老年人社区应急管理现状及研究进展

doi:10.12114/j.issn.1007-9572.2021.00.276

摘要/Abstract

摘要： 随着全球人口老龄化逐渐加重、老年人慢性病患病率增高且慢性病急性发作和意外伤害事件增多，老年患者对急救医疗资源的需求也随之增加。传统的以医院为中心的救护模式存在空诊率高、呼叫反应时间长、非急危重呼叫者占用大量院前急救医疗资源等诸多问题，结合目前所倡导的分级诊疗大趋势，社区在老年院前急救管理中发挥的监测预警、现场处理-紧急调度和健康教育等作用逐渐受到重视。这些在国外已有较好的实践，在我国虽然已有不少学者提出了初步的想法与建议，但在实践方面，还有很大的发展空间。本文通过对社区在老年应急管理中承担的以上3个主要方面的作用进行阐述，以期为发挥社区在老龄化社会中老年人急症发作和意外伤害时应急处理方面的作用提供借鉴。

关键词: 社区卫生服务, 老年人, 院前急救, 院前应急管理, 社区急救, 综述

Abstract:

Due to high chronic disease prevalence and attacks as well as high incidence of injuries, the needs of emergency care resources are growing in the increasing number of older people. The traditional hospital-based emergency care in China has many limitations, such as high rate of invalid ambulance attendance in prehospital emergency care, long ambulance response time, and the occupation of a great amount of emergency care resources by non-urgent callers. Against the background of advocating tiered diagnosis and treatment, communities have been increasingly appreciated for their roles in prehospital emergency care for older adults, including monitoring and early warning, emergency dispatch and on-site treatment, and health education. In foreign countries, communities have demonstrated better practice. In China, despite many scholars' implementation recommendations, communities still have a lot of room for development. We reviewed the advances in above-mentioned three roles of communities in prehospital emergency care for older people, providing insights into the use of communities for emergency care in an aging society.

Key words: Community health services, Aged, Prehospital first aid, Emergency management, Paramedicine, Review

中图分类号:

R197

李如月,吴超. 老年人社区应急管理现状及研究进展[J]. 中国全科医学, 2022, 25(04): 510-514. DOI: 10.12114/j.issn.1007-9572.2021.00.276.

LI Ruyue, WU Chao.

Community-based Emergency Care for Older Adults: Current Status in China and International Research Advances [J]. Chinese General Practice, 2022, 25(04): 510-514.

参考文献 50

[1]	World Health Organization. Aging：aging and health[EB/OL]. （2018-02-05）[2021-01-12]. .
[2]	冯俏彬. 全面建成小康社会后经济社会发展十大展望[N]. 中国经济时报，2020-12-04（04）.
[3]	KANASI E, AYILAVARAPU S, JONES J. The aging population：demographics and the aging biology of aging[J]. Periodontol，2000，72(1):13-18.
[4]	Centers for Disease Control and Prevention. Public health and aging：trends in Aging-United States and worldwide[EB/OL]. （2003-02-14）[2021-01-12]. .
[5]	OSBORN R, DOTY M M, MOULDS D，et al. Older Americans were sicker and faced more financial barriers to health care than counterparts in other countries[J]. Health Aff（Millwood），2017，36(12):2123-2132. DOI：10.1377/hlthaff.2017.1048.
[6]	BURTON E, LEWIN G, O'CONNELL H，et al. Falls prevention in community care：10 years on[J]. Clin Interv Aging，2018，13:261-269. DOI：10.2147/CIA.S153687.
[7]	GOLDSTEIN J, JENSEN J L, CARTER A J，et al. The epidemiology of prehospital emergency responses for older adults in a provincial EMS system[J]. CJEM，2015，17(5):491-496. DOI：10.1017/cem.2015.20.
[8]	KAHN J H, MAGAURAN B G, OLSHAKER J S，et al. Current trends in geriatric emergency medicine[J]. Emerg Med Clin North Am，2016，34(3):435-452. DOI：10.1016/j.emc.2016.04.014.
[9]	SHANKAR K N, BHATIA B K, SCHUUR J D. Toward patient-centered care：a systematic review of older adults' views of quality emergency care[J]. Ann Emerg Med，2014，63(5):529-550. DOI：10.1016/j.annemergmed.2013.07.509.
[10]	HASTINGS S N, WHITSON H E, SLOANE R，et al. Using the past to predict the future：latent class analysis of patterns of health service use of older adults in the emergency department[J]. J Am Geriatr Soc，2014，62(4):711-715. DOI：10.1111/jgs.12746.
[11]	王亚东，关丽征，彭迎春，等. 社区卫生服务在院前急救网络中的作用[J]. 中华医院管理杂志，2007，23(12):811-813. DOI：10.3760/j.issn:1000-6672.2007.12.006.
[12]	王明飞，肖晓兰. 某城区635例院前死亡病例分析和院前急救探讨[J]. 中国病案，2014，15(6):33-35. DOI：10.3969/j.issn.1672-2566.2014.06.014.
[13]	胡苏珍. 社区居民自救互救体系的建立与实施[D]. 上海：复旦大学，2012.
[14]	柳俊. 以社区卫生机构为依托的城市院前急救体系研究[D]. 武汉：华中科技大学，2011.
[15]	CHAN P S, MCNALLY B, TANG F，et al. Recent trends in survival from out-of-hospital cardiac arrest in the United States[J]. Circulation，2014，130(21):1876-1882. DOI：10.1161/CIRCULATIONAHA.114.009711.
[16]	VILLANI M, NANAYAKKARA N, RANASINHA S，et al. Utilisation of prehospital emergency medical services for hyperglycaemia：a community-based observational study[J]. PLoS One，2017，12(8):e0182413. DOI：10.1371/journal.pone.0182413.
[17]	魏奕星. "云健康"监测与智能预警系统的市场分析[J]. 电子商务，2014，21(6):11-12. DOI：10.14011/j.cnki.dzsw.2014.06.027.
[18]	CAMERON P A, JOSEPH A P, MCCARTHY S M. Access block can be managed[J]. Med J Australia，2009，190(7):364-368. DOI：10.5694/j.1326-5377.2009.tb02449.x.
[19]	MEISCHKE H, FAHRENBRUCH C, IKE B，et al. Feasibility of partnering with emergency medical services to identify people at risk for uncontrolled high blood pressure[J]. Prev Chronic Dis，2012，9:e48.
[20]	陈先辉，孙国平，罗建业，等. 基于三网融合的社区精神病患者及高危人群健康管理模式的构建研究[J]. 实用心脑肺血管病杂志，2015，23(4):155-158.
[21]	苏明亮，王士泉，李伟. 基于主动健康访问技术的医养结合智能综合服务管理平台研究[J]. 医疗卫生装备，2019，40(6):31-35. DOI：10.19745/j.1003-8868.2019137.
[22]	邓卫国，邓维，欧红梅. 基层社区院前急救疾病谱7 814例分析[J]. 中国现代医生，2014，52(22):68-70.
[23]	KANT R E, VEJAR M, PARNES B，et al. Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program[J]. Geriatr Nurs，2018，39(5):574-579. DOI：10.1016/j.gerinurse.2018.04.003.
[24]	DAINTY K N, SEATON M B, DRENNAN I R，et al. Home visit-based community paramedicine and its potential role in improving patient-centered primary care：a grounded theory study and framework[J]. Health Serv Res，2018，53(5):3455-3470. DOI：10.1111/1475-6773.12855.
[25]	CHELLAPPA D K, DECHERRIE L V, ESCOBAR C，et al. Supporting the on-call primary care physician with community paramedicine[J]. Intern Med J，2018，48(10):1261-1264. DOI：10.1111/imj.14049.
[26]	WILSON M H, HABIG K, WRIGHT C，et al. Pre-hospital emergency medicine[J]. Lancet，2015，386(10012):2526-2534. DOI：10.1016/S0140-6736(15)00985-X.
[27]	NOLAN M J, NOLAN K E, SINHA S K. Community paramedicine is growing in impact and potential[J]. CMAJ，2018，190(21):e636-637. DOI：10.1503/cmaj.180642.
[28]	DYSON K, BRAY J E, SMITH K，et al. Paramedic exposure to out-of-hospital cardiac arrest resuscitation is associated with patient survival[J]. Circ Cardiovasc Qual Outcomes，2016，9(2):154-160. DOI：10.1161/CIRCOUTCOMES.115.002317.
[29]	侯晋，周晟劼，李波. 基于急诊胸痛中心概念的远程急救系统探索与研究[J]. 中国数字医学，2017，12(3):83-85.
[30]	黄远泉，丘锦彪，周育瑾，等. 深圳地区社区健康服务中心上转院前急救患者病种、病情分析[J]. 中国社区医师，2014，30(8):156-157,159. DOI：10.3969/j.issn.1007-614x.2014.8.99.
[31]	张亚杰，于波心，李铁刚. 社区老年病人院前急救现状及研究进展[J]. 实用老年医学，2018，32(8):707-709. DOI：10.3969/j.issn.1003-9198.2018.08.003.
[32]	李超红，陶雨婷，曲新凯，等. 社区联动下胸痛患者院前救治体系的实践与思考[J]. 中国医院管理，2018，38(3):29-31.
[33]	CHIANG W C, KO P C, CHANG A M，et al. Bystander-initiated CPR in an Asian metropolitan：does the socioeconomic status matter[J]. Resuscitation，2014，85(1):53-58. DOI：10.1016/j.resuscitation.2013.07.033.
[34]	TANIGAWA K, IWAMI T, NISHIYAMA C，et al. Are trained individuals more likely to perform bystander CPR? An observational study[J]. Resuscitation，2011，82(5):523-528. DOI：10.1016/j.resuscitation.2011.01.027.
[35]	SHANNON C. Understanding community-level disaster and emergency response preparedness[J]. Disaster Med Public Health Prep，2015，9(3):239-244. DOI：10.1017/dmp.2015.28.
[36]	HUNT M L, JONES M S, SECULA D. Are Kentucky farmers prepared for farm-related emergencies[J]. J Agromedicine，2019，24(1):9-14. DOI：10.1080/1059924X.2018.1536571.
[37]	张卫红，袁慧琳，靳岩鹏，等. 社区老年人居家养老服务需求及影响因素[J]. 中国老年学杂志，2016，36(12):3032-3033. DOI：10.3969/j.issn.1005-9202.2016.12.098.
[38]	蔡少莲，杜娟. 社区老年人对院前急救知识的认知及需求调查研究[J]. 护理研究，2017，31(22):2757-2760.
[39]	陈静，石晓燕. 社区老年人急救护理的现状与研究进展[J]. 世界最新医学信息文摘，2017，17(71):197. DOI：10.19613/j.cnki.1671-3141.2017.71.172.
[40]	AGARWAL G, ANGELES R, PIRRIE M，et al. Reducing 9-1-1 emergency medical service calls by implementing a community paramedicine program for vulnerable older adults in public housing in canada：a multi-site cluster randomized controlled trial[J]. Prehosp Emerg Care，2019，23(5):718-729. DOI：10.1080/10903127.2019.1566421.
[41]	JACOBS L M, BURNS K J, MCSWAIN N，et al. Initial management of mass-casualty incidents due to firearms：improving survival[J]. Bull Am Coll Surg，2013，98(6):10-13.
[42]	TATEBE L, SPEEDY S, KANG D，et al. Empowering bystanders to intervene：trauma responders unify to empower（TRUE） communities[J]. J Surg Res，2019，238:255-264. DOI：10.1016/j.jss.2019.02.029.
[43]	JORM A F, KITCHENER B A, REAVLEY N J. Mental health first aid training：lessons learned from the global spread of a community education program[J]. World Psychiatry，2019，18(2):142-143. DOI：10.1002/wps.20621.
[44]	BURTON E, LEWIN G, O'CONNELL H，et al. Can community care workers deliver a falls prevention exercise program? A feasibility study[J]. Clin Interv Aging，2018，13:485-495. DOI：10.2147/CIA.S162728.
[45]	LAORAKSAWONG P, SANPOOL O, RODPAI R，et al. Impact of the health education and preventive equipment package（HEPEP） on prevention of strongyloides stercoralis infection among rural communities in Northeast Thailand：a cluster randomized controlled trial[J]. BMC Public Health，2018，18(1):1184. DOI：10.1186/s12889-018-6081-6.
[46]	AL-SANE M, BOURISLY N, ALMULLA T，et al. Laypeoples' preferred sources of health information on the emergency management of tooth avulsion[J]. Dent Traumatol，2011，27(6):432-437. DOI：10.1111/j.1600-9657.2011.1025.x.
[47]	朱青，郑夏静，谢嘉欣，等. 基于Delphi法的社区老年人应急准备教育指标体系研究[J]. 护理学杂志，2018，33(12):70-73. DOI：10.3870/j.issn.1001-4152.2018.12.070.
[48]	杜晶，杨新伟，张鹭鹭. 国内外院前急救社区化[J]. 解放军医院管理杂志，2018，25(9):835-838. DOI：10.16770/j.cnki.1008-9985.2018.09.011.
[49]	CLARKE C S, ROUND J, MORRIS S，et al. Exploring the relationship between frequent internet use and health and social care resource use in a community-based cohort of older adults：an observational study in primary care[J]. BMJ Open，2017，7(7):1-8. DOI：10.1136/bmjopen-2017-015839.
[50]	李超凡. 公共卫生突发事件的社区卫生服务保障体系研究[D]. 西安：西北农林科技大学，2013.