Vertical Evacuation Simulation of Critically Ill Patients in a Hospital
Vertical Evacuation Simulation of Critically Ill Patients in a Hospital
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医院危重病人垂直疏散模拟
DOI：
10.1017/s1049023x00002600
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发表时间：
2005
影响因子：
2.2
通讯作者：
Stuart Etengoff
中科院分区：
文献类型：
--
作者：
Jon R Gildea;Stuart Etengoff
摘要导言：世界上新的社会环境决定了灾难发生时需要做好准备。备灾领域的一个警告是医院病人的垂直疏散。几乎没有关于患者疏散的数据，如果没有做好准备，后果可能是毁灭性的。因此，如果将危重病人的垂直后送强加给社区医院，急救服务和辅助人员的反应在很大程度上是未知的。方法：在医院应急管理委员会的指导下，由当地消防员、在职护理人员、住院医生和辅助人员从新建和空置的重症监护病房4楼对12名模拟危重病人进行垂直疏散。随机挑选的四组消防员，两组由三名人员组成，两组由四名人员组成，在上升到四楼抢救一名患者之前和随后的每一次体面上，都对生命体征进行了计时和评估。每支队伍都穿着全套道具，救出了三名病人。每个模拟患者都被制成了模拟气管插管、静脉导管、监护仪，四名患者中有三名安装了Pleurovac®。分析生命体征是否有因训练过程中的劳累和/或压力引起的显著变化或模式。演习结束后，向所有参与者分发了评价。结果：除心率外，每组成员的生命体征平均值从基线到完成都有微小的增加。四个成员组的收缩压均有下降。消防员的主观评估表明，他们的体力只有“极小”的增加。平均提取时间为14.7min。完成了患者的转移和疏散，对患者或工作人员无并发症。只有一名消防员要求更换。完成的评估表明，在组织、承诺、安全和护理方面的表现高于平均水平或突出表现。评论包括关于运输过程中的设备管理、更好的沟通、楼梯间宽度、为插管患者进行呼吸困难、疏散时间的改善以及随着演习的进行而组织的声明；三个成员小组在空间上的工作好于四个小组。结论：这次演习反映了消防员、护士和辅助人员在身体和组织上的令人印象深刻的准备水平。如果需要对危重病人进行垂直疏散，四名消防员救援队以及随行的护士和呼吸治疗师将能够以每层3.75分钟的速度疏散一名患者。
Abstract Introduction: The world's new social environment dictates the need for preparedness should a disaster occur. One caveat in the realm of disaster preparedness is the vertical evacuation of hospital patients. Little data regarding the evacuation of patients are available, and the consequences of not being prepared could be devastating. Therefore, if the vertical evacuation of critically ill patients was thrust upon a community hospital, the response of emergency services and ancillary staff is largely unknown. Methods: The vertical evacuation of 12 simulated critically ill patients from the fourth floor of a newly constructed and vacant critical care unit was undertaken by local fire fighters, on-staff nursing, residents, and ancillary staff, all under the direction of the hospital Emergency Management Committee. Four randomly selected groups of firefighters, two teams consisting of three personnel and two teams of four personnel, were timed and had vital signs assessed prior to ascending to the fourth floor to retrieve a patient and upon each subsequent decent. Each team, dressed in full turnout gear, retrieved three patients. Each simulated patient was fashioned with mock endotracheal tube, intravenous lines, monitor, and a Pleurovac® was attached in three of the four patients. Vital signs were analyzed for significant changes or patterns due to exertion and or stress during the drill. Evaluations were distributed to all participants upon completion of the drill. Results: Mean values for the vital signs of the members of each team showed minimal increases from baseline to completion with the exception of heart rate. A decrease in systolic blood pressure was present in both of the four member teams. Subjective evaluation by the firefighters, indicated a “minimal” increase in exertion. Mean extraction time was 14.7 minutes. Patient transfer and evacuation was completed without complication to the patients or staff. Only one firefighter requested a replacement. Completed evaluations indicated above average or outstanding performance on organization, commitment, security, and care. Comments included statements regarding equipment management during transport, better communication, stairwell width, difficulty with ventilating intubated patients, improvement of evacuation time, and organization as drill progressed; three member teams, spatially, worked better than four. Conclusion: This drill reflected an impressive level of preparedness by firefighters, nurses, and ancillary staff both physically and organizationally. Should a vertical evacuation of critically ill patients be necessary, a four firefighter extraction team and accompanying nurse and respiratory therapist would be able to evacuate one patient at a rate of 3.75 minutes per floor.