1
BACKGROUND
In recent years, the disaster situation has changed complicatedly, containing
many uncertain factors. The fact that disasters occurs without warning, occurs very
suddenly increased the number of victims should be cured, transportation ...
always exceeds the capacity of the health sector response. To restrict to a
minimum the loss of life and material caused by the disaster, the need for
coordinated action of many forces, media synchronization, in which modern health
sector had an important role. The military zone hospital (MZH) was a general
hospital had specialist (type B), located on the strategic areas of the country,
performing tasks of treatment for soldiers and people in the area. There is
particularly important role in emergency medical response when disaster strikes.
But so far, there was no unified model, RRVMD by the military zone hospitals
was difficult. Therefore, we conducted this research subject to the following
objectives:
1. Status of receiving, rescue victims of mass disasters from military zone
hospitals in the period of 2007-2012.
2. Modeling, deployment experimental exercises and evaluate results of
model organization RRVMD in Hospital 4, Military Zone 4, in 2012-2013.
* New contributions on the practical science of the thesis:
- Has been described real operating condition, capacity of RRVMD of
military zone hospitals (MZH): There was adequate staffing organization by
decision; There are facilities, fully equipped, convenient infrastructure for
RRMVD; Have established the Steering Committee, annually implemented plan
RRMVD; In 6 years (2007-2012) the hospital had 1-2 times receiving, rescue mass
victims; Capable of sorting from 50-100 victims/hour, receiving treatment from
30-60 victims/hour, maximum deployment 4-10 surgical teams, often held 5-6
mobile health groups available assignment of a task; Ability to rescue specialist
early for the victims of disaster and responsive, effective for the second disaster.
- Has been developed and successfully tested model RRMVD of MZH:
Depending on the size, characteristics and extent of each type of disaster can be
implemented in one of two solutions:
+ Option 1: deployment of mobile military medical team to the field;
Organization the clinical patients in order to be ready to rescue victims.
2
+ Option 2: deployment of mobile military medical team to the field;
establishment of field hospitals; Forces remaining on duty regularly.
+ After 2 rehearsals empirical model was considered reasonable, realistic,
feasible high. 90.9% - 92.9% of experts rated on organization, staffing, use of
force in 2 alternatives was reasonable. 100% expert opinion evaluation with the
model was built, MZH capable of completing tasks in similar situations.
The layout of the thesis: The thesis consists of 132 pages include:
Background 2 pages; Chapter 1-Overview: 34 pages; Chapter 2- Objects and
research methods: 21 pages; Chapter 3-Results: 41 pages; Chapter 4-Discussion:
31 pages; Conclusion: 2 pages; Recommendations: 1; 44 tables; 11 schemes; 2
appendix ; 136 references (79 Vietnamese, 51 English, 6 Russian documents).
Chapter 1
OVERVIEW
1.1. Situation disaster, losses from disasters around the world and in Vietnam
1.1.1. The concept of disaster
According to the World Health Organization: "The disaster is the
phenomenon caused the damage, the economic upside, the loss of life, human
health, damage to health facilities with a large extent, requires the mobilization of
relief especially from outside to the disaster area. "
According to the Ministry Health and National Defense "Disaster is the risk
or unexpected event occurs, causing great loss of life and material."
1.1.2. Classification disaster
- According causes: natural disasters, human disasters
- As the number of victims: from 3-4 degree
- As request of medical interventions: immediate loss, lasting consequences
- In time of disaster: long, short, acute, chronic ...
- Geographically, regions, geography, population ...
1.1.3. Disaster situation in the world and Vietnam
1.1.3.1. Disaster situation in the world
Catastrophic events in the world were coming complicated and growing
rapidly. In 10 years (2002-2011), there are 3.942 worldwide natural disasters,
including floods accounted for 1.793 cases, whirlwind accounted for 1.022
3
cases ... The disaster caused by people common as: fire, terrorism, war, industrial
accidents, traffic accidents... In 10 years (2002-2011), there were 2.622 disasters
caused by humans, killing 82.609 people and affected up to 152.900 people life,
loss of 38.112 million dollars.
1.1.3.2. Disaster situation in Vietnam
From 2003 - 2012, there were 103 big natural disasters killed 7.748 people
and 6.740 people injured, the loss of material wealth estimated thousand billions.
In Vietnam disaster caused by humans was diverse, complex and increasingly
more serious. Many disasters cause huge losses of life and materials, only traffic
accidents in 10 years (2003-2012) had 36.409 cases occurred, killing 9849 people
and 38.064 people injured.
1.2. The work of emergency medical response to disasters
- In the world: the system for emergency medical response in disasters was
organized to two trends: There were separated organizations outside the health
system or in health system sector.
- In Vietnam: based on the medical establishment to civilian and military
organize searching, rescue, treatment victims due to the line of treatment system.
1.3. Model of receiving, rescue victims of mass disasters in hospital
1.3.1. Situation of ability RRMVD in hospital
Hospitals can deploy RRMVD, depending on the severity of the disaster as
well as the number and structure of victim injury. However, hospitals have no
standard and full model for deployment RRMVD effective and systematic.
1.3.2. RRMVD model of some hospitals through rehearsal
- Rehearsal BV-06 of Hospital103: Hospital 103 in collaboration with the
forces of the military unit organization and onsite RR practice for 300 victims of
the fire disaster in the industrial area of Ha Dong District . Forces have been used
as follows: At the field using 3 surgical teams performing total rescue task with
emergency, sorting victims; Established receiver and additional emergency;
Organizations RRV in the clinical.
- Rehearsal CN-10 at BV4/QK4: From forces and tools available of a hospital,
in coordination with other forces in the area, RR for 170 victims of the collapsed
multi-storey buildings under construction in Vinh city. Organizations were
4
implemented as follows: One military medical force at the field; At the hospital
detached a force to be arranged independently of the hospital campus with RRV duty.
- Rehearsal BV-05 at Hospital175: Hospital in collaboration with the
Ministry of Defense forces organization RR for about 450 victims of fire disaster
caused by tall buildings, including victims of poisoning. Hospital organizations
deploy: Area receiving, sorting; emergency zone and shock management; victims
of severe treatment areas; Face identification and preservation of the body.
Chapter 2
SUBJECTS AND METHODS
2.1. Subjects, materials, time and location of study
2.1.1. Research Subjects
- Research subjects situation: the MZH (infrastructure, equipment, staffing
organizations, professional activities ...)
- Subjects intervention: military zone hospitals participation in RRVMD.
- Leadership, command hospital head of some department of the military
zone hospital directly related to the work RRVM in disaster.
- Officers and staff of the Hospital 4 - Military Zone 4 in the exercise
RRMV experimental.
- Specialist in medical, military medicine, military, political, logistical and
technical, local rescue Steering committee.
2.1.2. Material Research
- The legal documents relating to the care and protection of people's health,
the combined military and civilian medical response to an emergency condition.
- The document of the situation and the damage caused by the disaster in the
world and in Vietnam, the period from 2002 - 2012
- The document summarizes the work RRVM disaster and the results of a
number of hospitals.
- The statistical reports on infrastructure, staffing organizations, media
equipment, qualifications and professional competence ... of MZH.
2.1.3. Study sites
At 7 military zone hospitals, organizations 2 experimental maneuvers
(BMT-13 and NA-NĐ13) in the province of Nghe An.
5
2.1.5. Research time
- Phase 1, describes the current status surveys: from 07 2011-06/2012.
- Phase 2, experimental exercises: from 7/2012 - 12/2013.
2.2. Methodology
2.2.1. Study Design
Research describes across, the retrospective study combined quantitative
and qualitative research and intervention by experimental maneuvers.
2.2.2. Sample sizes and sampling studies
2.2.2.1. Sample sizes and sampling baseline study
- All 7 military zone hospitals of the army
- 84 leaders, commander of the military zone hospitals
- 50 experts in: medicine, military medicine, military, logistics...
2.2.2.2. Sample sizes and sampling intervention studies
- Intervention model: choose intentionally Hospital 4 - Military Zone 4
- The entire staff of 110 employees in H4/MZ4
- 61 turns of experts selected for interviews, opinions (1 st rehearsal: 33
experts, 2nd rehearsal: 28 experts).
2.2.3. The scope, content and index research
2.2.3.1. The scope, content and status research index
- Task and organize forces, number of beds
- Facilities and equipment of hospital
- The situation properly and heal in 6 years (2007-2012)
- Construction work plans and activities to meet the emergency medical
- Ability to organize and implement a RRVMD.
2.2.3.2. The scope, content and intervention research index
- Content RRVMD model in military zone hospitals: discipline of the model;
Depending on the characteristics of the disaster can be implemented in one of two
alternatives.
- The results of the last two experimental rehearsals: Preparation; Results
deployment model; Opinion, evaluation of expert.
2.2.4. Methods and tools to gather information
* Methods, tools for data collection in a status research
6
- Research Methods: Secondary data analysis; Observations described;
Direct interviews; Professional method.
- Research tools: form number 1, form number 2, form number 3.
* Method and tools of assessment intervention results
- Method: Empirical exercises with 2 plans
+ Option 1: the type of disaster occurs near the hospital or in the hospital
may receive direct victims.
+ Option 2: major disaster, away from the hospital, casualties, difficult
transportation conditions.
- Assessment tool: form number 4 and form number 5.
2.3. Errors and remedies
- Form design research to ensure adequate information, unified
- Conduct a pre-test, complete toolkit
- Choose enumerators, supervisors are experienced staff
- Organization of adequate training and close supervision
2.4. Methods of analysis and data processing
- Clean form before accessing computer
- Data processing using Excel 2007 software, SPSS 13.0.
2.5. Research organization
- Investigate, analysis the situation in 7 hospitals under the form
- Organizing two rehearsals corresponding to 2 plans were built.
2.6. Limitation of the thesis
- No research on: equipment, drugs, facilities, materials ...
- No evaluation of the ability of each forces participating in a specific way
- Not given model for each type of disaster
- No deep research on the treatment, ensure logistics...
2.7. Ethical aspects of research
- The study subjects entirely voluntary
- The information only used for research purposes and to ensure security.
7
Chapter 3
RESEARCH RESULTS
3.1. Current status and operational capacity of RRVMD of MZH
3.1.1. The task, organization forces.
- Hospitals type B, general hospitals with specialist; With a payroll of 270
employees, was organized into six departments, 7surgical, 7 Internal Departments
and 6 Para clinical Departments.
- MZH had 7 tasks, including: "Ready combat, combat service and meet
emergency medical situations such as natural disasters, catastrophes" .
3.1.2. The number of employees(E) and number of beds(B)
- The MZHs were staffed from 200-250 beds, actual deployment from 250574 B. Served ratio is lower than specified, ranging from 0,69 to 1,30 E/B.
- Only from 2,0% -18,0% of the doctors in general level, the rest have been
trained specialist. Pharmacists have university degrees from 18.0%-38.0%. Nurses
have an intermediate level between 84.0% - 97.0%. Technicians had intermediate
level from 64.0% to 100%.
3.1.3. Status of physical facilities and equipment of the hospital research
Table 3.4: The infrastructure of the hospital in research
Index
H11
0
59
18
5
3
8
H10
9
788
60
4
2
6
H7
H4
H1
7
18
12
7
3
10
H7A H121
Campus area/bed (m2)
113
36
79
2
Using area/bed (m )
30
19
25
Present (room)
4
4
3
3
Operating
More (room)
3
3
4
3
rooms
Total (room)
7
7
7
6
Empty ground of Hospital
500
500 400 1500 800 500 1250
(m2)
Extra beds (bed)
100
50
100 150 100 120
120
- Each hospital had from 3-7 operating rooms, when emergency medical
response can deploy more from 2-4 operating rooms. Each hospital can deploy
more from 50 – 150 B enough to properly cure the disaster 1 to level 2.
8
- The research hospitals were equipped with basically for examination,
diagnosis and treatment of patients, but the number was small, some just a single
type should not be a transfer available on mobile military medical team.
- All research hospitals had mobile equipment and materials as artificial
respiration apparatus, anesthetic machine, operating tables, mobile X-ray... all type
of cars to transport patients but not enough quantity to meet if disaster happened.
- All hospitals were not equipped with the tools of preventing biological
weapons, chemical, nuclear, such as sanitation treatment systems, test facilities
and tools of personal protection, respirator protection, DDA car ...
3.1.4. The situation of receiving and rescue of hospitals in 6 years (2007-2012)
- Number of hospital surgery was not the same, the difference between the
hospitals quite large (2043-7981 cases per year). Individual hospitals have
relatively stable, the next year always higher.
- The targets were exceeded professional regulations: bed utilization rate
reached 116.9% - 184.0%; The rate of illness from 68.2% - 82.8%; The number of
examination/day highest from 190-1471 people/day; The number of
emergency/day highest from 14-140 people/day.
3.1.5. Current status of the organization and the ability to deploy properly and
heal victims of the mass Hospital Research
Table 3:13: The receiving ready, rescue victims of mass in research hospitals
Content
H11
0
H10
9
H7
H4
H17
H7A
- Executive Steering Committee All research hospitals had decision
RRVMD
established the Steering Committee.
H12
1
on
- Plan to mobilize forces, facilities, All hospitals had annual research plan on
supplies and medical equipment in RRVMD, mainly respond to floods, fires and
RRVMD
explosions, traffic accident ...
- Times of RRVM from 2007 to
2012
2
2
2
3
2
1
2
- The highest number of victims
was received and rescued at a time
20
25
30
32
26
17
45
9
The hospitals had executive board on emergency medical response to
disasters by the Director as its head; were planed, organized force ready to respond
to an emergency medical condition but mainly in response to floods, fire, traffic
accidents ... including content reserve facilities equipment, and medical supplies.
The statistics in 2007 - 2012 showed that 100% of patients had at least one
RRVMD time with highest number of victims from 17-45 victims.
Table 3:18: Ability to organize RRVM of research hospitals
Hospital
H110
H9
Victims
sort/hour
(people)
50
50
Operation
(cases)
10
6
Motivated
Victims
surgical team RR/hour(peopl
(team)
e)
5
50
5
50
H7
100
8
5
50
H4
50
6
6
50
H17
100
6
5
60
H7A
50
4
5
30
H121
100
6
6
60
The hospital research can be classified from 50-100 victims/hour and
received treatment from 30-60 victims/hour. Regularly held 5-6 emergency groups
and can deploy 4-10 surgical team.
- 56.5% - 66.7% opinions of experts and staff that MZH only meet a part
mission of RRVMD, due to the lack of planning (53.6% - 57.5%); No RRVMD
model (65.0% - 71.4%); lack of practical training RRVMD (67.5% - 81.0%).
- Only 29.8% - 32.7% suggested that the practical ability of medical staff
had good capability in rescue emergency victims of disaster.
3.2. Building RRVMD model in MZH
3.2.1. Basic on model building
- Functions and tasks of military zone hospitals
- The need for rescue victims
- The system of legal documents related to the work TDCCNN
- Reality RRVMD ability of the hospitals.
10
3.2.2. Content of RRVMD model in MZH
* Principles RRVMD at military zone hospitals
"Use the force, available tools of hospital implemented emergency RR properly
and timely the basic wounds of the victim. Ready assist and come to emergency
disaster place. Simultaneously, ensure regular tasks of the hospital. "
Table 3:22: Comments of the research objects on model and principles RRVMD
Commanders(n = 84)
Experts (n = 50)
Assessment content
Quantity Rate (%)
Quantity Rate (%)
1. The need to build the model:
- Very necessary
82
97,6
48
96,0
- Necessary
2
2,4
2
4,0
- No need
0
-
0
-
82
96,4
50
100
- No reasonable, additional
3
3,6
0
-
- Other ideas
0
-
0
-
2. Principles of RRVMD:
- Reasonable
Opinion of the leaders, commanders of hospitals and research experts that
very necessary (96.0% - 97.6%) and necessary (2,4 - 4,0%) to build RRVMD
models for the MZH.
96.4% of leaders, commanders of the research hospital and 100% of the
experts believe that the RRVMD principle was reasonable, only 3.6% of
respondents need additional contributions to be fully taking advantage of the
MZH: there are professional and technical staff experienced in handling medical
conditions, surgical field, high mobility, equipment diversity, richness and
advanced modern science can treat most basic and specialist help RRVMD timely
and limited mortality disabled.
* Content model: Depending on the specific situation, organizations can deploy
RRVMD model as the following options:
11
Area field
Commander
board
First aid area
Death body
place
Nơi để tử thi
Sorting mild victims
area
Sorting severe,
moderate victims area
Emergency area
Delivery mild
victims
Delivery severe,
moderate victims
area
Deliver to Hospitals
Chart 3.2: Diagram deployed forces in place disaster
+ At the disaster site (at the field: hold a mobility medical teams (MMT)
capable of first treatment that the core is basic treatment surgical team(BTST)
enhanced sort and deliver group, maneuver quickly to the disaster field, parts was
organizing according to diagram 3.2.
+ At the hospital:
If number of victims was moderate, not continuous, can use examination
part to receive and sorting, emergency (if any), write patient records and put the
victim in the clinical with professional treatment.
12
If more number of victims, the hospitals overwhelmed, examination part not
guarantee, organizations a team for receiving and sorting (RRT) in examination
ground, pitch, garage ..., emergency management (if any), write patient records
and victim transported to the clinical treatment.
Simultaneously, the cumulative clinical patients who are undergoing
treatment for stable patients discharged from hospital, surgical patients were
transferred out of time to monitor internal medicine to spend some empty beds
ready to receive victims emergency treatment.
Receive and sorting
team(RST)
At Hospital
Clinical department
Chart 3.3: The basic deployment diagram in hospital of option 1
- Option 2: The disaster occurred huge in hospital, casualties, difficult
transportation conditions, not directly transfer the victim to the MZH.
Organizations implemented as follows:
+ At the field: Organized MMT to the field to search for victims, emergency
rescue, sorting, delivering victims to the treatment facility. MMT that the core is
BTST enhanced deliver compact ensure light, mobile and highly specialized.
+ At the hospital:
From the hospital's payroll detached a force to deploy HF for disaster
response, 10-15 km far from the field, go after MMT. Number of employees
remaining hospitals do routine tasks, but narrowing the scope of the rescue.
MZH
Hospital field
(HF)
The remaining
forces of hospital
Mobility Medical
Team (MMT)
Chart 3.4: The basic deployment diagram in hospital under option 2
13
Size, staffing: Decision No. 20/QĐ-TM 02/01/2009 Chief of General Staff
of the Vietnam People's Army.
3.2.3. 2 Results through two empirical rehearsals in Hospital 4 - MZ4
3.2.3.1. Rehearsals BMT-12 on 7/2012 (In accordance with option 2)
- Preparatory work;
+ Establish committees: a steering committee, organizing committee,
building committee documents, assisting part, part to ensure...
+ Component in the exercise forces: Forces in hospital staff and
coordination.
+ Prepare assumption victims: cases structure like a disaster have occurred,
have more situations poisoning victims.
- Organization of practice exercises and assessment model results:
+ Coordinate with MZ Hygienic team deployed MZ sanitary treatment
+ Deployment MMT arrived the field: the core is first aid team enhanced
delivering group (including 1- 2 nurse practitioners).
+ Deployment HF as basic organizational model of military medical sector.
Table 3:24: Results of deployment hospital field model to RRVMD
Parts
The departments, parts of
HF
The whole sanitary part
Form
Content
Maneuver
Time
deployment
deployment
time
deployment
Cottage,
True,
25’
50 ‘
tent
enough
Cottage,
True,
25 ‘
60 ‘
tent
enough
All parts of HF are fully deployed both in person as well as equipment to
RRVMD, maneuver time was 25 minutes, time to deploy parts of HF was 50
minutes, while time implementing sanitary treatment part was 60 minutes.
14
Table 3:25: Results RRVMD of HF according to the time, diagnosis and
treatment
Content Criteria
Phase I
Phase II
The number of victims
55
70
45
Maximum
18
16
17
Minimum
4
4
4
7,63
6,81
7,47
± 3,25
± 3,15
± 3,17
Time for a
victim
classification
Diagnosis
Result
Average
Phase III Total
170
Corre
ct
SL
46
62
40
148
%
83,6
88,6
88,9
87,1
Wron
g
SL
9
8
5
22
%
16,4
11,4
11,1
12,9
The earliest
10
8
10
Latest
23
20
21
Time
Average
13,8 ± 1,8 12,5 ± 1,6
13 ± 1,7
Time to sort out a victim at least 4 minutes, maximum 18 minutes, with an
average of 6,81 ± 3,15 (min) to 7,63 ± 3,25 (min). Time moving to departments
earliest 8 minutes, latest 23 minutes, on average from 12,5 ± 1,6 to 13,8 ± 1,8
(min). There were 22/170 victims (12,9%) not diagnosed correctly when moving.
Table 3:26: Results hygienic treatment for victims contamination at MZHF
Content
Quantity Time for 1 sanitary victim(minute)
victim
Minimum Maximum
Average
Victims must be off
8
7
19
12,15 ± 4,27
Victims can walk, bath
13
7
23
11,35 ± 5,61
15
Minimum time was 7 minutes, maximum 19 minutes, averaging 12.15 ±
4.27 for sanitary a victim off. Similarly, need 7- 23 minutes, averaging 11.35 ±
5.61 for sanitary victims can walk, bath.
Table 3:27: shock result against resuscitation for VMD in MZH
Content
Satisfactory
Victims need antishock
Quantit
%
resuscitation(ASR)
y
Unsatisfactory
SL
%
Phase I
7
6
85,7
1
14,3
Phase II
12
11
91,7
1
8,3
Phase III
5
5
100
0
0%
Total
24
22
91,7%
2
8,3
There are 2 victims (8.3%) in group ASR unsatisfactory about: consoles
form victims, medical records, transfer process. Other contents: 100% real victims
are good at and HSCC requirements.
Table 3:28: Expert evaluation of model MZHF in RRVMD (n = 33)
Content Assessment
Good
Additional
need
Not good
Qu
%
Qu
%
Qu
%
Perform tasks RR part
32
97,0
1
3,0
0
0
Perform tasks sanitary part
31
93,9
2
6,1
0
0
Perform tasks surgical HSR
33
100
0
0
0
0
Organization and staffing RRVMD
30
90,9
3
9,1
0
0
Evaluate the ability to complete
tasks similar situation
33
100
0
0
0
0
Most (90.9% - 100%) expert reviews of good evaluations all parts of the
content. Only one reviews (3.0%) that should be added: "The RR part should
16
contract with the delivery team so close to transport injured victims immediately
after sorting to help improve circulation quick follow order of priority". 2
comments (6.1%) that required additional content for sanitary station: "It should
work synergistically with internal delivery team for victims must be off".3
comments (9.1%) said that: "It should increase the number of people to transport
victims when the victim receives so many at the same time, there must be
provisions for collecting specific types of preventive stretcher, to ensure sufficient
quantities needed for transporting victims to avoid wasting time".
3.2.3.2. Rehearsals NA-ND13, June/2013 (In accordance with option 1)
- Preparation: similar to BMT-12 drills, but no force participation Hygienic
team and implemented under option 2.
+ Prepare assumption victims: victims cases structure like a disaster have
occurred, however no victims poisoned.
- Organization of practice exercises and assessment model results:
Table 3:30: Results of deployment preparation force in the field and
hospitals
Form
Content
Maneuver
tine
Maneuver
part
Tents, cottages
Right, enough
30 min
20 min
Examination
Frees hallway
Stretcher,
trolley
15 min
15 min
Arrange patients
Right, enough
15 min
20 min
Para clinics
Vehicles,
consumable
supplies medicines
Right, enough
15 min
15 min
Ensure parts
Serve patients,
family
Right, enough
20 min
15 min
Parts
Clinics
Time
+ Deployment MMT arrived at the field: the core is basic treatment team
enhanced 2 delivery group (including 6 nurses).
17
+ At the hospital: established RRT, arrange beds, to be ready for RRVMD.
All parts of the hospital are fully deployed with people and equipment to RRVMD
according to the content requirements set out. Division deployed earliest was
examination part and para-clinics, after 30 minutes to re, receive, sort, transport,
test for the first victims.
The minimum time required to classify a victim as 3 minutes, maximum is
16, the average time to classify a victim from 5,81 ± 2.17 to 5,47 ± 2,15 minutes.
Table 3:31: Results RSRV in hospital in NA-NĐ13 (from the exam to clinics)
Content
Phase I Phase II Phase III
Total
The number of victims
Time for a
victim
classificatio
n(min)
10
25
20
Maximum
16
14
15
Minimum
3
3
3
6,63
5,81
5,47
6,15
± 2,25
± 2,17
± 2,15
± 2,35
100
96
100
98,2
1
0
1
0
1,8
Average
%
Correct
Diagnostic
Results
Quantity
%
0
4
5
8
7
Latest
15
16
18
Average
13,8 ±
3,5
16 ± 4
15 ± 3
55
Time transporting to clinics earliest was 5 minutes, 18 minutes at the latest.
There were 1/55 victims (1,8%) not diagnosed correctly when moved into
treatment.
In rehearsal NA-ND13 (6/2013), H4/MZ4 BTST used to maneuver the field
to organize the RRVMD, 25 km distance on 30 minutes.
18
Table 3:32: Anti-shock resuscitation results in deployment RRVMD in H4/MZ4.
Satisfactory
Content
Victims need ASR
Phase I
Unsatisfactory
Qu
%
Qu
%
3
3
100
0
0
Phase II
4
4
100
0
0
Phase III
3
3
100
0
0
Total
10
10
100
0
0
At the disaster site to coordinate medical forces Nam Dan district, first aids,
transport as indicated to Nam Dan district hospital 35 victims and 55 victims to
H4/MZ4. 100% of victims were treated ASR in hospital satisfactory in all content.
Table 3:33: The results of the expert evaluation to perform the tasks of parts in
rehearsal NA-NĐ13 (n = 28)
Need
Good
Not good
addition
Content Asessment
Qu
%
Qu
%
Qu
%
Perform tasks RR part
27
96,4
1
3,6
0
-
Perform tasks ASRS part
28
100
0
-
0
-
Organization staffing and force
of RRVMD
26
92,9
2
Evaluate the ability to complete
tasks when similar situations
occur
28
100
0
7,1
0
-
-
0
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Most (92.9%-100%) experts opinion on the forces of organization so good
and also the mission of RRVMD. Only 2 reviews (7.1%) said that: "It should add
up the number of people to transport victims in many cases the victim receives
many at a time, there must be some indication for internal transport forces to
make job easier ".
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Chapter 4
DISCUSSION
4.1. On the capacity of RRVMD of MZH
One of the important tasks for the MZH such as: when disaster strikes, mass
casualties, then under the leadership of Commanders of military Regions and the
Steering Committee remedial disaster. Rescue forces were mobilized, deployed to
search and rescue, sorting and transporting victims as directed by the medical
establishment to medical facilities. The victim is promptly treated to reduce to the
lowest mortality, disability caused by the disaster. In some hospital researched
were general hospitals with specialist will be the receiving place, rescue for bulk
victim request.
Although the number of patients MZH was huge now and always
overloaded on the number of patients to treatment as well as a shortage of human
resources for serve, this is considerable pressure for hospital, will be more difficult
if a large number of victims at a time when a disaster occurs . But professional
forces of hospital were formal training, highly qualified, had strong command
system, experienced in handling emergency situations. Regular employees were
well trained, highly professional nature and always full meticulous planning in
response to the disaster.
In fact, the hospital has developed from 250-574B, although the payroll of
the MZH from 200-250B, bed occupancy rate always reaches 150% (2007) to
nearly 200% (2012); discharge rate from 70% (2007) to 87% (2012). So hospitals
researched receive the number of patients treated beyond all norms prescribed. As
a result, when disaster strikes in the province should undertake receive and rescue
a large number of victims, the hospital can fully implement receiving, rescue,
treatment exceeds the number of victims assigned to each hospital was entirely
possible. Although the current number of such increase but by examining the
current situation in 5 years that the MZH could deploy more from 50 to 100 beds
when a disaster occurs.
Over the 5-year statistics recently 7/7 MZH participating RRVMD at least 12 times, with all type of disaster but the number of victims is not much, lowest 17
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victims, maximum 45 victims. The application RRVMD model of hospitals in
dealing with new disasters just for the experience of a number of experts, but not
the basic model that hospital can be deployed work RRVMD in situations to
emergency medical response for each type of disaster can happen to hold annual
training effective.
Through surveys state facilities, technical expertise situation, the results of
RRVMD of hospitals, found that all hospitals can receive and classify from 50100 victims an hour, rescue at a time on 100 victims, emergency from 30-60
victims, additional 2-3 operating table and 3-5 surgical teams to perform surgical
tasks handle foreign wounded for the victims.
In addition, most hospitals have plans to ensure health in unexpected
situations such as: have executive Steering Committee met in medical disaster;
plans to meet health in disaster; has been prepared to meet the health care plan for
each type of disaster, most especially hospitals are organized BTST, rescue teams,
military maneuver, rescue specialist ... and training, and additional test equipment
regularly should be able to respond quickly when there is an emergency situation.
4.2. About the RRVMD model in MZH
4.2.1. In principle RRVMD of MZH
In terms of hospital professional activities regularly, have collected a large
capacity victims in a time, to avoid the unnecessary disturbance and upset the
rhythm of the scientific work, the entire hospital board on the other hand create the
best conditions for the maximum concentration of manpower, facilities in
RRVMD and avoid other consequences related to emergency medical response,
such as task often hampered regular hospital, infecting victim when poisoned,
radioactive, infectious ... So RRVMD principles of MZH (hospital B) based on the
principles:
- Ensure regular professional activities of the hospital.
- Make the most of the facilities, vehicles, equipment and forces available
technical staff of the hospital.
- RRVMD based on the principle of rescue transport in lines, according to
regional military and civilian combined.
- Good organization and effective work RRVMD to reduce lowest mortality,
disability for the victims.
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