Research On Emergency Medical Rescue System In China Based On The Theory Of Seamless Government

[Purpose]This study aims to analysis the current status of emergency medical rescue in China, and learn from foreign experience in emergency medical rescue system through seamless government theory to improve our emergency medical rescue system and eliminate external "gap" in order to make it more "smooth","coherent" and "flexible", to further improve the functions, optimize processes, integrate mechanism. The final establishment of a high-quality, efficient and adaptable emergency medical rescue system, balancing both quality and efficiency, will satisfy the needs of emergency medical rescue work to the greatest extent.[Methods](A) Systematic review and comparative analysis method:the seamless government theory was refined and summarized by the systematic review and comparative analysis method, of which the applicability was analyzed in the field of emergency medical rescue. And the core elements for the establishment of "seamless" emergency medical rescue system were proposed by the theory mentioned. The priority of the core elements of the "seamless" system of emergency medical rescue was determined by multiple input superiority chart method. The features extracted from overseas emergency medical rescue system "seamless" core content were summarized through literature research and systems analysis, combing the United States, Japan, Germany, Russia and other developed countries. Learn from medical hazard vulnerability analysis of Kaiser model to construct the emergency medical rescue vulnerability analysis model.(B) Investigation and statistical methods:Collecting data nationwide of4960hospitals undertaking emergency medical rescue missions in emergency medical rescue capabilities via surveys. In addition, a typical survey focusing on provincial and municipal hospitals undertaking the national major commitment for emergency medical rescue mission, and data from386medical institutions in emergency medical rescue core competencies feature was finally collected. Systematic review was processed by descriptive methods, combined with the interviews of relevant administrative officials, medical workers, experts and scholar, the current running situation of emergency medical rescue organization was comprehensively summarized from the two aspects of work organization system and operation system. On the basis of data analysis and systematic reviews as well as combination of seamless government theory, the emergency medical rescue work in the "gap point" was proposed and analyzed.(C) Expert consultation ran throughout this study.[Results](A) The characteristics of seamless government theory and emergency medical rescue work suit for each other, which can be used to analyze and guide the emergency medical rescue.(B)"Seamless" emergency medical response system, including institutional "building seamless","institutional functions seamless" and11"seamless" core elements, including the two most important elements of the "logistical support seamless" and "institutional capacity seamless."(C) The "seamless" core content of emergency medical rescue system in developed countries:Setting coordinated emergency medical rescue agencies; possessing multiple medical rescue forces and special medical care institutions; owning advanced emergency medical rescue equipment completely and fully equipped; establishing emergency medical rescue rapid response system to emergent events, and timely, fast, smooth information system; sufficient rescuing team with clear responsibilities as well as professional staff with high-quality.(D) At present, there are still big gaps in Chinese emergency medical rescue system including:1. Organization:There are11.6%of medical institutions have not set up health emergency leading group,9.8%of the medical institutions have not set up an emergency medical rescue team yet.2. Functions:Fragmentation still exists between different agencies and departments in emergency medicine; different sectors of health care systems are lack of unified coordination and rescue forces, the rescue work is not continuous; we don’t have a specific law and regulations for emergency medical rescue system.3. Capacity:11.3%of the medical institution in the country don’t have emergency beds; the number of beds in tertiary hospital and the eastern region hospital which can be used for emergency medical rescue is still relatively low, were3.77%and4.86%; each medical institutions only have3.2ordinary cars ambulance and0.2units negative ambulance; the number of burn suspended bed and burn turning bed for the country is very low;16.0%of the municipal medical institutions and28.3%of the medical institutions at the provincial level can not amplify beds,17.4%of the medical institutions have amplified bed conditions but without amplification scheme.4. Management:there are1.6%of medical institutions have not yet developed an emergency medical rescue plans and work programs;22.3%of the medical institutions do not vacated bed systems and processes; nearly10percent of medical institutions have not been held for a year each type medical rescue drill, drill held medical institutions the proportion of the year and only8.1%across sectors.5. Personnel duties:in emergency medical rescue work, there are lack of scientific decision-making.6. The technical staff skills:the number of senior medical staff in emergency medical rescue team is9.9in average. The proportion of emergency medical rescue team in senior medical staff is only26.1%.7. Professional internal satisfaction with:Only22.2%of the national health care institutions purchase personal accident insurance for staff who participate in the emergency medical rescue work;32.6%of medical institutions paid the staff high-risk allowance who participate in an emergency medical rescue. 8. Rescue Process:the process of emergency medical rescue is not clear, long command, complicated procedures and so on.9. Information:at present the transmission of emergency medical rescue information is timelines.10. Logistical support:There are18.1%of medical institutions did not set a secondary triage sites;10.9%of the medical institutions have no material reserves, there are37.2%of medical institutions have stockpiles without repackaging and distribution capacity; there is5.4%medical institutions don’t have emergency medical rescue training venue; only13.0%of medical institutions have tarmac,60.1%of medical institutions teleconsultation capacity.11. Operation management system:emergency medical rescue resource were distributed seriously unbalanced.[Conclusions]At present, emergency emergency medical rescue work primarily in "the internal mechanism of the medical emergency medical rescue organizations, lack of coordination institution-building";"the lack of emergency medical rescue team building" and20"gap " seriously hampered China emergencies to carry out emergency medical rescue work.The goal of emergency medical rescue in China is to establish a convenient, smooth, high effective and quality medical rescue service system, which could provide continuous medical care service to maximize the recovery of the physical and mental abilities of the injuries and minimize the health impacts related to the emergency events after the occurrences of emergency.Emergency medical rescue vulnerability analysis model including three dimensions and seven secondary dimensions, covering natural disasters, accidents and other six categories of28risk factors, by four grades can be determined in medical institutions of emergency medical rescue work in the different risk factors of vulnerability.In the process of improvement and development of China’s emergency medical rescue system should be by strengthening the emergency medical rescue main body construction, strengthen the participation of emergency medical rescue personnel capacity building and promoting emergency medical rescue mechanism standardized operation three aspects, the implementation of11specific initiatives to bridge the gap, and built the "seamless" emergency medical rescue system.[Innovation and Limitation]The main innovation of this study:(A) This is the first time to survey the national second and third class hospitals undertaking emergency medical rescue missions. Finally, the data from4960medical institutions nationwide were collected, which could be used to know the current situation of emergency medical rescue capability comprehensively and systematically.(B) This is the first time for the application of "seamless government theory" in the field of domestic emergency medical rescue as well as medical service system construction. The core elements of "seamless" emergency medical rescue system is firstly proposed and used for the analyzing the "gap point" of emergency medical rescue in China and "seamless" core contents of emergency medical rescue system in developed countries.(C) Propose emergency medical rescue vulnerability analysis model, medical institutions can use the model to identify the vulnerability of emergency medical rescue work under different risk factors.Limitations of this study:There is still a lack of specific, complete and operable evaluation system for emergency medical care system. The study conclusions still need to be tested further in theory and practice.