| [Purpose]The pre-hospital emergency medical service system(EMSS)is an important part of the emergency medical system.Its system structure,supply capacity and operation mechanism directly affect the efficiency and quality of service supply.Through literature research,field investigation,statistical analysis and theoretical analysis,this study aims to understand the overall situation of the construction of EMSS in different rural areas,to explore the supply capacity and efficacy of the construction of EMSS and related services in typical rural areas,to find out cognition and evaluation of the construction and optimization of EMSS and its related services among the rural pre-hospital emergency personnels and rural doctors,and build a theoretical optimization model of the EMSS in rural China.On this basis,analyzing the existing support,problems and obstacles to realize the optimization model of rural EMSS,and putting forward targeted suggestions.[Methods]1.Literature and theoretical research: Combing the domestic and foreign literature,policy documents and statements and other information to lay the foundation for the design of questionnaires and interview outline.Meanwhile,the national policy orientation needed to optimize the rural EMSS was clarified,the characteristics of pre-hospital emergency services were summarized and analyzed.Combined with the theory of crisis management and the theory of social division of labor,this research analyzed the key links of pre-hospital emergency services.To sum up,the construction principle and the optimization model of the rural EMSS was proposed.2.Field investigation: Using convenience sampling method,a wide range of surveys were conducted in six counties / county-level cities of Z City,X county,D City,B County in Hubei Province,Y County in Henan Province,and F County in Anhui Province.Interview materials and questionnaires of the county emergency(command and dispatch)center were collected to master the overall status of EMSS in different rural areas.On this basis,with the typical sampling method,in-depth investigation in Z City and X county of Hubei Province were carried out.Policy documents,interview materials,organization questionnaires,questionnaires of pre-hospital emergency personnel and rural doctors were collected to explore the supply capacity and efficacy of the construction of the rural EMSS and its related services,and to find out cognition and evaluation of the rural pre-hospital emergency personnels and the rural doctors on the construction of rural EMSS.3.Statistical method: Spss21.0 was used to make descriptive statistics.Chi-square test and Fisher’s exact test were used to compare the characteristics of ambulances and attendants in different county.T-test was used to compare the cognitive and evaluation differences of influencing factors of service provision in different types of pre-hospital emergency personnel.Chi-square test was used to compare the overall evaluation differences of different types of respondents on the construction of rural EMSS and its related service supply.T-test and ANOVA were used to compare the cognitive and evaluation differences of different types of respondents on rural EMSS optimization and optimization strategies.[Results]1.There were three modes to set up the rural pre-hospital emergency(command and dispatch)center: first,to set up the county emergency command and dispatch center independently(X county);to set up the emergency center relying on the County People’s Hospital(Z City,Y County,F County,D City);third,to set up emergency telephone in the County People’s Hospital,but this hospital did not have the power to dispatch the ambulance in emergency stations,therefore,each emergency station provided pre-hospital emergency services independently(B County).2.Rural pre-hospital emergency network: in most of the investigated areas,the County People’s Hospital,the hospital of traditional Chinese medicine,the hospital of maternal and child health(the second People’s Hospital)and all township hospitals were included in the pre-hospital emergency network(Z City,X county,B County,F county).Although the village clinics were not clearly included in the pre-hospital emergency network,it provided pre-hospital emergency services for residents.In addition,private hospitals were included in the pre-hospital emergency network(D County);in order to avoid doctor-patient disputes,some areas had not set up emergency stations in township hospitals(Y County).3.In terms of pre-hospital emergency resources: about the equipment related to prehospital emergency,none of the township emergency stations in the investigated areas was equipped with rescue(monitoring)type ambulances;the basic equipment allocation rate of ambulance breathing balloon mask(90.91%),adhesive tape and bandage(90.91%),sphygmomanometer(90.91%),blood sugar meter(68.18%),car stretcher(81.82%)in Z City and X county was not 100%;the allocation rate of ambulance equipments for advanced life support in county-level was higher than that of township-level;the advanced life support in township hospitals was higher than that of ambulance in the whole county;9.52% of the village clinics were not equipped with a emergency kit.About the pre-hospital emergency personnel,in addition to the pre-hospital emergency work,the county and township prehospital emergency medical staff and the drivers of the township emergency station needed to take into account other works in the hospital,with a large workload;76.19% of the investigated county and township institutions had provided emergency training for rural doctors.4.In terms of the efficacy of pre-hospital emergency service supply: about seeking ambulance service,the caller could not only call 120 emergency call,but also directly contacted the emergency station and village clinic.About dispatching visits,in Z City and X,65.97% and 51.21% of the visits were undertaken by the People’s Hospital,1.92% and 25.68% by the hospital of traditional Chinese medicine,0.44% and 1.32% by the hospital of maternal and child health care in counties,31.67% and 21.79% by the township emergency stations.In addition,the implementation rate of hospital emergency measures in township hospitals is higher than that of on-site emergency measures in whole pre-hospital institutions.In the selection of transfer institutions,72.87% of the respondents said that they usually transfer the patients to county-level hospitals.About the supply effect,the average dispatching time of Z County was 5 minutes and 35 seconds,and the average task time was 1 hour and 58 seconds;the average dispatching time of X County was 11 minutes and 26 seconds,and the average task time was 44 minutes and 18 seconds.5.There were 46.55% of the respondents thought that efficacy of EMSS and its related service supply was average.The number of ambulances and the medical service ability of the emergency station,as well as the smooth communication with the emergency station were the main factors that affected the selection of the emergency station by the dispatcher.The most important factor that affected the implementation of on-site rescue measures was the ability of on-site personnel to deal with symptoms and identify diseases.The main factors influencing the selection of medical institutions for transferring patients were the rescue ability,response speed and rescue equipment of the medical institution.The respondents had a better understanding and evaluation of optimizing the rural EMSS,especially the establishment of emergency stations in township hospitals,the strengthening of emergency medicine discipline construction in township hospitals,and the provision of emergency publicity and guidance by rural doctors to residents.6.Through policy and theoretical analysis,the service subjects of rural EMSS include county emergency(command and dispatch)center,county-level hospitals,township hospitals and village clinics,while encouraging social capital,rural grassroots organizations,transportation,public security,fire protection and other departments to participate.In terms of service supply and its key links,it should include providing health management to the risk groups and providing emergency publicity and education to the residents.In terms of dispatching vehicles,on-site medical emergency and transfer hospital selection,the suitability of classification and grading and service provision should be emphasized.At the same time,the rural EMSS need to pay attention to telephone pacification and guidance,prehospital to hospital connection and profit from previous work.The efficient operation of the system needs to be supported by sufficient capital investment,sound management system,excellent resource allocation,sufficient personnel capacity and full use of information technology.[Conclusions]1.The existing support to realize the construction of the optimization model of rural EMSS includes: the current supply capacity of pre-hospital emergency services of rural primary medical and health institutions,typical experience in the construction of the rural EMSS and its related service supply in the investigation areas,and high awareness of the optimization of rural EMSS for relevant personnel.2.The problems and obstacles to realize the optimization model of rural EMSS include: the network of rural EMSS is not perfect,the resource utilization is not sufficient,the government investment is not enough,the management system is inadequate,the resource allocation is not sufficient and unbalanced,and the construction of talent team still needs to be strengthened.3.It is suggested to establish and improve the fund guarantee mechanism,improve the management system,optimize the related resources,improve the service supply capacity and enhance the service motivation of the related personnel,and strengthen the publicity to realize the construction of the optimization model of the rural EMSS. |
PDF Full Text Request