摘要
目的 调查我军野战医疗所手术组伤员流饱和冲击的应对现状,为制定伤员流转方案提供参考。方法 采用便利抽样法,于2023-07-01~30日抽调12个城市15所军队医院,按照纳入、排除标准,选取野战医疗队人员作为研究对象。通过文献审阅、卫勤资料查阅、多轮专家磋商及预调查验证,制订了本调查问卷,包括人员及物资设备等配置现状、围手术期伤员流转现状及阻力(术前准备、术中衔接、术后转运)、流转效率宏观问题等3个维度23个条目。结果 本研究共纳入来自12个城市15所医院的155名野战医疗队人员(医护人员、保障人员)进行问卷调查,问卷有效回收率100%。手术组人员及物资设备等配置现状方面,75名野战医疗队人员认为手术组医护最佳配比为1∶2,手术物资不能满足需求的最主要原因是人员不足(30.97%)。围手术期伤员流转现状及阻力方面,术前准备时,仍有9.03%的野战医疗队人员认为重伤员在准备帐篷需要等待20~30 min,手术物资不能满足需求的最主要原因是手术台流转不畅(45.81%)和伤员处置时人员不足(67.10%);术中衔接时,造成伤员术中流转障碍及影响连台手术正常衔接的最主要原因分别是中心静脉穿刺或气管插管困难(50.97%)和转运伤员延迟(45.16%),手术组护理人员存在的主要问题是伤员交接时间过长(51.61%);术后转运中,缩短术后转运时间的关键环节中转运人员配置(71.61%)占比最高,术后转运合理的方式是前接与后转相结合(67.10%)。伤员流转效率宏观问题现状方面,影响伤员流转最主要的问题是与其他组室间伤病员流动策略不明确、交接不到位(67.74%),手术组面对伤员流饱和冲击时的关键核心技术主要是人员动态定位(78.71%)。结论 野战医疗所手术组应对伤员流饱和冲击时伤员流转存在多层障碍,建议优化人力、物力配备,解决围手术期伤员流转的主要痛点与堵点,提高团队协作能力,明确伤员流转策略和人员动态定位,缓解手术伤员积压留滞,高效完成医疗保障任务;同时为今后野战医疗所手术组护理人员作业提供理论支撑。
Objective To investigate the coping status of casualty flow saturation impact of surgical teams in field medical stations,so as to provide reference for developing casualty transfer plans.Methods A total of 15 military hospi-tals from 12 cities were selected using convenience sampling method from July 1 to 30,2023,and personnel of field medi-cal stations were chosen as research subjects in accordance with the inclusion and exclusion criteria.The questionnaire was developed through literature review,medical data consulting,multiple rounds of expert consultation and pre-survey verifi-cation,and 23 items in 3 dimensions,including the current allocation of personnel,materials and equipment,the current situation and resistance of perioperative transfer of wounded(preoperative preparation,intraoperative connection,postop-erative transfer),and macro problems of transfer efficiency.Results A total of 155 personnel from field medical station(medical personnel and support personnel)from 15 hospitals in 12 cities were included in this study,and the effective re-covery rate of the questionnaire was 100%.In terms of the current allocation of personnel,materials and equipment in the surgical teams,75 field medical team personnel believed that the best ratio of doctors to nurses in the surgical teams was 1∶2,and the main reason for the lack of surgical materials was insufficient personnel(30.97%).In terms of the current situation and resistance of perioperative wounded transfer,during preoperative preparation,9.03%of the field medical team members still believed that it was nec-essary to wait 20-30 min for the severely wounded to prepare the tent.The main reasons for surgical materials not meeting the needs were poor circulation of the operat-ing table(45.81%)and insufficient personnel in the treatment of the wounded(67.10%);during the intraoperative con-nection,difficulties in central venipuncture or tracheal intubation(50.97%)and delay in transferring wounds(45.16%)were the main reasons for intraoperative circulation obstacles and affecting the normal connection of consecutive opera-tions,the main problem of nursing staff in the surgical teams was too long time of transferring wounded(51.61%);dur-ing postoperative transfer,the key link to shorten the postoperative transport time was the allocation of transport person-nel(71.61%),and the reasonable way of postoperative transport was the combination of anterior transfer and posterior transfer(67.10%).In terms of the macro problems of the transfer efficiency of the wounded,the main problems affect-ing the transfer of the wounded were the unclear strategy of the transfer of the wounded to other departments and the in-adequate handovers(67.74%),the core technology of the surgical teams when facing the saturation impact of the woun-ded flow was mainly the dynamic positioning of the wounded(78.71%).Conclusion There are multiple layers of obsta-cles in the circulation of the wounded when the flow of the wounded is saturated,it is suggested to optimize the allocation of human,materials and equipment resources,solve the main pain points and blocking points of the perioperative circula-tion of the wounded,improve the teamwork ability,clarify the strategy of the circulation of the wounded and the dynamic positioning of the personnel,alleviate the backlog of the surgical wounded and complete the task of medical security effi-ciently;at the same time,it provides theoretical support for the operation of nursing staff in the surgical teams of the field medical institute in the future.
作者
鲁虹言
邱晨
王淑君
李倩
杨林娜
滕英杰
赵佳义
刘佳佳
LU Hongyan;QIU Chen;WANG Shujun;LI Qian;YANG Linna;TENG Yingjie;ZHAO Jiayi;LIU Jiajia(Department of Burns and Plastic Surgery,the Fourth Medical Center of the General Hospital of the People's Liberation Army,Beijing 100048,China)
出处
《联勤军事医学》
2025年第9期820-825,共6页
Military Medicine of Joint Logistics
关键词
野战医疗所
手术组
伤员流转
饱和冲击
卫生勤务
Field medical station
Surgical team
Casualty transfer
Saturation impact
Medical logistics
