| BackgroundChina is among one of the countries with widest range and the highest frequency of public health emergencies, as well as the biggest loss. Since the SARS epidemic in2003, the national health emergency response capacity was enhanced building, especially in the efficient response to the Wenchuan earthquake in2008and the influenza A (H1N1) outbreak in2009. However, many challenges remained to be addressed against the great progress in terms of China’s health emergency response system. This study was designed to carry out a baseline survey on the current situation in health emergency response system in health sectors, which involve many levels such as administrative departments, disease control and hospital systmes, for the establishment and further strengthening the national health emergency response system.ObjectiveTo understand the health department health emergency response systems at provincial, city and county level, personnel status, equipment and reserves, including staffing, equipment, reserve and funding;To find out gaps and challenges in the development of emergency response system;To find a solution to the challenges for the national health emergency system construction, especially the Health Emergency development programme during the12th Five-Year Plan as well as the’Medical and Health Care Medium and Long-term Talent Development plan (2011-2020)’under Ministry of Health.Methods Standard survey program and questionnaire were developed on the basis of experts discussion and pre-experiment; China CDC was in charge of database establishment and programme training at provincial CDC. The survey included a set of health emergency response agencies, staffing, team building, financial support, emergency equipment and reserves.Health facilities at provincial level were in charge of the local survey at city and county level. Staff at provincial level were trained to take the responsibility of local training and supervision, field investigation, quality control, data inputs by using EpiData and report to China CDC.The database will be established by using EpiData3.1and data analyzed by using SPSS and EXCEL.ResultsA total of10,654health facilities were surveyed, of which2837were administrative sectors, inlcuding31at provincial level,307at municipal level and2499at county-level. The completion rate were100%,88.5%and85.3%at each level, respectively. A total of2857CDC were investigated, including36at provincial level,325at municipal level, and2496at county level, with the completion rate of100%,93.7%and85.2%, respectively. Totally4960medical institutions were surveyed, of which935were third-class hospitals,4025second-class hospitals, with the completion rate of75.8%and61.7%, respectively.1. Institution structureIt showed that the proportion of an independent emergency management agency in a health administrative sector was100%,42.3%and18.8%, respectively, at provincial, municipal and county level. Proportion of an independent emergency management department in CDC was72.2%,31.1%and21.2%, respectively, at provincial, municipal and county level. A total of4553medical institutions designated Medical Service (Branch), Hospital Office and Emergency Management Office which account for91.8%of the total medical institutions. 2. StaffingResults showed that there were2160staff in health administrative sectors (1320for fixed-term, accounting for61.1%),4186in CDC (1794for fixed-term, accounting for42.9%),37,897in medical institutions. The average number of staffing was7.6people per medical institution, most of whom were part-time.3. Team buildingTotally18846emergency response teams at provincial, city and county level were formed with210,000people. Among them,104,113were under8232emergency medical rescue sub-teams,55,816were under5360acute infectious disease emergency response sub-teams,40,617were under4029poisoning emergency response sub-teams, and nuclear and12,384were under1225radiation emergency response teams. The percentages of uniforms for the above team were51.6%,16.0%and16.2%at provincial, municipal and county level. Percentages of personal accident insurance rate were51.6%,6.5%and3.6%at prinvicial, municipal and county level in provincial health administration sectors, and19.4%,8.0%and5.4%at prinvicial, municipal and county level in provincial CDCs.4. Emergency equipmentAccording to’health emergency response team and equipment reference catalog (Trial)’issued by the Ministry of Health health,58.1%,39.7%and35.2%emergency teams were equiped at the provincial level, municipal and county level. The allocation rate of health emergency command vehicle in health administrative sectors was64.5%,18.9%and28.8%at the provincial, municipal and county level. The CDCs own four mobile BSL-3laboratories with a simple microbiological testing vehicle every36CDCs, and a simple physical and chemical detection vehicles every65CDCs. In average,3.2ambulances,7.3respiratory machines,1.1intensive care units (ICU),0.2Pediatric Intensive Care Units (PICU) are equiped in each medical institutions.5. Funding Among31provinces,29health administrative sectors are funded with rountine emergency budget, among which sectors funded of200,000to500,000Yuan accounted for24.1%, sectors funded of500,000to1million Yuan accounted for20.7%and those funded over1million Yuan accounted for31.0%.46.3%and37.3%health administrative departments at municipal and county level are funded with rountine emergency budget, of which68.3%municipal level sectors are under100,000Yuan while53.2%county-level sectors are under50,000.6. Emergency reserveGovernment reserves are provided under the guidance of health sectors and implemented by the Industry and Information Department, of which80.6%,83.1%and82.0%are stock-in at provincial, municipal and county level. In2009, the total value of the physical reserves was about920million Yuan, most of which were flu vaccine and Tamiflu. Uneven reserve in CDC and hospital systems was observed with49.5%CDC reserve less than50,000Yuan or even no reserve and49.2%the medical institutions less than50,000Yuan or no reserves. A total of38.7%,28.3%and35.1%health administrative agencies at provincial, municipal and county level have a health emergency reserve.There are a total of110,393national hospital beds for emergency, most of which are for emergency. The avarage number of emergency beds in each health is23.1with5,8intensive care unit (ICU) beds. In case of emergency, the average time spent for additional30,50and100beds is1.5,3and4days.Conlusions(1) Emergency response system has been well established with adaquate emergency plans (2) Staffing in emergency response sectors exceeds the actual needs with large disparities of degrees (3) Staff with multi-disciplinary backgrounds should be increased (4) The frequency of annual exercises and emergency response training is increasing by year (5) Specific committee has been set up as consultancy to emergency response (6) There is a big gap between the euqipment and emergency reserve and its demand with large disparities in different areas. Normally, it is better at provincial level than that at city or county level (7) Routine funding is not adaquate and persenal accident insurance is always delayed (8) Well equipped biosafty laboratories as well as basic needs such as reagents, consumable are not enough (9) The number of hospital beds are urged to be increased in case of large-scale emergencies. |
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