There isparticularly important role in emergency medical response when disaster strikes.But so far, there was no unified model, RRVMD by the military zone hospitalswas difficult.. Status
Trang 1In recent years, the disaster situation has changed complicatedly, containingmany uncertain factors The fact that disasters occurs without warning, occurs verysuddenly increased the number of victims should be cured, transportation .always exceeds the capacity of the health sector response To restrict to aminimum the loss of life and material caused by the disaster, the need forcoordinated action of many forces, media synchronization, in which modern healthsector had an important role The military zone hospital (MZH) was a generalhospital had specialist (type B), located on the strategic areas of the country,performing tasks of treatment for soldiers and people in the area There isparticularly important role in emergency medical response when disaster strikes.But so far, there was no unified model, RRVMD by the military zone hospitalswas difficult Therefore, we conducted this research subject to the followingobjectives:
1 Status of receiving, rescue victims of mass disasters from military zone hospitals in the period of 2007-2012.
2 Modeling, deployment experimental exercises and evaluate results of model organization RRVMD in Hospital 4, Military Zone 4, in 2012-2013.
* New contributions on the practical science of the thesis:
- Has been described real operating condition, capacity of RRVMD ofmilitary zone hospitals (MZH): There was adequate staffing organization bydecision; There are facilities, fully equipped, convenient infrastructure forRRMVD; Have established the Steering Committee, annually implemented planRRMVD; In 6 years (2007-2012) the hospital had 1-2 times receiving, rescue massvictims; Capable of sorting from 50-100 victims/hour, receiving treatment from30-60 victims/hour, maximum deployment 4-10 surgical teams, often held 5-6mobile health groups available assignment of a task; Ability to rescue specialistearly for the victims of disaster and responsive, effective for the second disaster
- Has been developed and successfully tested model RRMVD of MZH:Depending on the size, characteristics and extent of each type of disaster can beimplemented in one of two solutions:
+ Option 1: deployment of mobile military medical team to the field;Organization the clinical patients in order to be ready to rescue victims
Trang 2+ Option 2: deployment of mobile military medical team to the field;establishment of field hospitals; Forces remaining on duty regularly.
+ After 2 rehearsals empirical model was considered reasonable, realistic,feasible high 90.9% - 92.9% of experts rated on organization, staffing, use offorce in 2 alternatives was reasonable 100% expert opinion evaluation with themodel was built, MZH capable of completing tasks in similar situations
The layout of the thesis: The thesis consists of 132 pages include:
Background 2 pages; Chapter 1-Overview: 34 pages; Chapter 2- Objects andresearch methods: 21 pages; Chapter 3-Results: 41 pages; Chapter 4-Discussion:
31 pages; Conclusion: 2 pages; Recommendations: 1; 44 tables; 11 schemes; 2appendix ; 136 references (79 Vietnamese, 51 English, 6 Russian documents)
Chapter 1 OVERVIEW 1.1 Situation disaster, losses from disasters around the world and in Vietnam
1.1.1 The concept of disaster
According to the World Health Organization: "The disaster is the phenomenon caused the damage, the economic upside, the loss of life, human health, damage to health facilities with a large extent, requires the mobilization of relief especially from outside to the disaster area "
According to the Ministry Health and National Defense "Disaster is the risk
or unexpected event occurs, causing great loss of life and material."
1.1.2 Classification disaster
- According causes: natural disasters, human disasters
- As the number of victims: from 3-4 degree
- As request of medical interventions: immediate loss, lasting consequences
- In time of disaster: long, short, acute, chronic
- Geographically, regions, geography, population
1.1.3 Disaster situation in the world and Vietnam
1.1.3.1 Disaster situation in the world
Catastrophic events in the world were coming complicated and growingrapidly In 10 years (2002-2011), there are 3.942 worldwide natural disasters,including floods accounted for 1.793 cases, whirlwind accounted for 1.022
Trang 3cases The disaster caused by people common as: fire, terrorism, war, industrialaccidents, traffic accidents In 10 years (2002-2011), there were 2.622 disasterscaused by humans, killing 82.609 people and affected up to 152.900 people life,loss of 38.112 million dollars.
1.1.3.2 Disaster situation in Vietnam
From 2003 - 2012, there were 103 big natural disasters killed 7.748 peopleand 6.740 people injured, the loss of material wealth estimated thousand billions
In Vietnam disaster caused by humans was diverse, complex and increasinglymore serious Many disasters cause huge losses of life and materials, only trafficaccidents in 10 years (2003-2012) had 36.409 cases occurred, killing 9849 peopleand 38.064 people injured
1.2 The work of emergency medical response to disasters
- In the world: the system for emergency medical response in disasters wasorganized to two trends: There were separated organizations outside the healthsystem or in health system sector
- In Vietnam: based on the medical establishment to civilian and militaryorganize searching, rescue, treatment victims due to the line of treatment system
1.3 Model of receiving, rescue victims of mass disasters in hospital
1.3.1 Situation of ability RRMVD in hospital
Hospitals can deploy RRMVD, depending on the severity of the disaster aswell as the number and structure of victim injury However, hospitals have nostandard and full model for deployment RRMVD effective and systematic
1.3.2 RRMVD model of some hospitals through rehearsal
- Rehearsal BV-06 of Hospital103: Hospital 103 in collaboration with the
forces of the military unit organization and onsite RR practice for 300 victims ofthe fire disaster in the industrial area of Ha Dong District Forces have been used
as follows: At the field using 3 surgical teams performing total rescue task withemergency, sorting victims; Established receiver and additional emergency;Organizations RRV in the clinical
- Rehearsal CN-10 at BV4/QK4: From forces and tools available of a hospital,
in coordination with other forces in the area, RR for 170 victims of the collapsedmulti-storey buildings under construction in Vinh city Organizations were
Trang 4implemented as follows: One military medical force at the field; At the hospitaldetached a force to be arranged independently of the hospital campus with RRV duty.
- Rehearsal BV-05 at Hospital175: Hospital in collaboration with the
Ministry of Defense forces organization RR for about 450 victims of fire disastercaused by tall buildings, including victims of poisoning Hospital organizationsdeploy: Area receiving, sorting; emergency zone and shock management; victims
of severe treatment areas; Face identification and preservation of the body
Chapter 2 SUBJECTS AND METHODS 2.1 Subjects, materials, time and location of study
2.1.1 Research Subjects
- Research subjects situation: the MZH (infrastructure, equipment, staffingorganizations, professional activities )
- Subjects intervention: military zone hospitals participation in RRVMD
- Leadership, command hospital head of some department of the militaryzone hospital directly related to the work RRVM in disaster
- Officers and staff of the Hospital 4 - Military Zone 4 in the exerciseRRMV experimental
- Specialist in medical, military medicine, military, political, logistical andtechnical, local rescue Steering committee
Trang 52.1.5 Research time
- Phase 1, describes the current status surveys: from 07 2011-06/2012
- Phase 2, experimental exercises: from 7/2012 - 12/2013
2.2 Methodology
2.2.1 Study Design
Research describes across, the retrospective study combined quantitativeand qualitative research and intervention by experimental maneuvers
2.2.2 Sample sizes and sampling studies
2.2.2.1 Sample sizes and sampling baseline study
- All 7 military zone hospitals of the army
- 84 leaders, commander of the military zone hospitals
- 50 experts in: medicine, military medicine, military, logistics
2.2.2.2 Sample sizes and sampling intervention studies
- Intervention model: choose intentionally Hospital 4 - Military Zone 4
- The entire staff of 110 employees in H4/MZ4
- 61 turns of experts selected for interviews, opinions (1st rehearsal: 33experts, 2nd rehearsal: 28 experts)
2.2.3 The scope, content and index research
2.2.3.1 The scope, content and status research index
- Task and organize forces, number of beds
- Facilities and equipment of hospital
- The situation properly and heal in 6 years (2007-2012)
- Construction work plans and activities to meet the emergency medical
- Ability to organize and implement a RRVMD
2.2.3.2 The scope, content and intervention research index
- Content RRVMD model in military zone hospitals: discipline of the model;Depending on the characteristics of the disaster can be implemented in one of twoalternatives
- The results of the last two experimental rehearsals: Preparation; Resultsdeployment model; Opinion, evaluation of expert
2.2.4 Methods and tools to gather information
* Methods, tools for data collection in a status research
Trang 6- Research Methods: Secondary data analysis; Observations described;Direct interviews; Professional method.
- Research tools: form number 1, form number 2, form number 3
* Method and tools of assessment intervention results
- Method: Empirical exercises with 2 plans
+ Option 1: the type of disaster occurs near the hospital or in the hospital
may receive direct victims
+ Option 2: major disaster, away from the hospital, casualties, difficult
transportation conditions
- Assessment tool: form number 4 and form number 5
2.3 Errors and remedies
- Form design research to ensure adequate information, unified
- Conduct a pre-test, complete toolkit
- Choose enumerators, supervisors are experienced staff
- Organization of adequate training and close supervision
2.4 Methods of analysis and data processing
- Clean form before accessing computer
- Data processing using Excel 2007 software, SPSS 13.0
2.5 Research organization
- Investigate, analysis the situation in 7 hospitals under the form
- Organizing two rehearsals corresponding to 2 plans were built
2.6 Limitation of the thesis
- No research on: equipment, drugs, facilities, materials
- No evaluation of the ability of each forces participating in a specific way
- Not given model for each type of disaster
- No deep research on the treatment, ensure logistics
2.7 Ethical aspects of research
- The study subjects entirely voluntary
- The information only used for research purposes and to ensure security
Trang 7Chapter 3 RESEARCH RESULTS 3.1 Current status and operational capacity of RRVMD of MZH
3.1.1 The task, organization forces.
- Hospitals type B, general hospitals with specialist; With a payroll of 270employees, was organized into six departments, 7surgical, 7 Internal Departmentsand 6 Para clinical Departments
- MZH had 7 tasks, including: "Ready combat, combat service and meetemergency medical situations such as natural disasters, catastrophes"
3.1.2 The number of employees(E) and number of beds(B)
- The MZHs were staffed from 200-250 beds, actual deployment from
250-574 B Served ratio is lower than specified, ranging from 0,69 to 1,30 E/B
- Only from 2,0% -18,0% of the doctors in general level, the rest have beentrained specialist Pharmacists have university degrees from 18.0%-38.0% Nurseshave an intermediate level between 84.0% - 97.0% Technicians had intermediatelevel from 64.0% to 100%
3.1.3 Status of physical facilities and equipment of the hospital research
Table 3.4: The infrastructure of the hospital in research
- Each hospital had from 3-7 operating rooms, when emergency medicalresponse can deploy more from 2-4 operating rooms Each hospital can deploymore from 50 – 150 B enough to properly cure the disaster 1 to level 2
Trang 8- The research hospitals were equipped with basically for examination,diagnosis and treatment of patients, but the number was small, some just a singletype should not be a transfer available on mobile military medical team.
- All research hospitals had mobile equipment and materials as artificialrespiration apparatus, anesthetic machine, operating tables, mobile X-ray all type
of cars to transport patients but not enough quantity to meet if disaster happened
- All hospitals were not equipped with the tools of preventing biologicalweapons, chemical, nuclear, such as sanitation treatment systems, test facilitiesand tools of personal protection, respirator protection, DDA car
3.1.4 The situation of receiving and rescue of hospitals in 6 years (2007-2012)
- Number of hospital surgery was not the same, the difference between thehospitals quite large (2043-7981 cases per year) Individual hospitals haverelatively stable, the next year always higher
- The targets were exceeded professional regulations: bed utilization ratereached 116.9% - 184.0%; The rate of illness from 68.2% - 82.8%; The number ofexamination/day highest from 190-1471 people/day; The number ofemergency/day highest from 14-140 people/day
3.1.5 Current status of the organization and the ability to deploy properly and heal victims of the mass Hospital Research
Table 3:13: The receiving ready, rescue victims of mass in research hospitals
- Executive Steering Committee
RRVMD
All research hospitals had decision onestablished the Steering Committee
- Plan to mobilize forces, facilities,
supplies and medical equipment in
RRVMD
All hospitals had annual research plan onRRVMD, mainly respond to floods, fires andexplosions, traffic accident
- Times of RRVM from 2007 to
- The highest number of victims
was received and rescued at a time 20 25 30 32 26 17 45
Trang 9The hospitals had executive board on emergency medical response todisasters by the Director as its head; were planed, organized force ready to respond
to an emergency medical condition but mainly in response to floods, fire, trafficaccidents including content reserve facilities equipment, and medical supplies
The statistics in 2007 - 2012 showed that 100% of patients had at least oneRRVMD time with highest number of victims from 17-45 victims
Table 3:18: Ability to organize RRVM of research hospitals
Hospital
Victims sort/hour (people)
Operation (cases)
Motivated surgical team (team)
Victims RR/hour(peopl
- 56.5% - 66.7% opinions of experts and staff that MZH only meet a partmission of RRVMD, due to the lack of planning (53.6% - 57.5%); No RRVMDmodel (65.0% - 71.4%); lack of practical training RRVMD (67.5% - 81.0%)
- Only 29.8% - 32.7% suggested that the practical ability of medical staffhad good capability in rescue emergency victims of disaster
3.2 Building RRVMD model in MZH
3.2.1 Basic on model building
- Functions and tasks of military zone hospitals
- The need for rescue victims
- The system of legal documents related to the work TDCCNN
- Reality RRVMD ability of the hospitals
Trang 103.2.2 Content of RRVMD model in MZH
* Principles RRVMD at military zone hospitals
"Use the force, available tools of hospital implemented emergency RR properly and timely the basic wounds of the victim Ready assist and come to emergency disaster place Simultaneously, ensure regular tasks of the hospital "
Table 3:22: Comments of the research objects on model and principles RRVMD
Assessment content Commanders(n = 84) Experts (n = 50)
Quantity Rate (%) Quantity Rate (%)
1 The need to build the model:
96.4% of leaders, commanders of the research hospital and 100% of theexperts believe that the RRVMD principle was reasonable, only 3.6% ofrespondents need additional contributions to be fully taking advantage of theMZH: there are professional and technical staff experienced in handling medicalconditions, surgical field, high mobility, equipment diversity, richness andadvanced modern science can treat most basic and specialist help RRVMD timelyand limited mortality disabled
* Content model: Depending on the specific situation, organizations can deploy
RRVMD model as the following options:
Trang 11Area field
Chart 3.2: Diagram deployed forces in place disaster
+ At the disaster site (at the field: hold a mobility medical teams (MMT)
capable of first treatment that the core is basic treatment surgical team(BTST)enhanced sort and deliver group, maneuver quickly to the disaster field, parts wasorganizing according to diagram 3.2
+ At the hospital:
If number of victims was moderate, not continuous, can use examinationpart to receive and sorting, emergency (if any), write patient records and put thevictim in the clinical with professional treatment
First aid areaCommander
board
Death bodyplaceNơi để tử thi
Delivery mild victims
moderate victims area
Sorting mild victims
area
Deliver to Hospitals
Trang 12If more number of victims, the hospitals overwhelmed, examination part notguarantee, organizations a team for receiving and sorting (RRT) in examinationground, pitch, garage , emergency management (if any), write patient recordsand victim transported to the clinical treatment.
Simultaneously, the cumulative clinical patients who are undergoingtreatment for stable patients discharged from hospital, surgical patients weretransferred out of time to monitor internal medicine to spend some empty bedsready to receive victims emergency treatment
Chart 3.3: The basic deployment diagram in hospital of option 1
- Option 2: The disaster occurred huge in hospital, casualties, difficult
transportation conditions, not directly transfer the victim to the MZH.Organizations implemented as follows:
+ At the field: Organized MMT to the field to search for victims, emergency
rescue, sorting, delivering victims to the treatment facility MMT that the core isBTST enhanced deliver compact ensure light, mobile and highly specialized
+ At the hospital:
From the hospital's payroll detached a force to deploy HF for disasterresponse, 10-15 km far from the field, go after MMT Number of employeesremaining hospitals do routine tasks, but narrowing the scope of the rescue
Chart 3.4: The basic deployment diagram in hospital under option 2
Hospital field
(HF) forces of hospital The remaining