Thoughts of resolving the ambulance retention of pre-hospital emergency

TIAN Jian-guang, ZHU Qin-zhong （ Shanghai Medical Emergency Center, Shanghai 200233, China ）

Chinese Health Resources

Abstract:This paper introduced the status of the ambulance retention in recent years,the overseas experience of emergency triage grading treatment,the exploration of the mechanism and the practice of emergency triage classification in China,and analyzed related problems affecting the implementation of emergency triage grading system.

Key words:pre-hospital emergency ;emergency treatment ;emergency triage grading

As medical institutions, timely and accurate patient in emergency first aid rescue, security is an important part of the safety of emergency patients. Emergency patients often sudden onset, in critical condition, early rescue to save lives is very important, therefore, have a scientific and rational, standardized emergency channel has great significance. In reality, however, when patients ambulance service emergency room, emergency room is often not timely, rapid reception of patients, resulting in longer remain in the ambulance to the emergency room, emergency resources and inefficient turnover; emergency rooms in major hospitals also facing "front disorder, poor backdoor" dilemma. For solving this problem, I think is very necessary in a short time, comprehensive coordination of interests of all parties, to mobilize all forces to establish strict scientific triage and referral mechanisms, efficient use of resources in emergency first aid.

Pressure pre-hospital emergency ambulance stretcher status

Currently the use of medical resources, imbalance exists, especially in three general hospitals excessive concentration of pathogens, resulting in the ambulance arrives can not achieve a smooth transition after the hospital, emergency resource efficiency significantly reduced turnover, called "ambulance stretcher pressure . " After the ambulance could not reach the emergency room fast transfer of patients, prolonged stay in the emergency room has become the pre-hospital emergency resources to effectively influence turnover of fatal illnesses. According to rough statistics, the Shanghai Medical Emergency Center 2011 press stretcher 9634 views (3.4 percent of the total number of the bus), 2012 press stretcher 19 108 times (6.1% of the total number of the bus), 2013 In pressure stretcher 30224 views (9.6 percent of the total number of the bus). Although health planning administrations organized several specialized hospitals to analyze and solve the problem, but because did not establish an effective operational mechanism, the pressure stretcher issue has not been fundamentally alleviated.

Emergency treatment abroad preflight rating

To solve this problem is not without remedy available. In foreign generally established preflight emergency classification system …. For example, in France, the emergency room features accurate positioning, symptomatic treatment center patient vital signs stable, complex cases are mainly made directional diagnosis. Triage is an important part of the emergency, triage nurse only through the national nursing certification and acceptance of the French Health Bureau triage nurse uniform training will they qualify. According to the severity of the patient's condition when points triage 5: 1 waiting less than 3min, two waiting less than 20min, three waiting less than 60min, 4 waiting less than 120min, wait less than five 240min. Patient diagnosis and treatment of the order, carried out in strict accordance with triage classification, diagnosis and treatment of critically ill is preferred, we should not have a first-come first treatment concept. In some hospitals triage go further with a physician-assisted triage difficult cases. Emergency patients observing time is not more than 24h, after emergency disposal outside the hospital and the hospital were transferred to the appropriate department. Patients unconditional acceptance of the whereabouts of the physician decision. No family members of all emergency patients bedside, accompanied by family members in the waiting hall Hou diagnosis. Patients and their families the full confidence of physicians, emergency medical care can be undisturbed. French Health Bureau to prepare nurse triage guidelines, have regular annual training nurses to triage done to quantify refinement, triage nurse in strict accordance with guidelines to judge the severity of the disease, were graded.

1993 Australian study identified Ipswich International preflight ruler in 1995 on the basis of Canada, through research and clinical practice to establish a pre-screening scale emergency, and in 1997 to promote the use nationwide. After the service the hospital critically ill patients, emergency nurses will preflight and possible causes for the condition of the patient, in accordance with the priorities were successively sorted, use the green channel, shorten the waiting time and improve emergency treatment rate. The purpose of the scale is determined by the preflight preflight nurse based on the severity of the patients were divided into 1-5 grades, indicating the degree of severity of the disease, different patients with different levels of time waiting for treatment, fully embodies the emergency treatment of critically ill patients priority purposes .