Study On Prehospital Emergency Medical Service System Of Urban Based On Community Health Institutions

ObjectiveThrough the study on the first-aid facilities status of the community health services situations at present in China,first-aid skills of health technicians in community health services situations,the first-aid awareness of the community patients,first-aid service and skills needs , and the research on important role of the first-aid system in urban community health institutions, to know community health agencies about first-aid ability and the community patients for the first-aid service requirement, and to improve emergency medical services system of pre-hospital care feasible way, to contruct emergency medical service system of urban based on community health institutions. For ensuring the life safety of the masses, we give some suggestions to this system construction, and enhance responsive of primary health institutions to the health emergency events, for the perfection of our health emergency system to provide certain conditions.Content and Methods(1)Through the literature review and intelligence analysis, collecting the literature about prehospital emergency medical care system and first-aid system based on community health institutions, to know the status and problems of prehospital emergency medical service,community health agencies participate in first-aid, then we can provide the basis for the subsequent research.(2)Using questionnaire, surveying the status and problems of the community health service institutions,health technical personnel structure,the mastery of first-aid knowledge skills,first-aid equipment facilities deployment, etc, we got the status and problems of first-aid hardware facilities,health personnel structure,first-aid ability in the community health service institutions in the sample areas; surveying the prehospital emergency cognitive and demand of community patients. Aimed at the status of prehospital care disease in hospital, call location, first aid radius, emergency response time, emergency patients died, to interview four sample hospital emergency department director in Guangdong province of Hubei province.(3)Using quantitative descriptive analysis, including chi-square test(Fisher's test), to analyse first-aid hardware facilities,health personnel structure,first-aid ability in community health agencies, and using logistic regression to analyse the factors of first-aid medical technical personnel working competence in community health agencies.(4)Using SWOT analysis, to point out the factors of prehospital emergency medical Service system based on community health institutions, then provide suggestions to perfect our first-aid system and strengthen public health incident emergency mechanism.Results(1)Through the literature analysis, we found that foreign first-aid models development were relatively perfect, there were British-American mode and France - Germany mode. Domestic first-aid started later, development is relatively slow, first-aid pattern sorts are more, and the connection with community health service is not well.(2)In the investigation of the 8 community health service institutions, two community health organizations have emergency department alone; two community health organizations have separate emergency duty but no emergency department. First-aid basic facilities equipped of the community health institutions are not enough. There are no an ambulance in the 8 community health service institutions which we have investigated .(3)We have investigated 230 health technical personnel in the sample community health service institutions, 57.6 percent in the total health technical personnel. The culture degree of health technical personnel are mainly Junior college and below, which occupied 60.9 percent; professional title are mainly Junior and below, which occupied 66.4 percent; the subtropical high and above only 1.3%. The average age is 34.3 years old, the age between 25 and 35 is the most, which occupied 53.3 percent. We can know that the culture degree and title of health technical personnel are relatively low, and the age structure is young.(4)Though investigating 230 health technical personnel in the sample community health service institutions, we have found that the first-aid awareness of health technical personnel is 99.1 percent in the 8 community health service institutions. 92.6 percent health technical personnel think that community health institutions are necessary to carry out first-aid work, only 3.0 percent think there is no necessary. Though fisher's test, we can know that the gender(χ~2=23.156,P=0.004),culture degree(χ~2=22.538,P=0.006),title(χ~2=19.087,P=0.025)and age(χ~2=19.852,P=0.023)of the health technical personnel affect the attitude of necessity whether community health institutions carry out first-aid work.(5)In the aspects of first-aid skill mastery, vital signs detection,cardiopulmonary resuscitation (CPR),hemostasis cleanup and bandage general wounds are mastered better, respectively occupied 60.0 percent,56.1 percent and 50.9 percent; fractures fixed technology,acute poisoning processing and first-aid equipment use are mastered worse, respectively occupied 29.1 percent,19.6 percent and 8.7 percent. There are average 71.7 percent health technical personnel have training needs to all basic first-aid knowledge skills. We can found that the training needs of the health technical personnel to first-aid basic knowledge skills are intense.(6)Though community health institutions patients investigated, we have got 58.0 percent community patients heard of prehospital emergency medical care; 58.0 percent community patients don't understand the contents of prehospital emergency medical care, only 2.5 percent community patients know the contents of the service. There are 60.5 percent community patients think community health institutions can play a role in prehospital emergency medical care; 38.3 percent community patients think community health institutions are important in prehospital emergency medical care, only 1.2 percent community patients think it has't much effect. There are 55.5 percent community patients accept the first-aid skill level of community health institutions.(7)28.3 percent health technical personnel think they can competent the job of prehospital care, 60.4 percent health technical personnel think their competence general, 11.3 percent health technical personnel think they can't competent the job of prehospital care. Though the Logistic regression analysis, we have found that the factors which affect the first-aid working competence of medical technical personnel, the analysis showed that gender,working years,cultural degree,post,first-aid service attitude have influence to the working competence of medical technical personnel.(8)Though qualitative analysis to the prehospital Emergency Medical Service system based on community health institutions, we can found the main factors which affect the system construction are the government's attention and policy support, reasonable financing compensation mechanism, construction of emergency personnel team, superior hospital support and guidance, first-aid equipment facilities of community health agency, community health institutions first-aid function consummating , the acception and application of community residents to community health emergency service.Discussion and ConclusionDiscussion: (1)The emergency hardware facilities of community health service agencies is relatively inadequate; (2)The age structure of community health technicians is relative unreasonable, culture degree and the title are low; first aid skills is relatively low; (3)The awareness and approval of community patients to community emergency services need further ascend; (4)Community health service center function orientation needs further clear or expand; (5)Attention of leadership isn't enough and lack of corresponding policy support; (6)Financing compensation mechanism is imperfect; (7)Prehospital service concept of community health service center needs further change; (8)Prehospital emergency service system of urban should be further improved. Conclusion: (1) The government should pay great attention to urban community emergency emergency service; (2)Reasonable financing compensation mechanism; (3)Optimizing community health organization structure, and establishing high quality community emergency personnel team; (4)Developing community education; popularize knowledge about first aid (5)The first-aid equipment facilities of community health department should be equipped; (6)Transforming first-aid service concept of community health technicians; (7)Establishing career development mechanism of prehospital emergency service technicians; (8)Promoting the establishment of an unified city first-aid system.Innovations and DeficiencyInnovations: The research mainly focus on the hospital emergency service at present, rarely involves community first-aid and relative content. The paper emphasizes the importance of community health service agencies participating in first-aid, puts forward of constructing and exploring Prehospital Emergency Medical Service system of urban based on community health institutions, and mainly from the point of community health institutions, investigation, analysis and discussion on community health institutions in constructing the city relying on first-aid system process conditions, problems and the difficulty they have ever met, for perfecting the urban emergency medical service system and health emergency mechanisms provide reference and suggestions.Deficiency: Due to the limitations of time and funding, only 8 community health service center and 4 hospitals have been investigated on-site in Hubei province and Guangdong province, the results of the research may not be representative; During the investigation, we don't make enough use of the interview results, it may not reflect all influence factors of prehospital emergency medical service in community health service institutions; our investigation process has been done in community health service institutions and hospitals, part of data may not reflect the real ideas of health technical personnel fully.