當(dāng)前院前急救中可能引發(fā)法律糾紛的幾個(gè)問(wèn)題

當(dāng)前院前急救中可能引發(fā)法律糾紛的幾個(gè)問(wèn)題

?？谑行l(wèi)生局呂傳柱馬維秋海口市120急救中心黃航IssuesMayRaiseLegalDisputesInPrehospitalEmergencyMedicalService

Presentedby:Prof.LuChuan-ZhuHaikouMunicipalHealthBureau,ChinaLuChuanzhuMD

Professor,SenionrConsultantDoctor

ExpertanWinnerofSpecialGovernmentAllowanceofStateDepartment

TutorforMasterDegreeStudent

DirectorGeneral&PartySecretaryofHealthBureauofHaiou

DirectorofHaikouEmergencyCenter

MemberofTheInternationalAssistanceCenterofMinistryofHealth,P.R.C

ViceChairmanofTheEmergencyMedicalCenter(FirstAidStation)BranchforChineseHospitalAssociation

BranchofChinaMedicalInstitute

EditorofChinaEmergencyMedicineJournal

EditorofChinaPracticalSurgicalMedicineJournal

MemberofAmericanCollegeofEmergencyPhysicians

MemberofSocietyofCriticalCareMedicine(U.S.A)

ChiefAdvisorofEmergencyMedicalServiceSystem,ChinaBranch

MBAofUniversityofWalesCollege,Newport

前言Preface沒(méi)有規(guī)矩不成方圓Norulesnostandards前言中國(guó)院前急救開(kāi)展的第一階段單純的救護(hù)車(chē)轉(zhuǎn)運(yùn)

PrefacethefirststageinprehospitalemergencydevelopmentinChinaonlytransportingbyambulance前言中國(guó)院前急救開(kāi)展的第二階段獨(dú)立型院前型依托型指揮型PrefacethesecondstageinprehospitalemergencydevelopmentinChinaIndependencemodelPrehospitalmodelDependencemodelCommandmodel前言中國(guó)院前急救開(kāi)展的第三階段信息通暢、分布合理、覆蓋全面PrefacethethirdstageinprehospitalemergencydevelopmentinChina

unblockeccommunication,reasonabledistributing,completecovering

.前言Preface可喜的局面Goodsituation

令人為難的局面Awkwardsituation前言Preface相關(guān)的各種法律規(guī)章的建設(shè)的滯后和缺失

急救中心被推上被告席的事件屢屢發(fā)生，并呈上升趨勢(shì)。

公眾需求的增加，對(duì)院前急救了解的深入，維權(quán)意識(shí)的增強(qiáng)院前急救的內(nèi)涵建設(shè)水平參差不齊++1問(wèn)題與現(xiàn)象1.1院前急救的可及性和公平性問(wèn)題1.1.1急救半徑如何設(shè)置一個(gè)急救半徑才適宜，沒(méi)有統(tǒng)一的標(biāo)準(zhǔn)!1ProblemsandPhenomena

1.1AvailabilityandJusticeInPrehospitalEmergency1.1.1EmergencyRadius

ConsiderWhatWehaveConsiderhowtobestsolvethepatients’problems

設(shè)置了合理的半徑

政府為到達(dá)此半徑而加大投入運(yùn)作模式為到達(dá)此半徑而進(jìn)行修改和調(diào)整管理為到達(dá)此半徑而強(qiáng)化內(nèi)涵建設(shè)為到達(dá)此半徑而加強(qiáng)公眾平時(shí)就被告知他所居住的城市政府能夠提供的院前急救半徑最大是多少

減少了早到、晚到的爭(zhēng)執(zhí)

準(zhǔn)那么當(dāng)然是越短越好但是要考慮到現(xiàn)有的資源水平要考慮到最大限度的為病人解決問(wèn)題1.1.2院前急救有限資源與根本需求的平衡點(diǎn)在哪里？電腦排隊(duì)人工接聽(tīng)？取舍和利用要謹(jǐn)慎，要有法律和規(guī)章的依據(jù)

？1.1.3回車(chē)率急救中心是否有權(quán)力回絕一個(gè)患者的呼救？1％1‰＞目標(biāo)對(duì)于日常的急救消滅回車(chē)率

？1ProblemsandPhenomena

DoTheEmergencyCentershaverightstorefuseapatient’scalling?1.1AvailabilityandJusticeInPrehospitalEmergency1.1.3Non-ambulancesRate1.2從業(yè)人員的資格執(zhí)業(yè)地點(diǎn)執(zhí)業(yè)范圍重要要素普通外科醫(yī)生泌尿外科醫(yī)生骨科醫(yī)生心內(nèi)科醫(yī)生神經(jīng)內(nèi)科醫(yī)生呼吸內(nèi)科醫(yī)生婦產(chǎn)科醫(yī)生…………急診科輪轉(zhuǎn)？院前急救1ProblemsandPhenomena1.2QualificationSurgeonsurologistsOrthopaedicsdoctorscardiologistsneurologistsRespiratoryspecialistsObstetriciansandGynaecologists…………ERRotations？PrehospitalEmergency非常不利于急救中心的專(zhuān)業(yè)化建設(shè)和正常的業(yè)務(wù)開(kāi)展分區(qū)劃片

非急救專(zhuān)業(yè)的醫(yī)生院前急救的特點(diǎn)標(biāo)準(zhǔn)、合理、有效、快速、正確、盡可能完美的現(xiàn)場(chǎng)處置行為顯得格外重要。而遺憾的是，目前很難做到這一點(diǎn)。1ProblemsandPhenomena1.3TechnicalCriteriainPrehospitalEmergencyEmergencyMeasuresCriteria，Rationality，effectiveness，Speedinessandexactnessareimportantinon-spotmanagement.

Regretfully,it’sdifficulttodothesenow.

1.3.2急救文書(shū)社會(huì)形象和公信力令人堪憂(yōu)！

客觀？真實(shí)？憑證？1ProblemsandPhenomena1.3TechnicalCreterionsinPrehospitalEmergencyEmergencydocumentationImpersonality?Truthfulness?Proof?1.4信息對(duì)稱(chēng)醫(yī)療措施的緊急性和患者病情的復(fù)雜性、多變性患者或其家屬無(wú)法實(shí)時(shí)的、全面的了解所有的細(xì)節(jié)盲目的附和或拒絕醫(yī)生的建議

知情同意難以進(jìn)行或?qū)嵸|(zhì)性地進(jìn)行

1ProblemsandPhenomena1.4SymmetricalinformationUrgencyofmedicalmanagementandthecomplexityandlevityofthepatientsThepatientsortheirrealtivescan’tknowallthedetailswithrealtime

EyelessagreementorrefusalofDoctor’sadvice

Beinginformedtogetagreementsishardtoimplement

1.5院前急救中的公正性患者的權(quán)力和義務(wù)醫(yī)生的權(quán)力和義務(wù)1ProblemsandPhenomena1.5JusticePatients’rightsandResponsibilitiesDoctors’srightsandResponsibilities惡意欠費(fèi)成為諸多問(wèn)題的始發(fā)因素

1.6急救中心〔站〕的建設(shè)標(biāo)準(zhǔn)和急救裝備的配置標(biāo)準(zhǔn)尚無(wú)一個(gè)權(quán)威、統(tǒng)一的標(biāo)準(zhǔn)！

急救中心〔站〕的建設(shè)標(biāo)準(zhǔn)占地和建筑面積指揮系統(tǒng)的完善程度人員的配備急救分中心、急救站的設(shè)置規(guī)模急救值班車(chē)和備用車(chē)的設(shè)定數(shù)量急救車(chē)輛類(lèi)型車(chē)內(nèi)人員數(shù)量和資質(zhì)設(shè)備、器械、消耗品的配備1ProblemsandPhenomena1.6EnergencyCenters’ConstructionstandardsandEquipments’standards.2解決途徑和方向

2.1當(dāng)務(wù)之急應(yīng)是從根本上解決專(zhuān)業(yè)化問(wèn)題2SolutionsandDirections2.1ThemostimportantthingisSolvingtheissueofspecialization模式之爭(zhēng)

專(zhuān)業(yè)化與非專(zhuān)業(yè)化之爭(zhēng)

EMSS應(yīng)該建立完整職能的社會(huì)急救醫(yī)療效勞體系不要僅僅看作是一個(gè)醫(yī)療單位的生存和開(kāi)展的問(wèn)題，它已完全成為表達(dá)政府職責(zé)和任務(wù)的一個(gè)保障和完善社會(huì)開(kāi)展的問(wèn)題，是政府為納稅人和整個(gè)社會(huì)應(yīng)履行的一項(xiàng)義不容辭的職責(zé)。SARS期間，北京急救中心的趙立強(qiáng)、王景琪車(chē)組表現(xiàn)突出。2.2盡快完善急救立法和行業(yè)規(guī)章制度EmergencylegislationandRulesmakingASAP有法可依有章可循

2.3加強(qiáng)專(zhuān)業(yè)教育和培訓(xùn)解除從業(yè)人員后顧之憂(yōu)

2SolutionsandDirections2.3SpecialityEducationandTraining2.4普及急救知識(shí)，提高全民素質(zhì)，提高急救人員和急救中心的公