ObjectiveTo use failure mode and effect analysis (FMEA) to check and improve the risk of severe acute respiratory syndrome coronavirus 2 nucleic acid detection, and explore the application effect of FMEA in the emergency inspection items.MethodsFMEA was used to sort out the whole process of severe acute respiratory syndrome coronavirus 2 nucleic acid detection from January 30 to February 21, 2020. By establishing the theme, setting up a team, analyzing the failure mode and potential influencing factors. Then calculate the risk priority number (RPN), formulate preventive measures and implement continuous improvement according to the analysis results.ResultsA total of 2 138 cases were included. After improvement, the number of potential failure modes has been reduced by 2 (17 vs.19); the value of total RPN decreased (3 527.49 vs. 1 858.28). There was significant difference in average RPN before and after improvement [(185.66±74.34) vs. (97.80±37.97); t=6.128, P<0.001].ConclusionsIn the early stage of emergency inspection items, using FMEA can systematically check the risk factors in the process, develop improvement measures. It also can effectively reduce the risk of severe acute respiratory syndrome coronavirus 2 nucleic acid detection in hospital.
Objective To use Kaiser model, three-dimensional risk matrix and Borda ordinal value method comprehensively to analyze the vulnerability of disasters, and identify the key prevention and control risks of the hospital. Methods From June to December 2020, a disaster vulnerability analysis was conducted on a tertiary hospital in southwest China. The risk event evaluation index system was established by referring to the Kaiser model, and the evaluation indexes were classified into three aspects: possibility, controllability and harmfulness. The three-dimensional risk matrix was used to calculate the risk score to determine the risk level. The Borda ordinal value was used to compare the ranking of risk events in the same risk level. Result “Violent medical injuries” “terrorist attacks” and “explosions” were the highest ranked risk events, which needed to be prioritized and targeted for improvement. Conclusions Disaster vulnerability analysis is an important means of emergency management in hospitals. Managers should dynamically assess hospital risks, take effective preventive measures for high-risk events, conduct emergency plan drills, continuously improve risk warning mechanisms, and enhance emergency management capabilities.
Objective Can we successfully make diagnosis, treatment and prevention in patients with SARS in the economically undeveloped region? Methods we retrospectively reviewed the whole process of diagnosis, treatment and prevention in three patients with SARS. Results All the three patients recovered with no socomial infection in medical staff and no second-generation patients. Conclusion In the economically undeveloped region, if one attached importance to epidemic crisis inwardly and put all the steps into effect really, and if one took four early steps, started the contingent mechanism up urgently, worked can onically and treated patients actively when the epidemic crisis broke out, the outbreak could be overcome successfully with little cost.
Medical records play an important role in medical treatment, prevention, teaching, scientific research and hospital management. The epidemic situation of coronavirus disease 2019 is very serious. How to complete the writing of medical records with high quality and high efficiency under the high-intensity, high-pressure environment of the prevention, diagnosis, and treatment of coronavirus disease 2019 is an important issue for medical quality control management departments. West China Hospital of Sichuan University has adopted various measures to continuously improve the quality management of medical records, including optimizing the medical records of fever clinics and isolation wards, and using various methods of medical record quality management under the support of electronic medical record information systems, so as to improve the writing quality and efficiency of medical records during the diagnosis and treatment of coronavirus disease 2019.
Objective To explore the allocation of necessary living goods for the emergency medical rescue teams at Lushan earthquake sites. Methods The living goods requirements of 59 emergency medical rescue members at Lushan earthquake sites were investigated using a questionnaire and then analyzed, in order to provide references for the allocation of necessary living goods for emergency medical rescue teams in future. Results The top five necessary living goods for emergency medical rescue members at earthquake sites were food, drinking water, toilet, communication product, and bedclothe. The needs of bath of the members who stayed longer than 3 days were more than the members who stayed shorter than 3 days, with a significant difference (Plt;0.05). The number of living goods that female members need were more than that male members need (Plt;0.05). Conclusion For improving the work efficiency and quality of life, emergency medical rescue teams need to be equipped with not only the medical supplies, but also necessary living goods based on the length of stay and the ratio between male and female.
Objective To analyze the injury characteristics and the rescue process and effects for the victims admitted in the People’s Hospital of Deyang City within 72 hours after 4.20 Lushan earthquake, so as to discuss how to adopt the emergency program to implement medical rescue in disaster relief. Methods The data of 25 earthquake victims admitted in the hospital from April 20th, 2013 to April 23rd, 2013 were collected to analyze age, gender, the location of injury, the injury state of different age groups, and the prognosis of victims. Results Of the 25 victims with injuries on 32 locations of the body, there were 20 cases with single injury (80.00%) and 5 cases with multiple injuries (20.00%). Most injuries were seen in four limbs, body surface, and soft tissues; and the incidence of single injury was higher than that of multiple injuries. The number of admitted victims was largest on the first day after earthquake, accounted for 92.00%, which was obviously higher than that on the second and the third day. Victims aged from 19 to 45 years old was more than those of other ages. Conclusion Scientific emergency command system and disaster emergency program play an high-efficient command role in disaster rescue, shorten the time of emergency response, and improve the ability of disaster rescue. The comprehensive capacity of self-rescue and well-organized rescue for disaster area can be improved as long as the general public is educated about the disaster emergency program and cooperative emergency drill. Meanwhile, smooth traffic and unobstructed communication are guaranteed in the disaster area, and the cooperative efforts are made by all walks of society.
Objective To comparatively analyze the rationality of emergency medication after Wenchuan earthquake with that after Lushan earthquake in West China Hospital of Sichuan University, based on the use of medicine of the victim’s disease spectrum. Method By using Excel, defined daily dose system (DDDs) and drug utilization index (DUI) were used as the evaluation indexes to analyze the rationality of emergency medication in West China Hospital of Sichuan University within one month after Wenchuan earthquake and Lushan earthquake. Results Within one month after Wenchuan and Lushan earthquake, there were 1 839 and 488 victims treated in the hospital, respectively. Within one month after the two earthquakes, the variation tendency of DDDs of drugs and number of victims was consistent, and the consistency was better in Lushan earthquake than that in Wenchuan earthquake. Among the 60 drugs which DDDs were ranked top five in their pharmacological class (top ten for antimicrobials) in Wenchuan earthquake, the majority of them were injections (injections vs. non-injections: 70.0% vs. 30.0%); the results showed that the medication (DUI=1) only accounted for 10.0%, the medication (DUI<1) accounted for 28.3%, which implied that the use of drugs was insufficient, the medication (DUI>1) accounted for 61.7%, which implied that drugs were overused; the average of DUI was 1.61. And in Lushan earthquake, injections also accounted for a larger proportion than non-injections (63.3%vs. 36.7%); the results showed that the medication (DUI=1) accounted for 15.0%, the medication (DUI<1) accounted for 38.3%, the medication (DUI>1) accounted for 46.7%; the average of DUI was 1.30. Conclusions Base on the DUI, we draw the conclusion that the rationality of emergency drug use and the timeliness of emergency drug supply were better in Lushan earthquake than those in Wenchuan earthquake. But the rationality of using the DUI, which is an evaluation index for normal conditions, to evaluate the emergency conditions still needs to be further verified.
Objective To evaluate the performance of emergency medical rescue (EMR) within 1 month after Lushan earthquake, and to prove and enrich the experience from Wenchuan earthquake, so as to provide useful references for global earthquake EMR with regard to decreasing death and disability rates. Methods All the following date published within 1 month after 4.20 Lushan earthquake were collected and analyzed, including official information, public documents, news release, relevant information from websites and victims’ medical records in the West China Hospital, then the relevant domestic and foreign literature about EMR (including EMR of Wenchuan earthquake). And then comparative analysis was conducted to evaluate the performance of EMR in Lushan earthquake. Results a) Being 87 km apart from each other, the main seismic zones of Lushan and Wenchuan located in the south west and middle north of Longmenshan fault zone, respectively. Although only 1 earthquake magnitude differed between them, the disaster area, and the number of affected population, deaths, disappearances, injured, severe injured and migration population in Wenchuan earthquake were 40, 23, 353, 853, 27, 14 and 51 times higher than those in Lushan earthquake, respectively. b) Learned from Wenchuan experience, the manpower scheduling in Lushan earthquake was quicker: the assembled medical personnel peak of Lushan vs. Wenchuan was 87.62% vs. 56.06 % in golden 72 hours post-quake. c) Supplies scheduling was more rational: the utilization rate was higher under the guidance of accurate information of demand. d) Medical treatment was more rational and efficient: the critical injured were treated following “Four concentration treatment principles”; saving life and restoring function at the same time; treatment and physical-mental rehabilitation at the same time; treatment and evidence production and implementation at the same time. e) Medical institutions and service returned to normal in time: 96.7% (440/455) of government owned township medical institutions in 21 affected towns returned to normal and provided medical services at their original sites. Conclusion By learning form Wenchuan experience, the following performance is implemented in Lushan earthquake: medical rescue guided by the accurate information; supplies scheduling guided by the accurate demand; both critical injured treatment,and physical-mental rehabilitation guided by the accurate assessment of injuries. So the medical rescue within 1 month after Lushan earthquake is quicker, more rational and efficient. After 20 days post quake zero death of critical injured was achieved. The early physical-mental rehabilitation fastens the functional reconstruction of the injured and helps them return to the society. So it suggests that the Lushan EMR enriches and develops the reference value of EMR experience of Wenchuan earthquake.
Objective To compare the medical emergency rescue systems used during earthquakes in America, Japan, Russia and China; so as to provide reference material for the establishment and improvement of such a system in China. Methods We searched the official websites of China, America, Japan and Russia, WHO.int, CNKI, OVID, The Cochrane Library and other authoritative sources to collect information involving the medical emergency rescue systems used during earthquakes. The mechanism, legal management, preventive measures and performance of each country’s medical emergency rescue system were summarized and compared. Results Crisis management, integrated action and legal support were highly emphasized in America, Japan and Russia. America and Japan have performed well in implementing routine preventive measures. The organizational structure of the medical emergency rescue system in China was similar to that of the other countries, but its performance was not satisfactory due to insufficient financial support, poor management, inefficient operational mechanism and poor preventive measures. Conclusion There is an urgent need for China to reinforce its medical emergency rescue system. Different models should be taken into account because of the different regional situations in China.