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Prevention and Decontamination of Chemical, Biological, Radiological, and Nuclear Contaminants for the Emergency Medical Personnel during Ambulance Services 救护车服务期间紧急医疗人员的化学、生物、放射和核污染物的预防和净化
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.146
Dong-min Shin
The first role and responsibility of emergency ambulance service is to provide a resource to save and serve the patient with the highest quality of care. Second, ambulance services are an option to temporarily provide treatment for an injured or exposed patient while removing decontamination. Lastly, rescue the exposed and or injured patient in the most suitable mode of transportation. These roles are all necessary to maintain a high level of confidence in ambulance practices while adhering to proper protocol transfer for a contaminated patient. Chemical, biological, radiological and nuclear defense (often abbreviated as CBRN defense or CBRND) is the term for protective measures taken in situations in which any of these four hazards are present. To account for improvised devices, the term CBRNe (e for explosives) is also used. CBRN defense consists of CBRN passive protection, contamination avoidance and CBRN mitigation [1]. Hanyang Med Rev 2015;35:146-151 http://dx.doi.org/10.7599/hmr.2015.35.3.146
紧急救护服务的首要作用和责任是提供资源,以挽救病人的生命,并为病人提供最高质量的护理。其次,救护车服务是一种选择,可以暂时为受伤或暴露的病人提供治疗,同时去除污染。最后,用最合适的交通工具抢救暴露或受伤的病人。这些角色都是必要的,以保持对救护车实践的高度信心,同时坚持适当的协议转移受污染的病人。化学、生物、辐射和核防御(通常缩写为CBRN防御或CBRND)是指在存在这四种危害中的任何一种情况下采取的防护措施。为了说明临时装置,也使用了术语CBRNe (e代表爆炸物)。CBRN防御包括CBRN被动防护、避免污染和减缓CBRN[1]。汉阳医学,2015;35:146-151 http://dx.doi.org/10.7599/hmr.2015.35.3.146
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引用次数: 2
Disaster Planning in Korea 韩国的灾害规划
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.157
I. S. Yoo
In response to modern events, every nation endeavors to develop plans to meet the challenges of disasters, but it is not possible to be prepared for every event and the ability to respond adequately is often limited. In the Republic of Korea, national disaster response efforts are defined by the Korea Basic Law for Disaster and Safety Management of 2004 and the establishment of the National Emergency Management Agency (NEMA) provides a framework for a holistic disaster prevention and recovery plan. However, the tragedy involving the sinking of the Sewol ferry in 2014 revealed a number of flaws in the current Korean disaster response system. In response to the shortcomings demonstrated in the Sewol incident, both NEMA and the Korean Coast Guard dissolved and the Korean disaster response system is being revised under the creation of the new Ministry of Public Safety and Security. However, the current national disaster management system still has many significant underlying and systematic problems that must be addressed. First, there is confusion concerning the responsible governmental organizations that will handle the various aspects of a comprehensive disaster management plan. Second, the relationships between the laws and government organizations involving planning, managing and reporting are in a vertical relationship, while the entities responsible for the actual response efforts exist in a horizontal relationship. This organizational limitation results in a slowdown of communication and confusion between the responsible parties. Thirdly, and consequently, there is a significant lack of unity and organization between the many organization responsible for disaster response. Finally, an efficient, accurate database of resources available to meet disasters remains to be developed. These and other limitations reveal that there is a significant amount of work that remains in order for Korea to have the same level of disaster response system of other developed nations.
在应对现代事件时,每个国家都努力制定应对灾害挑战的计划,但不可能为每一次事件做好准备,而且充分应对的能力往往有限。在大韩民国,2004年《韩国灾害和安全管理基本法》界定了国家救灾工作,设立国家应急管理局为全面的灾害预防和恢复计划提供了框架。然而,2014年发生的世越号惨案暴露了韩国目前的灾难应对体系存在的诸多缺陷。针对“世越号”事件的缺点,国家防灾厅和海警被解散,韩国的灾难应对体系正在被修改,并成立了新的国民安全处。然而,目前的国家灾害管理制度仍然存在许多重大的潜在和系统性问题,必须加以解决。首先,在负责处理综合灾害管理计划的各个方面的政府组织方面存在混乱。其次,涉及规划、管理和报告的法律与政府组织之间的关系是纵向的,而负责实际应对工作的实体之间的关系是横向的。这种组织上的限制导致了责任方之间沟通的放缓和混乱。第三,因此,许多负责灾难应对的组织之间严重缺乏团结和组织。最后,应对灾害的有效、准确的资源数据库仍有待开发。这些局限性表明,要使韩国的灾害应对体系达到与其他发达国家相同的水平,还有很多工作要做。
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引用次数: 8
Education and Training in Disaster Medicine 灾害医学的教育和培训
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.174
M. Choa, Hyunggoo Kang
Education and training of disaster medicine are the most important part of disaster management. There are so many training and education curriculum all over the world. However education courses based upon core competencies of disaster medicine are lacking. There is still a need to define the specific knowledge, skills, and attitudes that must be mastered by specialized professionals. Standardized core competencies for acute care medical personnel such as emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel are needed to ensure that effective emergency medical response can be provided efficiently during all types of disasters. Therefore education and training curriculum of other countries were reviewed in this article.
灾害医学教育和培训是灾害管理的重要组成部分。世界上有很多培训和教育课程。然而,基于灾害医学核心能力的教育课程缺乏。仍然有必要确定专业人员必须掌握的具体知识、技能和态度。需要急诊科护士、急诊医生和院外紧急医疗服务人员等急症护理医务人员具备标准化的核心能力,以确保在所有类型的灾害期间能够有效地提供有效的紧急医疗反应。因此,本文对其他国家的教育培训课程进行了综述。
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引用次数: 0
The Continuation of Erlotinib Treatment in Non-Small Cell Lung Cancer Patients Whose Brain Lesion Is the Only Site of Progression: Prospective Pilot Study 厄洛替尼在脑损伤为唯一进展部位的非小细胞肺癌患者中的继续治疗:前瞻性先导研究
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.180
K. Yoo, S. Kim, K. Jung, J. Lee, S. Lim, Min-Young Lee, Haesu Kim, H. Kwon, I. Kim, Jong-Mu Sun, J. Ahn, Keunchil Park, M. Ahn
There have been conflicting reports on the continuation of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with newly developed or progressive brain metastasis of non-small cell lung cancer (NSCLC). Patients with newly developed or progressive intracranial lesions, but who maintained well-controlled extracranial disease during erlotinib treatment, were enrolled in this study. The proposed therapy included stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT), and/or surgical resection for intracranial lesions. Erlotinib treatment was continued simultaneously unless extracranial disease progressed. The evaluation of both extra- and intra-cranial lesions was perform ed every 3 months. From October 2009 to June 2012, 14 patients were enrolled in this pilot study. For intracranial disease, 4 patients received SRS alone, 7 patients received both SRS and WBRT, 2 patients received SRS, WBRT and surgical resection, and 1 patient received no local therapy due to the presence of asymptomatic lesions. Of the patients with extracranial disease who were placed on continued erlotinib therapy, 6 patients (42.9%) showed partial response (PR), while 7 patients (50.0%) remained in stable disease (SD). The progression-free survival (PFS) of extracranial and intracranial disease was 11.1 (range 1.6-34.6) and 10.2 (range 1.5-34.6) months, respectively. In 5 cases, brain lesions relapsed before the progression of extracranial disease. Overall survival (OS) was 22.6 (range 2.1-50.4) months. For NSCLC patients with progression of only intracranial disease during erlotinib treatment, the continuation of erlotinib in combination with local therapy to brain metastases can be an effective treatment option.
关于表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKIs)在新发或进展性非小细胞肺癌(NSCLC)脑转移患者中的继续应用的报道存在矛盾。新发生或进展的颅内病变,但在厄洛替尼治疗期间保持良好控制的颅外疾病患者纳入本研究。建议的治疗包括立体定向放射外科(SRS),全脑放疗(WBRT),和/或手术切除颅内病变。厄洛替尼治疗同时继续,除非颅外疾病进展。每3个月评估一次颅外和颅内病变。从2009年10月到2012年6月,14名患者入组了这项初步研究。对于颅内疾病,4例患者单独接受SRS, 7例患者同时接受SRS和WBRT, 2例患者同时接受SRS、WBRT和手术切除,1例患者因无症状病变而未接受局部治疗。在持续厄洛替尼治疗的颅外疾病患者中,6例(42.9%)出现部分缓解(PR), 7例(50.0%)病情保持稳定(SD)。颅外和颅内疾病的无进展生存期(PFS)分别为11.1个月(1.6-34.6个月)和10.2个月(1.5-34.6个月)。5例脑病变在颅内外病变进展前复发。总生存期(OS)为22.6个月(2.1-50.4个月)。对于在厄洛替尼治疗期间仅发生颅内疾病进展的NSCLC患者,厄洛替尼联合局部治疗继续治疗脑转移可能是一种有效的治疗选择。
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引用次数: 0
Emergency Medical Services in Disasters 灾害中的紧急医疗服务
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.136
Chiwon Ahn, Tae-Ho Lim
Disasters, or mass casualty incidents, occurring in modern history differ from those occurring in even the recent past. In previous times, disasters were mostly the result of natural causes such as earthquakes or floods. Currently, multiple casualty incidents are often the result of human actions such as vehicular accidents involving many vehicles with multiple operators, passengers and collateral victims, terror attacks and acts of war, radiation accidents, toxic chemical releases, and pandemic infectious agent exposures. Especially, events involving accidental and intentional exposures of chemical, biological, radiological/nuclear materials, often abbreviated as CBR or CBRN events present unique challenges to the healthcare system in caring for the victims. In these mass casualty incidents, a fully comprehensive, coordinated team response involving many different components of the community healthcare system need to be mobilized to effectively meet the modern challenge of CBRN events. Necessary components of a modern emergency response include training for prompt triage, decontamination, detoxification, emergency medical treatment, as well as providing appropriate transport to the proper medical treatment facility. Meeting these challenges requires maintaining ongoing communications between agencies charged with meeting the disaster to allow acquisition of information and location for the patients, transfer the information to both the Central Medical Emergency Response Center and the designated hospital. While sharing this information was problematic in the past, modern wireless communications and information technologies provide convenient means for the rapid sharing of important patient data and current situational details. Finally, improving modern disaster response requires the development of a disaster response plan, ongoing training in implementing the plan including disaster scenario simulation, and budgeting to acquire the necessary equipment involved for the emergency response personnel to meet the presenting crisis.
现代历史上发生的灾难或大规模伤亡事件甚至与最近发生的事件有所不同。在过去,灾难大多是自然原因造成的,比如地震或洪水。目前,多重伤亡事件往往是人类行为的结果,例如涉及多辆车、多名操作员、乘客和附带受害者的车辆事故、恐怖袭击和战争行为、辐射事故、有毒化学品释放和大流行传染原暴露。特别是,涉及化学、生物、放射性/核材料意外和故意暴露的事件,通常简称为CBR或CBRN事件,对医疗保健系统在照顾受害者方面提出了独特的挑战。在这些大规模伤亡事件中,需要动员一个包括社区卫生系统许多不同组成部分的全面、协调的团队反应,以有效应对CBRN事件的现代挑战。现代应急反应的必要组成部分包括培训迅速分类、去污、解毒、紧急医疗,以及提供适当的运输到适当的医疗设施。应对这些挑战需要负责应对灾难的机构之间保持持续的通信,以便获取患者的信息和位置,并将信息传递给中央医疗应急响应中心和指定医院。虽然在过去共享这些信息是有问题的,但现代无线通信和信息技术为快速共享重要的患者数据和当前情况细节提供了方便的手段。最后,改进现代灾害反应需要制定灾害反应计划,在执行计划方面进行持续培训,包括灾害情景模拟,并编制预算,以获得应急反应人员应对当前危机所需的必要设备。
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引用次数: 3
Disaster Medicine in Korea 韩国的灾难医学
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.121
Tae-Ho Lim
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引用次数: 0
Emergency Medicine in Disasters 灾害中的急救医学
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.124
S. Wang
Disaster medicine and emergency medicine are common in many parts, particularly in the acute stage of disaster, so the role of emergency medicine in disaster is very important. For adequate disaster preparation and response, interest and investment to emergency medical care for emergency and safety issues that deal with most important thing, life conservation, must be made in the future. Specifically, support to the emergency medical centers as disaster base hospitals is necessary for emergency medicine to perform adequate roles in disaster, and it is also necessary to assign the role to the hospital in the area that holds the local risk factors. Because of the poor preparedness for nuclear, chemical or biological disaster in Korea, the important things are the preparation and establishment of infrastructure based on equipment and facilities, related to special type disasters. So the government should support the emergency medical system for the adequate response to disasters as well as individual emergency care.
灾害医学和急诊医学在许多地方都很常见,特别是在灾害的急性阶段,因此急诊医学在灾害中的作用非常重要。为了充分的备灾和救灾,未来必须对处理最重要的事情——生命保护——的紧急医疗和安全问题进行兴趣和投资。具体来说,支持急救医疗中心作为灾害基地医院是急救医学在灾害中充分发挥作用的必要条件,也有必要将这种作用分配给具有当地风险因素的地区的医院。由于韩国对核、化学、生物灾害的准备不足,因此最重要的是以特殊灾害相关的设备和设施为基础的基础设施的准备和建设。因此,政府应该支持应急医疗系统,以充分应对灾害,以及个人急救护理。
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引用次数: 2
Disaster Basic Physics and Disaster Paradigm 灾害基础物理与灾害范式
Pub Date : 2015-08-01 DOI: 10.7599/HMR.2015.35.3.131
Seunghwan Kim
Disasters are unpredictable and unavoidable. The definition of disaster is a serious disruption of the functioning of society, causing widespread human, material, or environmental losses that exceed the ability of affected society to cope using only its own resources. Disaster medicine is a discipline resulting from combination of emergency medicine and disaster management. The field of disaster medicine involves the study of subject matter from multiple medical disciplines, and disaster medicine presents unique ethical situations not seen in other areas of medicine. Disaster can be classified into two categories, natural disaster and manmade disaster, each type of disaster has its own characteristics. Disaster management has a cycle of 4 activities, preparedness, response, recovery, and prevention/ mitigation. Disaster medicine specialists have a role in each part of this cycle. To achieve effective disaster response, the National Disaster Life Support Foundation suggests the DISASTER Paradigm™, which consists of detection, incident command, safety and security, assess hazards, support, triage and treatment, evacuation, and recovery.
灾难是不可预测和不可避免的。灾难的定义是对社会功能的严重破坏,造成广泛的人力、物力或环境损失,超出受影响社会仅凭自身资源应付的能力。灾害医学是急诊医学与灾害管理相结合而形成的一门学科。灾难医学领域涉及多个医学学科的主题研究,灾难医学呈现出其他医学领域所未见的独特伦理状况。灾害可以分为两类,自然灾害和人为灾害,每一类灾害都有自己的特点。灾害管理有四个活动周期:准备、反应、恢复和预防/减轻。灾难医学专家在这一循环的每一部分都发挥着作用。为了实现有效的灾难响应,国家灾难生命支持基金会建议采用灾难范式™,它由探测、事件指挥、安全和保障、评估危险、支持、分类和治疗、疏散和恢复组成。
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引用次数: 2
Sensorineural Hearing Loss: Causes and Hearing Rehabilitation 感音神经性听力损失:原因和听力康复
Pub Date : 2015-05-01 DOI: 10.7599/HMR.2015.35.2.57
M. Baek
Sensorineural hearing loss is one of the most common chronic clinical disorders that we can easily encounter. The etiology of sensorineural hearing loss is multifactorial: congenital, idiopathic, traumatic, noise-induced, head injury induced, infectious disease, drug induced, degenerative, immune di...
感音神经性听力损失是最常见的慢性临床疾病之一,我们很容易遇到。感音神经性听力损失的病因是多因素的:先天性、特发性、外伤性、噪声性、头部损伤性、感染性疾病、药物性、退行性、免疫性等。
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引用次数: 2
Newborn Hearing Loss and Newborn Hearing Screening 新生儿听力损失和新生儿听力筛查
Pub Date : 2015-05-01 DOI: 10.7599/HMR.2015.35.2.72
Su-Kyoung Park
The incidence of bilateral profound hearing loss of newborns is 1 to 2 per 1,000 newborns. It is higher in infants with risk factors for hearing loss. Congenital hearing loss can cause many problems in language, learning, speech development and educational and occupational performance. Most develope...
新生儿双侧深度听力损失的发生率为每1,000名新生儿中有1至2名。在有听力损失风险因素的婴儿中,这一比例更高。先天性听力损失会导致语言、学习、言语发展以及教育和职业表现方面的许多问题。大多数发展……
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引用次数: 8
期刊
Hanyang Medical Reviews
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