应急管理医疗拣选:汶川地震的教训

汶川地震的救援工作暴露出在突发事件应急医疗卫生救援中医疗拣选(triage)的不足。虽有一些研究注意到这一重要教训,但更多的研究仅讨论了相关医疗技术问题。医疗拣选作用的发挥更主要地依赖于在突发事件应急管理体系建设中相关管理问题的改进。首先,在不同的突发事件(对应不同的医疗资源稀缺程度)和不同的时间阶段中,应当应用从医疗需要原则到救治率原则等不同的医疗拣选原则。其次,在应急管理体系建设中,应采取改进现有应急预案、应急法制和应急机制等措施,强化实践中医疗拣选不同原则的应用,从而实现医疗拣选的有效实施。其中最重要的改进措施是应急预案中医疗拣选程序的具体化和制定医疗拣选的法定标准。

Triage in Emergency Management:Lessons learned from Wenchuan Earthquake

There were great conflicts between medical demands on the one hand and the capacity of the health service provision in the first week of rescue after the Wenchuan Earthquake occurred on the other.It hence reveals the shortage of the triage in the emergency medical system of China.Some studies have noticed the problem,but most of them have focused on discussing the technology of triage.The present paper argues that the management problems of triage are even more serious.It firstly analyses the principles of triage in different emergency situations,and then discusses how to improve the implementation of triage during emergencies through the system construction in Chinese emergency management institutions.