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The Short Board Of The Ability Of Emergency Treatment For Epidemic Warning

2020/12/31 9:40:00 0

Epidemic SituationWarningEmergencyTreatmentCapacityShort BoardMedical TreatmentInfrastructure

Medical "new infrastructure" has become a new hot spot for investment and construction in the field of public health this year.

The new coronal pneumonia epidemic in 2020, to a certain extent, exposed the weakness of public health, especially the ability of major epidemic prevention and treatment. It is imperative to open the "new infrastructure" of medical and health care in the face of the short board of ability. However, many national major policy outlines, such as the 2020 government work report to the "14th five year plan", are involved in making up the medical and health "new infrastructure" and giving full play to the driving effect of science and technology. Among them, the "14th five year plan" mentioned that it is necessary to improve the monitoring and early warning handling mechanism of public health emergencies, improve the medical treatment, scientific and technological support, material security system, and improve the ability to deal with public health emergencies.

In addition, with the introduction of the "public health prevention and treatment capacity building program", it will become an important direction to improve the detection ability of biological laboratory, strengthen the construction of intensive care unit (ICU) and improve the treatment capacity of county-level hospitals. Many provinces and cities have announced the infrastructure investment plans involving the construction of medical facilities.

General Secretary Xi Jinping pointed out that the fight against the new crown pneumonia epidemic is a great test of the national governance system and governance capacity. It is necessary to study and strengthen the work of epidemic prevention and control, innovate and improve major epidemic prevention and control measures in terms of system and mechanism, improve the national public health emergency management system, and improve the ability level of responding to major public health emergencies.

Improve the mechanism of emergency system

It is particularly important to start the "new infrastructure" of medical and health and strengthen the construction of emergency response system for public health emergencies, and the construction of medical consortium is an important part.

In May 2019, the state issued the notice on carrying out the pilot work of urban medical consortium construction and the notice on promoting the construction of close county medical and health community, which made it clear that by the end of 2020, 100 pilot cities would form a grid layout of medical consortia and achieve obvious results, and a new County medical and health service system would be initially built in 500 counties (including county-level cities and municipal districts) Department.

In fact, in the face of the sudden outbreak of new crown pneumonia this year, how to deal with it has become a practical assessment of the construction of major medical consortia across the country. In this year's anti epidemic campaign, governments at all levels have repeatedly mentioned the need to play the role of medical alliance. However, it has been proved by practice that the advantages of medical consortium should be brought into full play in dealing with public health emergencies in the future, whether it is the supply and reserve of medical supplies or the patient load of emergency medical treatment.

Now it has reached the key node of the construction of the Medical Union, and the construction of the emergency system is accelerating to the county level, and the special construction mode of the Medical Union has also become an important starting point. In particular, this year is a crucial year to deepen the medical reform. As an important carrier of the construction of hierarchical diagnosis and treatment system with Chinese characteristics, the medical alliance can promote the connection of high-quality medical resources, gradually break down barriers and obstacles in administrative division, financial investment, medical insurance payment, personnel management, etc., promote the improvement of grassroots service ability, and promote the implementation of family doctor contract service, finally focusing on In the construction of hierarchical diagnosis and treatment system, it has achieved remarkable results in solving the problem of people's medical treatment and enhancing the people's sense of gain.

The construction of medical alliance, which allows high-quality medical resources to sink and regional resources to be shared, meets the support of the policy and accelerates the landing speed.

On August 1, 2020, the measures for the management of medical consortia (Trial Implementation) jointly issued by the National Health Commission and the State Administration of traditional Chinese medicine (hereinafter referred to as the measures) was officially implemented. According to the measures, the administrative departments of health and health at the prefectural, municipal and county levels shall formulate the construction plan of the regional medical consortium, divide the service areas into several grids according to the geographical relationship, population distribution, medical demand of the masses, distribution of medical and health resources, and integrate the medical and health resources within the grid, and establish a tertiary public hospital or a hospital representing the medical level of the jurisdiction First, a number of other hospitals, grass-roots medical and health institutions, public health institutions and other members of the medical consortium.

At present, all three-level public hospitals in China have participated in the construction of medical alliance, which has become a scale. According to the National Health Commission, by the end of 2019, 1408 urban medical groups, 3346 County medical communities, 3924 cross regional specialist alliances, 3542 telemedicine collaboration networks for remote and poverty-stricken areas, and 7840 social medical institutions have joined the medical consortium. In addition, according to the data of the sixth health service survey, 46.9% of the two-way referral patients were referred by the Medical Union, which was higher than other referral methods.

"As far as we know, there will be 600-700 hospitals or centers for Disease Control and prevention in Hubei alone to build or expand emergency systems." Tan Pingtao, chairman of Wuhan Huakang Century Medical Co., Ltd., once told reporters of the 21st century economic report that as one of the leading enterprises in the subdivision field, the clean room industry of public health system in which the company is located will also usher in a period of development opportunities.

Acceleration of hospital hardware construction

In addition to improving the construction of the medical emergency system, the "hardware construction" of the medical system is also increasing its power.

On July 21, 2020, the National Medical Center for major public health events started construction in Guanggu hospital, Tongji Medical College, Huazhong University of science and technology.

After Beijing and Shanghai, Wuhan has become the third city with a national medical center. The national medical center is also the Sixth National Medical Center, which is expected to be completed within 3-5 years. The center will focus on infectious diseases, natural disasters, nuclear radiation, toxic diseases, unexplained diseases and other major public health emergencies. Based on the concept of integration of medical education and research and the integration of production, teaching and research, and in accordance with the management mode of "peacetime and wartime integration", the center will build itself into a leading domestic and international first-class country integrating prevention, early warning, treatment, management, training and research and development A medical center.

According to the plan, the center will also focus on eight horizontal systems, including leading the construction of national major public health event emergency treatment system (national provincial city sentinel hospital / community), national major public health event information system (multi-point trigger early warning mechanism), national major public health event laboratory rapid diagnosis system, and major public health event adjustment Check the control team and network system, national medical equipment emergency rescue rapid response system, national hospital public health emergency management system, national major public health event decision support system, national major public health event research system.

At the same time, intensive care unit (ICU) has become another focus of hospital hardware construction. ICU plays an important role in the epidemic, because the treatment of critically ill patients is an important means. ICU Wards started late in China. Although the construction of ICU Wards has been strengthened in recent years, there is still a large gap in the indicators of ICU beds per capita in China compared with developed countries. The data show that at present, the number of ICU beds per capita in China is 3.8/100000, that in the United States is 34.7/100000, and that in Germany is 29.2 /100000 people, Italy 12.5 per 100000 people.

Xie Changyan, an analyst at Guoxin Securities, points out that it is expected that by 2023, the number of ICU beds will theoretically be more than five times larger than the current stock, which can reach 16.25 beds per 100000 people. The clean operating Department has high requirements for cleanliness and strong professional construction. There are about 8000 and 40000 new operating rooms to be built and renovated in this year. With the increasing investment in hospital construction in the future, the demand is expected to further increase.

In addition, after the impact of the new epidemic situation, the discipline construction of infectious diseases is also ushering in a substantial leap. According to the investigation of 21st century economic report, before that, in Wuhan, most of the large tertiary hospitals had infectious disease departments, and the allocation of departments was slightly different. Other small and medium-sized hospitals rarely set up infection department.

At present, both public health system and major hospitals have further increased the importance of infection discipline. Wuhan Union Medical College Hospital has planned to set up an infection medical center including diagnosis and treatment center, medical examination and clinical research center of infectious diseases, and set up a negative pressure isolation ward in accordance with the national standards, so as to achieve the purpose of dual-purpose medical treatment and prevention and the combination of peacetime and wartime.

"The Department of infectious diseases is an important and inseparable part of the hospital." Li Wei, deputy chief physician of the Department of infectious diseases of Wuhan Union Medical College Hospital, believes that as a modern general hospital, the infectious diseases department should undertake the tasks of antibiotic management, early identification of emerging infectious diseases, treatment of severe infections, cooperation with the hospital infection department to formulate nosocomial infection control scheme, and better scientific docking with local disease control departments at all levels, and strengthening prevention and control cooperation Mission. Powerful large-scale general hospitals also need to be equipped with second-generation sequencing related equipment, with the ability to detect new and rare pathogens, improve the level of diagnosis and treatment of infectious diseases, and reach the international leading level.

"In the future, as the clinical front-line of prevention and control, large comprehensive hospitals have the ability to do second-generation sequencing, timely issue scientific and authoritative reports to assess the infectivity and harmfulness of the disease, which not only can better targeted treatment, but also has great significance for controlling the spread of disease and protecting people's health." Li Wei said.

Talent training "combination of peacetime and wartime"

In addition to strengthening and improving the emergency system mechanism and hardware construction, the training and reserve of talents in medical "new infrastructure" is the key. The epidemic situation has also exposed the shortcomings of infectious diseases departments in some areas. The construction of critical rescue capacity of infectious disease hospitals needs to be improved from the aspects of basic discipline setting and talent team construction.

On May 26, 2020, the Ministry of Education issued the "notice on the central financial support for the central and western rural order oriented free undergraduate medical students' enrollment and training in 2020", which clearly defined that 6822 students with five-year medical order oriented free of charge would be trained in 2020, 122 more than that in 2019. At the same time, the enrollment expansion of the Ministry of education in 2020 will also focus on clinical medicine, public health and other fields.

On the other hand, many comprehensive colleges and universities also actively carry out the construction of medical related disciplines. This year, many first-class universities have set up medical related colleges to focus on the construction of medical related disciplines, including East China Normal University, Beijing University of Aeronautics and Astronautics, Tsinghua University, Hainan University, Nanjing Medical University, Southern University of science and technology and Nankai University.

From the perspective of practical needs, hospitals at all levels should carry out overall training of "peacetime and wartime integration" based on the existing medical talent team. Some insiders once pointed out to the 21st century economic reporter that public health emergencies may exist in respiratory tract, gastrointestinal tract, nervous system and other fields. For public emergencies, hospitals need to have a new thinking of "peacetime and wartime integration". For example, young specialists can choose a major specialty direction and an auxiliary specialty direction. For example, anesthesiologists can simultaneously minor in related disciplines, such as ICU departments, and conduct wartime coordination when necessary.

At present, Jinyinhu hospital, the fourth hospital district under construction in Wuhan Union Medical College Hospital, will be constructed and transformed in accordance with the thinking of dealing with large-scale public health events, and a center integrating clinical treatment, scientific research and personnel training will be set up in the hospital to deal with public health and safety incidents.

 

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