Fighting the "epidemic" line
Wearing armor in white to ensure medical treatment for the masses
Industry: Give medical staff more understanding and care
□ Our reporter Wen Yuanhao
In front of the emergency room, the family members of the patients were anxiously pacing and waiting for fear of hearing the broadcast sound of "The family members of the XX patient please come to the conversation room"; there was a long line in front of the emergency department, and the patients crowded the aisle, coughing and groaning. The voices kept coming and going; the doctor at the triage desk couldn't help coughing while asking the doctor, because he hadn't had a sip of water for several hours because he was wearing a face shield and an N95 mask...
This is the scene of the emergency department and rescue room of Jiangsu Provincial People's Hospital at around 4:00 am on December 26.
Recently, my country has optimized and adjusted its prevention and control policies according to the time and situation.
On December 7, the Comprehensive Team of the Joint Prevention and Control Mechanism of the State Council issued the "Notice on Further Optimizing and Implementing the Prevention and Control Measures for the New Coronary Pneumonia Epidemic" (referred to as the "New Ten Measures"); "Class B and B control" is implemented for virus infection.
Recently, the person in charge of epidemic prevention and control in Hainan, Jiangxi, Anhui, Zhejiang and other places revealed that the peak of the first wave of the epidemic is approaching, and the peak is predicted to be from the end of December this year to January next year.
The people are supreme and life is supreme.
Facing the influx of fever patients into the hospital, the vast number of medical staff are fighting on the front line. Many of them return to work as soon as the fever subsides, or even go to work with illness. Love and dedication protect the lives and health of the masses.
In response to the pressure and hardship of medical staff under the situation of high incidence of new coronavirus infection, Shanghai, Zhejiang, Guangdong and other places have successively issued protection and reward policies for medical staff. The policies involve ensuring the working and rest conditions of medical staff, reasonably arranging work tasks, Improve the health monitoring of medical personnel, implement incentive and guarantee policies and other aspects.
"With the arrival of the peak of infections, the peak of severe cases will also arrive." Experts interviewed by reporters from the "Rule of Law Daily" believe that in the face of the increase in the number of infections and the increase in the infection rate of medical staff, the prevention and treatment of severe cases must be placed on the prevention and control of the epidemic First, at the same time, protect medical staff through hierarchical diagnosis and treatment, medical shifts, etc., to avoid further strain on medical resources in the future.
Selfless dedication on the front line
Caring for patients with boundless love
The Fever Clinic of Jiangsu Provincial People's Hospital mainly treats and observes patients with fever and epidemiological history.
"Recently, the number of daily visits has increased significantly," said Zhu Chuanlong, director of the Department of Infectious Diseases.
As the coordinator of the fever clinic, Zhu Chuanlong has always stuck to his post, and he soon became positive.
"70% to 80% of the medical staff in the department have positive symptoms, and they only ask for leave when the symptoms are severe, and half of them insist on going to work. I have to hold on even more." Zhu Chuanlong, with a hoarse voice, told reporters.
At around 11 o'clock in the evening on December 26, he was busy coordinating a bed for a 90-year-old man with a high fever. "This old man is obviously a high-risk group who is prone to develop severe illness. Only by properly handling each such patient can the number of ICU patients be reduced." pressure".
After zero o'clock, Zhu Chuanlong, who had been busy all day, returned to the duty room, swallowed three kinds of pills including antipyretics, sleeping pills, and high blood pressure medicine, and prepared to take a rest and fight again the next day.
The reason why he didn't go home was because his two children, his wife and his parents-in-law all became positive a few days ago. "Always run on the front line, and the risk is more, so as to avoid cross-infection."
On December 12, Lu Ming, director of the Department of Infectious Diseases at Peking University Third Hospital (hereinafter referred to as the Third Hospital of Peking University), developed fever symptoms that night after performing tracheal intubation for two critically ill patients. pain.
"I knew at that time that I had been recruited, and the next day I did an antigen test to confirm that I was infected with the new coronavirus." Lu Ming recalled.
During the sick home rest period, Lu Ming was hardly idle. In addition to phone calls, WeChat and online meetings to deal with hospital and department affairs, he also received online consultations to provide real-time and fast consultation services for patients. He can receive 30 people a day to 50 people.
Lu Ming told reporters that on the basis of the original 24-hour fragmented follow-up service, the Internet Hospital of the Third Hospital of Peking University has added a real-time consultation function, mobilizing medical staff, especially home doctors, to conduct real-time online consultation and provide offline medicine collection. Or the home delivery service of medicines, which effectively alleviates the problem of "difficulty in seeing a doctor" caused by the shortage of manpower.
After the fever subsided, Lu Ming went back to work.
"Although my throat still hurts, and I can't say a few words before coughing, but the department has a lot of work that needs to be rushed back to deal with, there is really no way." Lu Ming said.
Now, he goes to work at 6:30 every morning, coordinates, holds meetings, and sees doctors. He has been busy until late at night, and he has to deal with online consultations before going to bed.
Yao Huaifang, a 55-year-old chief physician at the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, has six half-day outpatient clinics and two morning ward rounds every week.
On December 19, she felt a little uncomfortable when she got up, but after the nucleic acid test, she went to the outpatient clinic as usual, and received the confirmation result when she came back from get off work.
Fever started the next day, and Yao Huaifang was forced to stop the clinic for a week.
While at home, she insisted on seeing patients through the "network hospital", and returned to work immediately after the antigen was negative.
During this time, Xu Ting (pseudonym), the head nurse of a hospital in Hunan, and her colleagues are also staying sick.
On December 22, when she was at work, she felt sore, weak, and chills all over her body, and her body temperature was as high as 39.5°C.
For the next two days, she had a persistent sore throat, body aches, splitting headaches, chills and high fever, and she didn't want to eat.
Xu Ting said: "Although I was physically uncomfortable at the time, I still hope that the course of the disease will not be too long and the symptoms will not be too severe. Otherwise, how can I go to this class and what will I do with so many patients?" She insisted on finishing the day's class and staying at home the next day After a day off, he quickly returned to work.
On December 24, the first day back to work, she worked for 16 consecutive hours before leaving get off work.
At 22:57 on the same day, she posted a message on Moments at the hospital as a souvenir: The Smurfs have not even had time to drink a sip of water since they went to work, we have all worked hard!
Salute to all those who silently contributed to the fight against the epidemic.
Implement 24-hour shift system
Maximum protection for medical treatment
Lu Ming said that since December 8, the number of fever patients in the Third Hospital of Beijing Medical University has shown a short-term rapid growth: in the past, the daily number of fever clinics was about 150 people, and during this period it reached more than 600 people, and now it is about 300 people a day. people.
At the same time, Lu Ming's colleagues were also infected one after another, and about 80% of them have returned to work.
"After 15 doctors in our department fell ill, colleagues from other departments came to support. There were fifty or sixty people. They also became positive within a few days after they came. At night, my colleagues said that he fell ill and had to find another person to take his shift." Lu Ming said.
In his view, the most important thing at present is to strengthen the treatment of severe cases of the new crown and reduce the death caused by severe cases.
Facing the current situation of a large number of patients and medical staff being infected, how can we avoid and alleviate the pressure of medical runs?
Lu Ming introduced that in order to cope with the increase in fever patients, the Third Hospital of Beijing Medical University has uniformly mobilized medical staff to support fever clinics, opened additional consultation rooms, established fever shelter consultation rooms, and further improved the capacity of receiving patients. Medical staff implemented 24-hour shifts.
At the same time, to give full play to the role of limited medical resources, personnel with senior professional titles will work on the front line, increase the number of intensive care units, optimize equipment and staffing, and ensure that critically ill patients can be treated in a timely manner.
Reserve human resources above the chief resident physician level to conduct fever diagnosis and treatment procedures, critical illness treatment, nosocomial infection protection training and assessment, to deal with the shortage of emergency and fever clinic staff, and to ensure patients' medical treatment to the greatest extent.
In addition, the Third Hospital of Peking University has also strengthened the medical security for the elderly, children, patients with underlying diseases, pregnant women, hemodialysis patients and other groups.
As the National Clinical Research Center for Obstetrics and Gynecology and the Beijing Medical Center for the Treatment of Critically Ill Pregnant Women, the Third Hospital of Peking University undertakes the treatment of a large number of critically ill and febrile pregnant women.
To this end, the hospital optimized the medical treatment process for febrile pregnant women and set up a temporary special clinic area to facilitate febrile pregnant women to see a doctor.
As the referral center for critically ill newborns in Beijing, the hospital continues to provide medical treatment for critically ill newborns, and the wards are divided into different areas to ensure the safety of the children.
In the past three years, the emergency department and fever clinic of Jiangsu Provincial People's Hospital have not been "closed" for a day due to the epidemic.
Recently, in the face of the surge of fever clinics and emergency patients, the hospital adjusted its strategic deployment in a timely manner, adopted the strategy of "integrated management of fever clinics and emergency departments", coordinated resources, optimized processes, and handed over fever clinics to emergency care. You can get "one-stop service", which not only reduces the rush of patients' triage and referral, but also ensures the continuity of diagnosis and treatment.
"As for how to centralize the treatment, the hospital made a 'preemptive move' in our department." Zhu Chuanlong said that the infection building is located on the southernmost side of the hospital and is relatively independent. The general diagnosis and treatment area and wards have been quickly converted and remodeled, and 90 beds have been expanded on the second and third floors of the fever clinic.
At present, all infection buildings are used as fever clinics and observation wards. At the same time, the arrangement of medical and nursing forces is coordinated and optimized to treat patients infected with the new coronavirus.
Since the outbreak of the epidemic, as the last line of defense for life, many critically ill patients have been admitted to the ICU.
Cao Quan, Director of the ICU Department of Jiangsu Provincial People's Hospital, has always stuck to his post. Although he was also infected with the new crown virus a few days ago, there was no delay in ward rounds and consultations.
"There are 19 doctors in the department, and 16 of them are positive. Those with mild symptoms have gradually returned to work to replace those with severe symptoms. At present, 9 doctors are on duty, of which 6 are sick and have to bear the same workload as before. .” Cao Quan said.
Facing the dilemma of manpower shortage, the nurses in the ICU also carried it down with a lot of strength.
There are 73 nurses infected with the new crown virus, plus 9 who are on sick leave and maternity leave, accounting for 84% of the total staff.
More than 20 nurses returned to work immediately after only one or two days off after being sick. The 24 nurses who were not infected continued to work during the week from December 16 to 22 without a day off.
"70% of the nurses in the ICU participated in the fight against the epidemic in Wuhan. The hardships and perseverance during that period are still vivid in my memory three years later. The challenges and difficulties we are facing now are not weaker than those at that time." ICU Department of Jiangsu Provincial People's Hospital The head nurse, Liu Ying, sent the photo of the letter of invitation with red fingerprints on it to her colleagues again, "At that time, everyone overcame their fear little by little and persisted until the end. This time we will definitely be able to."
Scientific allocation of medical resources
Caring for medical staff
"Almost all the medical staff in our department have been infected, and the virus is not friendly to medical staff at all. However, waves of patients continue to pour into the hospital, and we must stick to it." When interviewed by reporters, Xu Ting kept coughing and her tone was full of exhaustion.
Xu Ting said: "Our hospital stipulates that after infection, you can rest for 3 days, but in fact it is 'minor injuries can't go to the line of fire'. It is like this from top to bottom. Some doctors have not had a day off."
On December 22, a nurse from a hospital in Wenzhou, Zhejiang was dragging her exhausted body and sitting in the nurse's station. Her colleagues found that she was not moving and did not respond to calling her, so they hurriedly called other medical staff to rescue her.
It turned out that the nurse fainted due to continuous high-intensity work shock, and was out of danger after rescue.
With the rapid increase in the number of infections in various places, medical institutions are facing tremendous pressure. Many hospitals have issued documents advocating that medical staff should not go to the line of fire for minor injuries and "persist in spite of illness".
While people were moved, they also called for greater protection of the rights and interests of medical personnel.
In order to better protect medical staff with high workloads, Shanghai, Zhejiang, Dongguan, Guangdong and other places have successively introduced protection and reward policies for medical staff.
The Shanghai Municipal Health and Health Commission recently released the "Opinions on Ensuring the Strength of Front-line Medical Personnel Against the Epidemic", proposing that in terms of implementing performance incentives, medical institutions at the city and district levels should directly participate in the front-line work of epidemic prevention and treatment of new coronavirus infection. Relevant subsidies are issued to medical personnel.
Zhejiang Province issued the "Notice on Further Implementing the Incentive and Guarantee Policy for Caring and Caring Medical Personnel", which includes the verification and increase of the total amount of one-time performance wages, temporary work subsidies, guarantee of grassroots medical and health institutions, assessment and evaluation and advanced awards, professional title review and post There are specific requirements for promotion measures, medical personnel's work and life guarantee, and medical and health institution operation guarantee.
The Medical Rescue Team of the Dongguan New Coronary Pneumonia Epidemic Prevention and Control Command Office issued the "Guidelines for Health and Epidemic Prevention and Care and Care for Staff of Medical Institutions in Dongguan", which clearly put forward the implementation of care and care measures, and implemented temporary work subsidies, performance-based wages and other incentives in accordance with regulations policy.
Increase efforts to publicize the professionalism of medical personnel, and commend and reward advanced models.
In order to alleviate the shortage of grassroots medical personnel, in accordance with the deployment of the joint prevention and control mechanism of the State Council, all localities can recruit medical personnel who have retired in the past five years to return to their posts.
Hospitals around the world have also increased their care for medical staff.
Lu Ming recalled that when he returned home after being infected, he infected all his family members. The family of five had fevers one after another, especially when his 74-year-old mother had to be hospitalized for pneumonia. He felt very uncomfortable during that time.
"At that time, I was busy with the affairs of the hospital, and I fell ill quite suddenly. I didn't have many medicines at home, especially after the whole family had a fever, and there was not enough antipyretic medicine. Fortunately, our hospital labor union organized a 'delivery of medicines to home', I was in a low mood at the time, but after receiving the medicine, I felt warm and empowered," Lu Ming said.
"In addition to their occupations, medical staff are also ordinary people who can be infected." Lu Ming said with deep emotion.
Yao Huaifang said that under unavoidable circumstances, some medical staff went to work with illnesses, but they must pay attention to protection.
She called on the whole society to care for and care for medical staff, and appropriately improve their treatment.
At present, if the physical condition is not good, the hospital should not force him to continue to work, otherwise the health will be destroyed, and the follow-up medical resources will be even more insufficient.
At the same time, I hope that patients can understand more about medical staff, be able to empathize, and be considerate of each other.
"The work is intense and stressful, and it is very necessary to strengthen psychological counseling. When this wave of epidemics passes, front-line medical staff in fever clinics and emergency departments need to do a good job of psychological counseling." Lu Ming said.
In this regard, Liang Jialin, editor-in-chief of the "Healthy National Policy 2050" academic platform, suggested that local governments should supervise the implementation of epidemic prevention subsidies and allowances for front-line medical staff, and at the same time use the time difference between the peak of infection to mobilize doctors from other places, retired medical staff, and residents who are waiting to graduate We will provide support to key areas and ensure that medical staff take short breaks.
Wang Yue, a professor at the School of Medical Humanities at Peking University, believes that in order to avoid running out of medical resources and reduce the burden on medical staff, medical resources should be allocated scientifically, and both the treatment of people infected with the new crown and the guarantee of daily medical services should be coordinated.
"The vast majority of patients should get self-healing and eventually recover in the family and basic medical institutions through the method of 'home + primary medical institutions + Internet medical care'." Wang Yue said that all localities should explore and improve diagnosis and testing according to local conditions. Measures such as admission, treatment, and isolation, give full play to the role of grassroots social organizations, and actively cooperate with the prevention and control of the epidemic; make good use of Internet medical resources to optimize the uneven distribution of medical resources.
Wang Yue suggested that after the diagnosis, the infected should be treated in different categories.
For ordinary, severe and risky infected persons, they should be admitted to designated tertiary hospitals for treatment in a timely manner; mild and asymptomatic infected persons should be mainly resolved through "home + grassroots medical institutions + Internet medical care".
Wang Yue also mentioned that during the peak period of the epidemic, tertiary hospitals should mobilize some non-emergency and critical medical resources to meet the needs of intensive care beds, and focus on preparing for the treatment of severe cases of new crown infection combined with basic diseases; further improve the prevention and control of nosocomial infections Work and maintain the stability of the medical team.
(Rule of Law Daily)