Danger Close: What Opioid Prescribers Can Learn from the Way the Air Force Drops a Bomb.
Danger Close: What Opioid Prescribers Can Learn from the Way the Air Force Drops a Bomb.
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危险临近：阿片类药物处方者可以从空军投掷炸弹的方式中学到什么。
DOI：
10.1007/s11420-018-09667-7
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Rich,Alex
中科院分区：
文献类型：
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作者：
Rich,Alex
向医生解释她开的药丸与战斗机飞行员从军用飞机上投下的炸弹有何相似之处并不容易。炸弹的设计目的与医生的誓言相反。尽管如此，在我的两个职业生涯中——首先是空军飞行员和飞行安全官，现在是健康信息学研究员——我对这些相似之处感到震惊。我相信阿片类药物危机将持续下去，直到有系统到位，为处方者提供与战斗航空领域相同水平的阿片类药物处方反馈、态势感知和问责制。我们可以构建这些系统。我们有责任这样做。空军所谓的近距离空中支援 (CAS) 业务通常可以归结为类似于“首先不要伤害……友军”的概念。^ 在 CAS 中，飞行员从事危险操作并使用潜在危险的工具，以最大程度地减少对他们有责任监视的人员的威胁。他们的工作受到经验得出的参考点的指导，这些参考点帮助他们在将弹药靠近友军地面部队以保护他们时管理风险。为疼痛患者开阿片类药物在精神上并没有什么不同，尽管我们作为一个国家缺乏与 CAS 飞行员的精确度相当的结构和反馈。很少有处方者知道他们何时过量服用阿片类药物。很少有人知道多余的药片被转移到哪里以及谁可能会受到它们的伤害。事实上，最近的一项研究显示，骨科手术患者的阿片类药物处方存在巨大差异，61% 的病例中未使用阿片类药物 [17]。一个完美的世界不需要炸弹或阿片类药物。我们生活的世界是不完美的；我们用有时必要的工具来面对它的缺陷，这些工具有可能造成毁灭性的破坏，需要最高程度的谨慎和警惕。一百多年来，战斗航空业已经制定了一些程序，旨在防止友军火力造成的悲剧性影响，即为了保护而投掷弹药，最终导致战友死亡的事件。面对阿片类药物危机，我们不能忽视战场上或其他地方的经验教训。
It is not easy to explain to a physician how a pill she prescribes may be similar to a bomb a fighter pilot drops from a military jet. Bombs are designed for purposes that are antithetical to the oaths physicians take. Still, in my two careers—first as Air Force pilot and flight safety officer, now as health informatics researcher—I have been struck by the parallels. I believe the opioid crisis will continue until there are systems in place to provide prescribers with the same levels of feedback, situational awareness, and accountability in opioid prescribing that exist in the world of combat aviation. We can build those systems. It is our duty to do so. The business of what the Air Force calls Close Air Support (CAS) often comes down to a concept akin to BFirst do no harm… to friendly troops.^ In CAS, pilots engage in risky operations and use potentially dangerous tools in order to minimize the threat to those they have a duty to watch over. Their work is governed by empirically derived reference points that help them manage risk when they put munitions close to friendly ground troops in order to protect them. Prescribing an opioid to a patient in pain is not all that different in spirit, though we as a nation lack much of the structure and feedback required to parallel a CAS pilot’s precision. Few if any prescribers know when they have overprescribed opioids. Few if any know where extra pills are diverted to and who might be harmed by them. In fact, a recent study shows massive variations in opioid prescribing to orthopedic surgery patients, with unused opioids in 61% of cases [17]. A perfect world would have no need for bombs or opioids. The world we live in is imperfect; we face its imperfections with tools that are sometimes necessary, that have the potential to cause devastating damage, and that demand the highest levels of caution and vigilance. Combat aviation has developed procedures over more than a hundred years that are designed to prevent the tragic impact of Bfriendly fire,^ incidents in which a munition dropped with the intent to protect ultimately results in the death of a comrade. In facing the opioid crisis, we cannot afford to ignore lessons learned on the battlefield—or anywhere else.