Former China's medical transfer system has not covered the non-emergency transfer area, and the non-emergency transfer service function is lacking, but in contrast, with the development of China's national economy, the acceleration of the aging population, and the promotion of new medical reform, non-emergency transfer services Demand is increasing and contradictions between supply and demand are gradually emerging. Non-emergency transhipment supplements the original medical transshipment system and has a broad prospect for development. However, the current non-emergency transshipment market is chaotic and lacks effective supervision. It is urgent to explore a set of effective management models. During the exploration process, the classification and rescue system of pre-hospital first aid introduced by some cities abroad was not fully applicable to local conditions, and the non-emergency transport companies operating socially also encountered various difficulties during the development process. This paper investigates and analyzes the current status of non-emergency transit services in Guangzhou, and combines domestic and foreign experience and current difficulties to explore countermeasures for building a non-emergency transit system, with a view to promoting the development of the non-emergency transit industry, increasing the supply of services, and better meeting the needs of ordinary people Increased demand for non-emergency transfers such as discharges and transfers.
“黑救护车”乱象已经成为社会广泛关注的焦点。 With the improvement of people's living standards, the acceleration of the aging of the population, and the advancement of tiered diagnosis and treatment and two-way referrals, the traditional medical transfer system cannot meet the increasingly diversified needs of medical transfers . "Black ambulance" chaos has become a focus of widespread concern in society . Constructing a standardized, safe and convenient non-emergency transfer system is of great significance to meet the needs of people's medical transfer and improve our country's medical transfer system.
1 Status of non-emergency transit services
1.1 Loss of non-emergency transport services
“广州120”）负责，主要承担急危重症和灾害事故患者的现场急救和监护转运、重大活动的医疗保障等院前医疗急救任务，具有公益和基础保障性质，享有政府价格补贴，收费较低，不提供非急救转运服务，也不提供跨省市服务。 Guangzhou's medical transfer task is mainly responsible for the Guangzhou Emergency Medical Command Center (hereinafter referred to as “Guangzhou 120”), which is mainly responsible for on-site first aid and monitoring transfer for patients with critical and critical illnesses and disasters, and medical support for major events such as pre-hospital medical emergency The mission is of a public welfare and basic guarantee nature. It enjoys government price subsidies and low fees. It does not provide non-emergency transfer services or cross-provincial services. The Guangzhou 120 ambulances are all "Mercedes-Benz" brands. The on-board equipment is equipped with first-aid standards, and the cost of vehicle use and maintenance is high. According to the current regulations of medical institutions, first-aid ambulances must be equipped with qualified medical practitioners Emergency doctor , high labor cost. In contrast, on the one hand, a large number of non-emergency transhipment services occupy resources for emergency transshipment and cause waste of resources; on the other hand, there is no car available when non-emergency transhipment is required. When patients need to be transferred to more medically developed areas for further treatment, large hospitals often lack sufficient manpower and resources to transport them to lower-level hospitals, and small hospitals often do not have sufficient transfer conditions. If they do not have medical personnel who can be dispatched, Ambulances, medical equipment, etc.
120急救转运业务的医疗机构[4-5]。 At present, there are only two medical institutions in Guangzhou that legally carry out non- 120 emergency transshipment services [4-5]. This article uses the convenient sampling method to sample 300 patients or family members from 3 top three hospitals in Guangzhou for a questionnaire survey. The survey results show that 73% of the respondents said they did not know or were not clear how to identify a regular ambulance; 91% of the citizens did not listen Said non-emergency transfer services. The formalized non-emergency transfer service is not yet universal. When patients need a car, it is difficult to accurately determine whether the non-emergency transfer service to be used is regular and legal, or even if there is a formal non-emergency transfer service to choose from, so "black ambulances" "It has long occupied the non-emergency transit market.
1.2 Diversified demand for non-emergency transit services
2010年第六次人口普查数据公报显示，我国65岁及以上人口占比8.87%，同2000年第五次全国人口普查相比，比重上升1.91%[6-7]，老龄化进程逐步加快，老龄人口医疗转运需求有所增加。 The data bulletin of the sixth census of China in 2010 showed that China ’s population aged 65 and over accounted for 8.87%, compared with the fifth national census of 2000, the proportion increased by 1.91% [6-7], and the aging process was gradually accelerated The demand for medical transport for the elderly has increased. As the new medical reform puts forward the requirements of tiered diagnosis and two-way referrals, the demand for medical transshipment corresponding to the new medical reform measures has gradually increased. In addition, China ’s traditional culture has the idea of “deciduous to return to the roots”. Many patients who give up treatment or are discharged from hospital or are in the terminal state have a desire to die at home and need an ambulance to escort them home. With the economic development and improvement of living standards, people The requirements of medical standards are also getting higher and higher, but the problem of imbalanced regional development of medical standards is still prominent, and transfers across provinces and cities are common; due to the restrictions of the current medical insurance policy, many foreign patients are hospitalized at the workplace but cannot enjoy medical insurance and need to return. Township medical treatment, non-emergency services are increasingly demanding . On the other hand, transferring patients who are difficult or critically ill can expand the source of disease for hospitals in medically developed areas; transferring patients who are recovering can improve the utilization rate of hospital beds at lower levels and the turnover rate of hospital beds at higher levels. important meaning.
“A机构”），2015年共配备救护车10辆，全年转运达2870车次，转运量与一家普通三甲医院相当；平均转运距离为134.0 km，远大于“广州120”4 km左右的平均转运半径；其中，跨省市长途转运1329车次，占总转运量的46.3%，见表1。 A medical institution specializing in non-emergency transfer in Guangzhou (hereinafter referred to as "A institution") was equipped with 10 ambulances in 2015, with a total of 2870 transfers throughout the year. The transfer volume is equivalent to that of an ordinary top three hospital; the average transfer distance is 134.0 km , Which is much larger than the average transfer radius of about 4 km from “Guangzhou 120” ; among them, 1329 long-distance transfers across provinces and cities accounted for 46.3% of the total transfer volume, as shown in Table 1. The two types of transfers, including rehabilitation and discharge from hospital and returning home for treatment, totaled 979 trips, accounting for 34.1% of the total transfer volume, as shown in Table 2. Among them, the need for long-distance transfers across provinces and cities and non-emergency transfers for the purpose of rehabilitation and discharge from hospitals and returning home for treatment, are difficult to meet with 120 command centers and hospital-owned ambulances.
1.3 Broad non-emergency transfer service market
3家大型三甲医院急诊科2015年救 o车出车量进行统计发现，其中不需现场急救的出车车次占比高达63.6%，见表3。2010年上海市医疗急救中心调研结果显示，如果将急救业务粗分为现场急救、康复和转院，非现场急救业务占30%左右。 The ambulance on-site services are roughly divided into two categories: on-site rescue and non-on-site rescue. The 2015 emergency department of 3 large-scale tertiary hospitals in Guangzhou found that the number of ambulance cars out of the city, including those that do not require on-site first aid. The proportion of train trips is as high as 63.6%, as shown in Table 3. According to the 2010 Shanghai Medical First Aid Center survey results, if the emergency service is roughly divided into on-site emergency, rehabilitation and transfer, off-site emergency services account for about 30% . According to the data released by the Nanjing Emergency Center, about 120,000 emergency trips were made in 2015. Among them, there were more than 60,000 emergency trips including colds, diarrhea, and transfers to hospitals, accounting for nearly 60% of the total number of trips. Limited resources are invaded, and about 10% of critically ill patients call for ambulances in the first place . First-aid resources are heavily crowded by non-emergency needs, and there is a large demand for non-emergency vehicles. There is a realistic basis for implementing medical transfer grading ambulance.
2 Management dilemma of non-emergency transit services
[12-14]。 There are currently two major forms of pre-hospital emergency care systems in the world, referred to as the American and British model and the French-German model [12-14]. More than 20 countries in Europe and the United States have implemented classified rescue. The United States began to apply the Medical Priority Hierarchical Dispatching System (MPDS) in the 1980s [15-16]. At that time, less than 0.3% of cases underestimated emergency situations, and no patients underestimated them. He was hurt by his illness .
2013年起，我国部分城市开始探索分类救治模式。 The pre-hospital emergency rescue ambulance system is still in its infancy in China. Since 2013, some cities in China have begun to explore classified rescue modes . At present, Suzhou, Wuxi, and Yunnan province emergency centers have started using MPDS, but there are many problems: Many months after the MPDS was applied in Yunnan province emergency centers, many citizens were dissatisfied because dispatchers used MPDS to ask questions significantly longer than before. This phenomenon also occurs in Wuxi City; after receiving a call for help, if the dispatcher makes a decision not to dispatch a car based on the MPDS assessment results, there is no legal basis in China, so only ambulances can be arranged according to the needs of first aid; Hierarchical emergency resource system, the current application stays at the stage of acceptance and has not entered the stage of dispatching .
Since 2014, two medical institutions in Guangzhou have been approved by the Guangdong Provincial Health and Family Planning Commission and the Guangzhou Municipal Health and Family Planning Commission to legally carry out non-120 emergency transshipment services, but the source of customers still depends on traditional methods such as small advertisements or hospital staff recommendations. Problems such as small scale of operation, poor economic benefits, slow response, low promotion, weak social identification, strong regional monopoly, and lack of supervision means. In addition, calling and calling requires repeated telephone communication, poor convenience and easy communication of information. There are also many problems such as insufficient price transparency and lack of an open service evaluation system. In addition, the shortage of human resources is a major problem for the operation of non-emergency transit agencies. The turnover rate of the above-mentioned A agency in 2015 was as high as 37.5%: because the services of full-time non-emergency medical personnel are mainly non-emergency patients or patients who have undergone hospital diagnosis and treatment, For patients with stable conditions or with clear diagnosis and doctor's orders, the work process lacks the value of learning and exercise, limited space for improvement, and a lack of sense of achievement, resulting in the failure to recruit outstanding talents and the retention of young personnel.
3 countermeasures and suggestions
3.1 Separation of first aid and non-emergency services
Considering that China's population education level and cultural quality are relatively low compared to developed countries at the current stage, and the supporting systems, laws and regulations are not complete, and other national conditions, it is not appropriate to directly introduce the European and American classified rescue model. [19-21]。 In the new medical reform, the government encourages social capital to develop medical and health undertakings. The plan proposes the establishment of a government-led multi-health investment mechanism, actively promotes the development of non-public medical and health institutions, and forms a medical system with diversified investment subjects and diversified investment methods. [19 -twenty one]. Realize the separation of emergency services from non-emergency services, and offload non-emergency transportation services to the community , which is different from 120 emergency systems, and use social forces to establish a large-scale non-emergency transportation system that regulates supply-demand relationships and service prices by the market. Fang is expected to solve the problem that 120 ambulances cannot afford non-emergency transit.
120急救服务专线的基础上，增设非急救服务专线，急救服务仍由广州120提供，其响应速度快，设备齐全，医护要求标准高，按物价局标准收费，价格较低，主要负责市内院前急救任务；非急救服务由社会提供，响应速度慢，设备简单，医护要求标准低，由市场定价，收费较高，可承担跨省市转运任务。 On the basis of the 120 emergency service line, a non-emergency service line is added. The emergency service is still provided by Guangzhou 120. It has a fast response speed, complete equipment, high standards for medical care, and is charged according to the price bureau standard. The price is lower. It is mainly responsible for the city. Pre-hospital emergency tasks; non-emergency services are provided by the society, with slow response speed, simple equipment, low standards of medical care, market pricing, higher fees, and can undertake trans-provincial and city-transit tasks. Citizens can choose different services according to their needs. In order to prevent the abuse of first aid resources and learn from Singapore ’s practice, for 120 emergency vehicles, if non-emergency patients use emergency services, a higher price will be charged according to market prices to reduce the random occupation of first aid resources; whether it is an emergency The condition is determined by the attending physician. For in-patients, the doctor's condition is evaluated to determine whether it is suitable for non-emergency transport. 3.2 Build an intelligent non-emergency call app
app及医疗app，整合成符合医疗实际，安全性、私密性更高的非急救用车管理平台，即“非急救呼车app”，app对接居民健康档案或医院电子病历系统，以提高申请用车时病情录入的准确性和便捷性。 Utilizing the increasingly mature mobile Internet technology, combined with the increasingly popular ride- hailing app and medical app on the market, it is integrated into a non-emergency vehicle management platform that conforms to medical practice, and has higher security and privacy, that is, “non-emergency call app” ", The app is connected to the residents' health files or the hospital's electronic medical record system to improve the accuracy and convenience of entering medical conditions when applying for a car. Citizens can submit car applications through the app, and calling will become more accurate, convenient, and safer. The non-emergency call app, as an open platform for unified management, can effectively help patients and even medical staff to accurately determine the qualifications of these transfer agencies. Patients can also use this platform to review the past service evaluations of these agencies and choose high-quality services independently. service.
3.3 Increase the opening of non-emergency emergency transportation business to social capital
app转运机构名录，接受卫生管理部门监督和技术指导。 Encourage social forces to participate in the supply of non-emergency transit services. The government is responsible for approving qualifications, issuing medical institution practice licenses for qualified institutions, clarifying their non-emergency transit business scope, including them in the directory of non-emergency call app transshipment agencies, and receiving health Management supervision and technical guidance. Approve a sufficient number of institutions to participate in non-emergency transit services to allow the market to fully compete in order to form economies of scale, reduce unit costs, and improve response speed.
3.4 Formulation of non-emergency transfer grading exit standards
120救护车人员的配备标准是一名3年以上临床经验的执业医师、一名2年以上临床经验的执业护士、两名担架员和一名司机。 At present, Guangzhou 120 ambulance staffing standards are a practicing doctor with more than 3 years of clinical experience, a practicing nurse with more than 2 years of clinical experience, two stretchers and a driver. However, non-emergency transport does not require such a high standard of equipment. Emergency medical assistants and medical ambulances should be introduced to participate in non-emergency transport services [1, 8], and non-emergency transport grading exit standards should be established. According to the patient's condition and wishes, Arrange appropriate medical staff to visit, equipped with different standards of equipment to improve the efficiency of resource use.
3.5 Improving the professional identity of non-emergency transport practitioners
Strengthen the training of non-emergency medical staff, regularly arrange for them to go to hospitals at all levels to study and improve, and promote promotion channels, so as to attract more young medical staff to join the non-emergency transport business. [1，8]。 Gradually establish an independent evaluation and promotion system for medical ambulance titles, and introduce a new profession in the medical profession as a non-emergency transport system [1, 8].
3.6 Do a good job in publicizing non-emergency transfer services
The successful launch of the new business is inseparable from the support of the people. The aforementioned survey found that the awareness rate of non-emergency transit services is very low among the citizens, prompting us to do a good job of publicizing non-emergency transit services through community education, television, 澳门现金娱乐网投papers, and the Internet. The media and other channels allow more citizens to know, recognize and actively use non-emergency transit services.
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