| Nowadays,our country is facing severe threats and challenges of emergencies.When emergencies occur,due to their contingency and huge destructive power,people’s lives and health as well as huge social and economic losses are caused.Emergency medical rescue is an important part in the emergency management system.Rapid and efficient medical rescue provided by medical institutions can minimize human casualties and economic losses to the greatest extent.Xinjiang is located in the northwest of the motherland,and it has eight neighbouring countries.The special geographical location and natural conditions make it a high risk of emergencies,and it tests the emergency management capabilities of the government and various departments at all times.Since Xinjiang’s tertiary comprehensive public hospitals take the heavy responsibility of regional medical rescue,it is of practical significance to study its emergency management of medical rescue.Objectives:This study took around to Xinjiang’s tertiary comprehensive public hospitals who had been undertook the main task of emergency medical rescue,it was A comprehensive analysis of the current situation and deficiencies of emergency medical rescue which came from three aspects of injury characteristics of hospitalized patients,medical personnel’s cognition of emergency rescue and management,and hospital risk event identification:Firstly,to analysis retrospective investigations about the injury situation of hospitalised patients in public hospitals by emergencies,it reflected the medical emergency pressure and social and economic loss by injures;Secondly,health workers were the core force of emergency rescue in hospitals,to analyze the awareness of health workers’comprehensive ability in medical rescue and their cognition of emergency management in hospitals,and finding the weakness of workers;Thirdly,the basis of the hospital to provide medical aid service was to do their own risk prevention,so to assessment the internal and external environment of the hospital in terms of emergencies and internal vulnerability risks,then help hospitals to determine the priority for medical rescue and emergency management intervention focus,do a good job in hospital disaster prevention ability.On this baias,it was comprehensively analysed the medical rescue emergency capabilities among Urumqi,northern Xinjiang,and southern Xinjiang as well as their differences by constructing a medical rescue emergency management indicator system of tertiary comprehensive public hospital in Xinjiang.Through the above all,it provided seamless bridging strategies and policy Suggestions of"government-society-hospital"for comprehensively improving the emergency management capacity of medical rescue in xinjiang.Methods:In the first part,(1)0it were collected information on 29,595 cases of hospitalization due to traffic accidents,occupational disaster accidents,fire accidents and social security incidents admitted in 2011-2018 through the medical record system of five tertiary comprehensive public hospitals in Urumqi,and analysed their sociodemographic characteristics(gender,age,ethnicity,occupation),injury characteristics(injury locations and injury characteristics),clinical characteristics(admission,length of stay,surgery,outcome),hospitalization costs,and established traffic accidents and occupational safety accident ARAMA prediction model by time series methods.The categorical variables were compared between groups using theχ~2test,the hospitalization costs were discounted and standardized using the CPI index.(2)It was used a questionnaire survey of 5022 health workers working at medical rescue related departments in Xinjiang’s tertiary comprehensive public hospitals to investigate their basic information(gender,age,ethnicity,position,title,education,working age,whether they were health technicians,whether they were members of the emergency rescue team),emergency training drills and rescue situations(number and level)in the past three years,awareness of medical rescue emergency capabilities(awareness of emergency,awareness of medical rescue roles,awareness of medical rescue work capabilities,awareness of first aid knowledge and technology)and awareness of hospital emergency management(undertaking emergency tasks,clarifying responsibilities at all levels,emergency training drills,emergency materials support,emergency experience summary and emergency information communication).The categorical variables were compared between groups using theχ~2 test,the continuous variables were analysed using the t-test or one-way analysis of variance,and the analysis of the factors affecting the awareness level of hospital emergency management was performed using Multiple Linear Regression.(3)It was used the risk matrix method and the Borda ordinal value method to calculate the risk probability and severity of 37 types of emergencies in 4 categories in Xinjiang and determine their risk levels.The Kaiser model risk assessment matrix was used to evaluate 30 types of emergencies in 4 categories that were likely to occur in hospitals.Risk events were analysed in terms of their probability and vulnerability(personnel,finance,operational impact and emergency preparedness,internal and external emergency response),and their relative risk values(R%)were determined and ranked.Pearson correlation was used to analyze the correlation between natural disaster and technical accident.The second part,a preliminary evaluation index framework was established through the literature research and expert consultation for medical emergency rescue capacity of tertiary comprehensive public hospitals in Xinjiang.Then the Delphi expert consultation method was used to screen and determine the comprehensive evaluation index system for emergency capacity of tertiary comprehensive public hospitals in Xinjiang.The analytic hierarchy process and entropy weight method were used to determine the weights of the evaluation indicators at all levels.Finally,the scores of the indicators of the tertiary comprehensive public hospitals in the whole of Xinjiang(21),Urumqi,Xinjiang(7),Northern Xinjiang(8)and Southern Xinjiang(6)were finally determined.Results:There were 29,595 hospitalized patients with emergency injuries during2011-2018.(1)Socio-demographic characteristics,males was accounted for 75.0%,and the age group was mainly concentrated in the 19-35yrs(35.3%)and 36-45yrs(24.1%)age groups.The occupations were mainly composed of workers(26.9%),freelancers(18.1%)and farmers and herdsmen(17.5%).(2)Injury characteristics:In terms of event type,traffic accident patients is the highest(50.6%),followed by social security incident patients(24.1%),and occupational safety accidents(23.3%);In terms of injury sites,upper and lower limb injuries(39.6%),and head neck injuries were predominant(34.8%).(3)Clinical characteristics:admitted patients were in critical condition(78.3%)at the time of admission,and the patients were mostly concentrated in orthopaedics,emergency trauma,and neurosurgery.The length of hospitalisation was longer,and 60%of them needed surgery as well as 90%of patients recovered and got better.Among the deaths,traffic accidents(66.43%)was the highest and occupational safety accidents(31.4%)ranked second.(4)In terms of direct economic burden,expenses of 29,595 patients incurred hospitalization was 800million yuan,and the highest expenses proportion of total hospitalization was the traffic accident(62.5%);after eliminating price factors,the total hospitalization expenses has been increasing,with an average growth rate of 5.9%.From 2011 to2018,the average cost of social security incidents increased by 6.2%.Among 5022 health workers,(1)59.3%of them had received emergency training in the past three years,60.8%had participated in emergency drills,the number of training and drills was relatively small and the level was relatively low;20.3%of the people participated in emergency rescue,However,20.3%of the people participated in emergency rescue,with more rescue times and higher level,and regional differences(P<0.05).(2)In terms of awareness of medical rescue emergency capabilities,the overall response error rate of emergency classification was 25.7%.The second was the lower response percentage of psychological support(76.0%),health education(62.2%),public health epidemic prevention(64.0%)and safety protection(85.4%)than first aid skills(94.7%)and first aid knowledge(95.3%)in the awareness of medical emergency rescue capabilities.Third,50.7%of the medical staff believed that their emergency knowledge could not meet the needs of rescue,and the response rate of first aid technology mastery of on-site disaster assessment(33.4%),psychological crisis intervention(33.4%),health education(36.9%)and biological pathogenic factor protection(19.4%)was lower than other first aid skills.Frequently used technologies had low response rates.The accident classification error rate in northern Xinjiang was 29.5%,which was higher than other regions.The awareness of medical rescue emergency capabilities among other regions was consistent with the overall one.(3)The health workers’awareness of hospital emergency management was generally not high.The overall self-rated scores of the emergency tasks and clear responsibilities of the hospital were 3.08±1.02 and 3.09±1.04 respectively,and the scores of other parts were lower than 3.0.Emergency training,drill and rescue were the influencing factors of the cognition level of emergency management.Except for some items,the awareness of hospital emergency management in southern xinjiang was higher than that in other two areas.In the risk level of external environmental emergencies,earthquake and road traffic accidents were extremely risky events,while snow,biological disasters,extreme temperatures,corporate safety accidents,fire accidents,environmental disasters,outbreaks of infectious diseases,"benzene poisoning,lead poisoning and pneumoconiosis"and economic safety events were high-risk events.The analysis of the vulnerability of internal disasters in hospitals revealed that the top relative risks were fire(48.72%),violent medical disputes(47.60%),hospital infection outbreaks(46.65%),earthquakes(45.40%),and power failures(44.94%),epidemic outbreaks(41.44%),information system failures(41.25%),elevator failures(40.23%),mass security incidents(38.30%),and food safety incidents(37.80%).some of the natural disaster had correlation with technology factors above of 0.4.The comprehensive evaluation index system for emergency capacity of Xinjiang’s tertiary comprehensive public hospitals had been established,a total of 8hospitals of first-level indicator,30 hospitals of second-level indicator,and 76hospitals of third-level indicator.After investigated the emergency management of medical rescue in tertiary comprehensive public hospitals,the score of ability in emergency management was determined based on the index system,Medical treatment capability score was 0.23806,emergency safeguard score was0.13622,training exercise and assessment index score was 0.10355,ranking among the top three,but the recovery and reconstruction score after the event is 0.00134,the emergency system scored 0.00106,and the monitoring and early warning system scored 0.00091,ranking the last three.The emergency management ability of medical rescue in Urumqi,north Xinjiang and south Xiniang was similar to the emergency medical rescue situation of Xinjiang as a whole.Conclusions:First,there were deficiencies in the emergency medical rescue of in tertiary comprehensive public hospitals:(1)Emergency injury caused highly medical emergency pressure owing to severe patients’injury,serious social hazards,increased medical emergency needs,and severe social and economic burdens;(2)Emergency training and exercise opportunity was less in Xinjiang tertiary public hospital medical,which was in contradiction with the actual medical rescue work.The awareness of emergency medical evacuation ability was not comprehensive,emergency cognitive was deficiency,there were lack of both the health education,psychological support,public health and epidemic prevention,safety knowledge,skills and abilities.The awareness of hospital emergency management level was not high,only by establishing a comprehensive specification system of emergency training and exercises to raise its awareness;(3)Xinjiang tertiary general public hospitals should clearly set earthquake and road traffic injury which were the extremely high risk as the priority of emergency management,focusing on the rescue of high risk events such as snowstorm,epidemic of infectious diseases,corporate safety accidents,etc.,continue to pay attention to medium and low risk events,and regularly adopt risk assessment measures of prevention and controlling.Internally,we should strengthen the building of disaster resistance to high risk events such as fire,violent medical disputes and outbreak of hospital infection,identify our own vulnerability,improve special emergency plans for high risk events,strengthen prevention and control by departments,and improve the level of emergency rescue.On the whole,Xinjiang tertiary comprehensive public hospitals had relatively good in medical treatment,emergency support,training,exercise and assessment,while relatively weak in post-disaster recovery and reconstruction,emergency response system and monitoring and early warning system.Therefore,post-disaster recovery and reconstruction,emergency response system and monitoring and early warning system should be enhance.Urumqi,southern Xinjiang and northern Xinjiang region emergency management capacity were similar with the overall.Abrove all,From the macro,middle and micro levels,we should improve the ability of medical emergency rescue management in tertiary comprehensive public hospitals comprehensively by the the government’s emergency rescue management system and social network emergency rescue system. |
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