Study On Response Mechanism Of Disaster Medical Assistance For Urban Communities

Objective:To analyze the main problems of urban communities’ disaster medical assistance（DMA）in our country through the practical researches and to explore the system andresponse mechanisms of DMA for urban communities, so as to provide some decision basisfor the governments in strengthening the construction and implementation of the urbancommunities’ DMA work.Methods:Multistage sampling method was used for10cities’ selection from the northeast,northwest, southeast, southwest and central plains of China, three communities from eachcity were also be chosen, regarded the community health service centers（CHSCs）,sub-district offices, community residents’ committees and community residents as theresearch subjects. The practical researches on evaluating the capacities of DMA were unfoldthrough questionnaire survey according to the Evaluation System of Disaster MedicalAssistance（DMA） for Urban Communities which established before, the DMA problems ofnational urban communities were analyzed, then the system framework of DMA for urbancommunities based on system theory was built, and then the response mechanisms of DMAfor urban communities were explored.Results:During the practical research process,30questionnaires were distributed to the selecteddirectors of the CHSCs and29valid questionnaires were returned,293questionnaires weredistributed to the selected health care workers of CHSCs and280valid questionnaires werereturned,30questionnaires were distributed to the selected directors of sub-district officesand28valid questionnaires were returned,60questionnaires were distributed to the selecteddirectors of community residents’ committees and58valid questionnaires were returned,240questionnaires were distributed to the selected staffs of sub-district offices and community residents’ committees,222valid questionnaires were returned,1000questionnaires weredistributed to the selected residents and974valid questionnaires were returned.The survey on the CHSCs shows that93.1%of the CHSCs have disaster emergencyplans,75.9%have professional DMA teams,62.1%organized the residents of disasterself-help and mutual-aid training and10.3%organized DMA exercises at some time in thepast,, but the workers’ correct rate of the test for DMA knowledge and skills is only64.4%.The survey on the sub-district offices and community residents’ committees shows that100%of the sub-district offices and94.8%of the community residents’ committees have thenational and local disaster rescue policies and regulations,96.4%and91.4%of them havedisaster rescue plans,78.6%and67.2%have places for rescuing the wounded when disasteroccurs,85.7%and86.2%think when disaster occurs they can organize the volunteers torescue before the external rescue power arrival;44.1%of the staffs think they have somenecessary knowledge and skills of disaster rescue,90.1%believe that establishingcommunity-based DMA system and response mechanism are significant.The survey on the community residents shows that49.1%of urban residents’ familieshave some disaster preparedness, but the pass rate of the test for disaster response knowledgeand skills is only37.3%.The comprehensive evaluation and analysis results on the DMA for urban communitiesrespond showed: From the legal level,31.0%of the CHSCs didn’t have the national and localdisaster rescue policies and regulations,27.6%didn’t organize the staffs to study the relevantlaws and regulations,41.4%of the CHSCs’ staffs did not participate in regulatory learningwhich parent unit organized. From rescue organizations level,27.6%of the communitiesdidn’t have volunteers, only69.0%communities trained volunteers,22.4%communities hadnever organized disaster drills. From the rescue team level, only31.0%of the communitiesorganized the DMA professionals drills,44.8%communities organized the professionalstraining for trauma care. From the rescue process level,23.6%medical staffs and62.7%residents lack for DMA-related knowledge and skills. From the rescue management level,only55.2%communities established the DMA contacts within the community,51.7%communities established the DMA outside contacts. From rescue indemnification level,79.3%communities had reserved DMA supplies, only3.4%communities have a specialDMA funding.Conclusions: It is necessary, urgent and feasible to carry out community-based DMA response.Compared with developed countries, there are big gaps on DMA preparation and DMAcapacities of the administrative organization and management institutions, the health serviceinstitutions and their staffs and residents in our urban community. Especially in urbancommunities the relevant laws and regulations coping with disaster medical assistance arelacking, corresponding duties that community management agencies, organizations andpersonnel in the community during disaster medical assistance can not be clearly.DMA knowledge and skills of medical staffs of urban communities should be improved,the coordination and management of inside and outside community organizations also needto be further strengthened. Efforts should be made from both government level andcommunity level. Construction should be made from the affect factors of the urbancommunities’ DMA, include the formulating and implementation of policies and regulations,construction of rescue organizations, the construction of rescue team, the rescue processresponse and disposal, the rescue management and the rescue indemnification. UrbanCommunity DMA System’s framework should be built from laws and regulations system,organization and management system and resource system. The normal (non-disaster time)DMA operating mechanism should be established from urban communities’ disaster training,drills and the DMA assessment. Emergency medical assistance response mechanisms shouldbe established from starting the DMA emergency response system, rapid response, unifiedmanagement and coordination.4kinds of DMA response models, which include communitymobile-hospital model, community and emergency subcenter (or station) model, community,fire control brigades and emergency model and region linkage model, may be established forurban communities based on the scope and harmful levels which disaster may affect. DMAresponse mechanisms for disaster stable period after disaster should be established fromcollecting disaster-related information, epidemic prevention and psychological intervention.Disaster rehabilitation response mechanism should be established both from the physicalhealth and mental health.