炸事故导致165人死亡、8人失联，797人因伤住院。天津某医院接诊298例伤员，医院响应过程中，经历2次医疗需求激增，爆炸后1h左右第1次医疗激增，1h接诊147例伤员；第2次医疗激增出现在事故后4h左右，接诊31例重症伤员，其中29例为天津急救中心转运的危重患者，经再分诊，确定11例危重患者，过度分诊率为62．07％。共有17例伤员进行手术，17例伤员进入ICU。结论院前急救不完善可导致两次医疗需求激增，首次伤员多，伤情轻；再次伤员少，伤情重。通过有效再分诊优化使用医疗资源和损伤控制原则，减低资源使用，提高医疗需求激增应对能力，应对两次医疗需求激增。Objective To analyze the massive explosions and burn at Tianjin Port in 2015 resulted in a mass casualty event, and the entire course of response of a hospital to deal with such major sudden accident in order to find a rational strategy for optimal use of medical resources and reduce the critical mortality. Methods This study was done by a retrospective analysis of data from one trauma center at an academic hospital. Data including outcome, triage, severity and pattern of injuries, patient flow, and medical resources used were obtained by the review of hospital records. Results This disaster caused 165 deaths, 8 missing contact, and 797 non-fatal casualties. The Pingjin Hospital admitted 298 casualties, and 29 of them were seriously injured referred to by Tianjin Emergency Medical Center. Excessive triage rate made after transfer to another hospital was 62. 07% with 11 of the 29 severely injured patients. Maximum （also the first） surge had 147 injured patients arrived around one hour after incident, the second surge had 31 seriously injured patients occurred around 4 hours after incident. Of them, 17 patients needed surgeryand 17 patients were admitted to the intensive care unit. Conclusions These data showed that the number of casualties in the first surge was substantially larger than predicted and those casualties had less severe trauma, whereas the number of the injured in the second surge was less but the trauma was more severe. In order to maintain the hospital surge capacity, an effective re-triage and a hospital-wide damage control principle can be used to deal with.

关 键 词：群体伤亡事件 分诊 再分诊 过度分诊 损伤控制原则 急诊医疗服务 创伤 

分 类 号：R197.323[医药卫生—卫生事业管理]