The reporter visited Beijing street communities, emergency centers and hospitals on the spot
How to keep healthy and prevent serious illness
Reporter Han Yadong Guan Xiaopu
As the focus of epidemic prevention and control shifts from infection prevention and control to medical treatment, how to carry out work related to health care and prevention of severe illness?
How to keep the "lifeline" unobstructed?
Middle-aged and elderly people are susceptible and high-risk groups of the new crown, how to race against time for treatment?
The reporter visited Beijing street communities, emergency centers, hospitals and other places to conduct interviews and reports.
Street community:
Daily calls with empty-nesters, set up a WeChat group for seeking medical advice, and family doctor team visits for consultations... Upgrade the resident personnel booklet to the key service object booklet
Recently, the family doctor team of the Beijing-directed Community Health Service Station in Fengtai District received an emergency call: Aunt Jiang, an elderly person living alone in the community, suddenly felt unwell and had convulsions in her hands and feet.
The family doctor team notified the situation to the Subdistrict People's Livelihood Office and Guogongzhuang North Street Working Group.
Ten minutes later, the community workers of the Guogongzhuang North Street Working Group, together with the property staff and the medical staff of the health service station, came to the elderly's home.
Sub-district People's Livelihood Office, Community Office, Safety Office and other departments also immediately contacted the emergency support vehicle to stand by and communicate at any time to understand the situation on the scene.
The family doctor team diagnosed and treated Aunt Jiang on the spot, and brought medicines in time.
The community workers contacted Aunt Jiang's family members, and accompanied Aunt Jiang all the way while waiting for her family members to help her relieve her emotions.
After diagnosis and treatment, Aunt Jiang's condition has basically stabilized.
Many medical staff told reporters that the threshold of "prevention" is very important. For example, the publicity of relevant knowledge by the whole society and timely intervention at the community level are very important.
If the front can be "prevented" well, the pressure on medical institutions to "treat" will be less, and patients can get better treatment results.
The reporter learned from the front line that some street communities have optimized the grid map formed during the epidemic prevention and control period into a service guarantee map, and upgraded the registration of residents to the registration of key service objects.
In the third community of Songzhuang Road, Fengtai District, every staff member has established a WeChat friend relationship with two or three hundred households, forming a key personnel account in its grid.
Whoever's family is an elderly person living alone, whoever has infants and young children under 3 years old, and whoever has a pregnant woman will be given special attention.
Mr. Zhao, who lives in the community, is 79 years old and is an old man living alone. He recently developed fever symptoms, but there is no antipyretic medicine at home.
Mr. Zhao contacted the community, and the problem was solved in time.
Mr. Zhao said: "The community has set up a WeChat group for the elderly to seek medical advice and medicine, and even prescribe medicine for us to deliver to our door. Now I feel more at ease."
Some sub-district communities integrate medical resources within their jurisdictions to ensure service guarantees.
Huaxiang Sub-district established 29 general practice family doctor teams, and announced the contact information of the teams in various ways.
The family doctor team directly connects with the community, and provides services such as one-on-one telephone consultation, door-to-door drug delivery, and offline diagnosis and treatment for the elderly, elderly living alone or with limited mobility, patients with cancer and chronic diseases, pregnant women, and children in distress.
Conduct regular telephone or WeChat follow-up interviews with special groups, and respond to residents' demands in a timely manner.
As a public rental housing community, Beijiaojiayuan Community, Fatou Street, Chaoyang District currently has more than 3,000 households, and there are more than 300 households in difficult groups such as subsistence allowances, empty nesters, and disabled people in the jurisdiction.
According to the age, service needs, etc., the community improves the information ledger of key groups by classification and grading, and assigns responsibilities to people according to the situation of building occupancy by community cadres; builds a platform to mobilize party members, volunteers, and residents of the building to take the initiative to carry out one-on-one team assistance Help, knock on the door and make a phone call every day to send care and warmth; mobilize community members, volunteers, residents and units in the jurisdiction to set up a caring characteristic volunteer service team to carry out haircuts, blood pressure measurements, and purchasing medicines and vegetables for key groups and other services to ensure the lives of people with disabilities.
"Community cadres are limited, and more forces need to be gathered to help key groups." Huang Li, Secretary of the Party Committee of Beijiaojiayuan Community, told reporters that for the elderly with children and relatives, the community will do work and try to let them take care of the elderly by their side; For the children of relatives, through voluntary mutual aid and other forms, a mutual aid platform for helping and caring is established among needy groups.
120 emergency operation:
Upgrade and expand the telephone system, increase emergency vehicles, and race against time for emergency deployment... 24-hour protection of the "life hotline"
"Female" "83 years old" in "Building 7, Xinyuan South District, West Bureau, Fengtai District"... At 5:35 p.m. on December 27, at the 120 Emergency Transit Command and Dispatching Center in Fengtai District, the operator Yang Jinzhong repeated the caller's information , while quickly entering it into the dispatching system of the Fengtai District Emergency Center.
The dispatch center is filled with calls one after another, replies with different accents, and typing.
The staff wear earphones, race against time, and guard the "lifeline" 24 hours a day.
"All the people who call are very anxious to hear the voice, they are especially difficult. When accepting the call, we will distinguish the type of patients according to the description of the other party: emergency and severe cases are marked in red, critical cases are marked in purple, and ordinary cases are marked in yellow. We will know whether they have special needs, such as whether they can move freely, whether they need flat cars, lifting, whether they need oxygen inhalation, whether they have other special circumstances, etc." Yang Jinzhong said.
"There is a critically ill patient in Silutong, please go to the nearest ambulance team quickly." "There is an old man in Wangzuo Town who is unwell, and he is a non-emergency and critically ill patient. Please go to the nearby ambulance team."...the operator The entered information is centrally processed by the dispatcher.
The reporter saw at the scene that there were three computer screens in front of each dispatcher, one showing the list of emergency vehicles to be deployed, one showing the location of the ambulance, and one for dispatching orders, answering calls and follow-up processing.
The staff stared at the computer screen, paid attention to the situation of help-seeking in real time, and dispatched in time.
Lin Qing, director of the Community Health Service Management Center of Fengtai District, told reporters that there are currently four types of emergency vehicles in the district: one is the original 29 ambulances in the 29 first aid stations in the district, which are responsible for accepting critical and critical cases; The 29 ambulances in the hospital are responsible for the diversion and transfer of non-emergency patients; the third is the caring team at the district level, which is responsible for medical needs such as transfer and transportation; the fourth is the caring team at the street and town level, which is responsible for regular needs.
"Recently, 120 emergency calls have surged. Fengtai District has established a 120 dispatch command center. The district education committee, district disease control center, district medical institutions, district transportation committee, political and legal committee, etc., under the overall arrangement of the district committee, quickly assembled and supported them. In the first aid and transshipment team. Although they come from different units, everyone cherishes the emergency transshipment work. A group of passionate people, in the face of the epidemic, together with everyone, do their best to save lives and help others." Lin Qing said.
On the evening of December 21, the first aid station of the Xiangshan Community Health Service Center in Haidian District received a letter of praise from the 12345 hotline. Mr. Wang, a citizen, said that after dialing 120 for his mother, the staff at the first aid station dispatched quickly. He was very touched by the timely and conscientious treatment.
"We will do our best to help what we can, and we will do our best to do what we can." Wu Li, head of the first aid station of Xiangshan Community Health Service Center, told reporters that it was very cold that day, and the temperature was more than ten degrees below zero. As soon as the order was over, a new order was received. Everyone did not dare to slack off and arrived at the destination in more than ten minutes. The old lady was lying on the bed, unable to move. Doctors, nurses, drivers and stretcher workers took her He was carried downstairs from the bed and sent to a nearby hospital.
The reporter learned from the Beijing Emergency Center that 120 emergency calls have been operating at a high level recently. The center officially launched the upgrade and expansion of the 120 telephone system on December 15. Expand to 100.
At present, the 120 dispatching system is running stably after the security upgrade, and the number of emergency calls received can reach up to 90,000 a day, and 40,000 dispatch orders are accepted.
All districts have expanded the dispatching seats and increased emergency vehicles. The 81 ambulance teams in Chaoyang can dispatch more than 1,000 trips a day.
Emergency room:
Expand the overall treatment capacity of the hospital, try our best to treat urgent and critically ill patients, and relieve the pressure of emergency and fever clinics
Usually, after the 120 sends the patient to the hospital, the nurse at the triage desk will first assess the patient's condition. If the condition is relatively stable, he will drain the water and see a doctor normally. Go to the emergency room.
"The so-called emergency department is actually to buy precious time for follow-up treatment and rescue." Ma Liping, an attending physician in the emergency department of Beijing Jishuitan Hospital, told reporters that despite being limited by resources such as equipment, beds, and venues, they still tried their best to carry out treatment.
"Most of the patients who come to the emergency department are seriously ill. If we wait for the rescue after falling out of bed, we will lose a few minutes of golden time, and may be unable to recover. When we have to, we can only borrow 120 beds to complete the invasive rescue measures first." " Ma Liping told the reporter, "In order to alleviate the problem of 120 bed presses, the hospital has mainly adopted two measures, one is to 'accept', to push each department to admit emergency patients to free up beds; the other is to 'borrow', through Various ways to coordinate the bed, try not to press the 120 bed."
"The old man has been smoking for a long time, and has been suffering from chronic bronchitis. He has been coughing and wheezing recently. It has been seven or eight days, and he has not had a high fever. It has gotten worse in the past two days, so we persuaded the old man to send it here." "You are probably infected with a virus. What is your usual blood pressure? Do you have diabetes? We have to deal with it quickly, and the follow-up disease may progress very quickly.” After briefly understanding and explaining the situation to the family members, the medical staff put in a new round of intensive treatment... On the afternoon of December 27, the reporter When I came to Beijing Chaoyang Hospital Affiliated to Capital Medical University, the emergency room was busy.
Patients with critical conditions and unstable vital signs were sent to the emergency room in time, and patients with relatively stable vital signs waited in line under the guidance of medical staff.
In the past two weeks, the emergency department of Chaoyang Hospital has continued to operate at a high level, with 75-90 ambulances entering the emergency department within 24 hours.
Taking December 26 as an example, there were 1,763 patients with fever in the emergency department, several times the usual number of patients, and 85 critically ill patients in the emergency room.
In order to improve the coping ability, Chaoyang Hospital established a special working class, organized a team of experts, and coordinated the hospital's emergency and critical care resources.
Guo Shubin, member of the Standing Committee of the Party Committee of Chaoyang Hospital, vice president, and director of the Department of Emergency Medicine, told reporters that the hospital dispatches emergency and severe fever patients on a daily basis. A series of measures such as "online consultation of new crown infection" in the hospital, setting up special outpatient clinics for respiratory disease diagnosis and treatment, and unimpeded referral between hospitals and medical alliances, etc., expand the overall hospital admission capacity, and do our best to treat emergency and critically ill patients, so as to relieve emergency and fever Outpatient pressure, speeding up the turnover of critically ill patients.
"We insist on grading diagnosis and treatment, not according to the order of patients who come first, but according to the severity of the patient's condition, and give priority to the treatment of critically ill patients." Mei Xue, member of the Party Committee of Chaoyang Hospital and deputy director of the Emergency Medicine Center, told reporters that patients were being triaged. The station evaluates the vital signs on the spot, and divides the patients into grades 1 to 4 according to the severity of the patient's condition. Patients with grade 1 and grade 2 are relatively seriously ill, and priority is given to see a doctor, while other patients with milder conditions are temporarily waiting.
Guo Shubin pointed out that when a patient with a new crown has the following conditions, it may indicate that the condition is aggravated: the patient is older than 70 years old; blood oxygen is less than or equal to 93%; dyspnea, that is, the respiratory rate exceeds 30 times; blood pressure is higher than or lower than 30% of the basic blood pressure.
"These situations are early warning indicators for severe cases of the new crown. Primary health service institutions need to clarify early warning standards, focus on protecting vulnerable groups, identify severe cases early, and strive to intervene as soon as possible. If they occur at the same time, they need to go to secondary and tertiary hospitals in time for treatment."
ICU:
Multidisciplinary cooperation, the establishment of a comprehensive treatment ward, strengthening the reserve of critically ill resources, and improving the hospital's ability to treat critically ill patients
Guo Shubin told reporters that after a period of rescue in the emergency rescue area and the infection ward of the fever clinic, the critically ill patients who have been screened in the emergency department and the fever clinic will enter the next stage of treatment after their vital signs are stable: stable vital signs, Those who can go home and recuperate will be discharged directly from the hospital; elderly patients with stable vital signs who still need medical care such as oxygen therapy and infusion should be transferred to the medical consortium hospital; severe patients who still need continuous medical treatment in the later stage should be transferred to the new crown hospital in the hospital. Intensive comprehensive treatment ward; critically ill patients are transferred to the intensive care ward.
Guo Shubin believes that all medical institutions should support the emergency department, fever clinics, ICU and comprehensive intensive care wards; coordinate resources and de-specialize the admission and treatment of various critically ill patients; cooperate with corresponding experts and specialized resources to patrol each ward, Achieve homogenization of diagnosis and treatment to ensure the quality of medical care; establish a medical consortium collaboration network to stabilize the timely transfer of patients and free up space for emergencies and critical illnesses.
Starting from December 15th, Chaoyang Hospital has strengthened resource reserves for critical illnesses through the integration of bed resources, renovation of intensive care units, intensive care theory and practical training, etc., to improve the hospital's ability to treat critically ill patients and reduce the fatality rate.
As of December 26, a total of 15 comprehensive treatment wards have been opened, with 538 open beds, including 69 critical care beds, and a total of 527 critically ill patients have been admitted to the comprehensive treatment wards.
Intermittent coughing, the hissing of the ventilator, the ticking of the monitoring equipment, plus the occasional few alarms, this is the impression given by the intensive care unit.
In the ICU, most of the patients are lying on the hospital bed wearing a ventilator.
Most of the patients living here are elderly patients, and the complex and changeable conditions require the careful observation of medical staff.
Every once in a while, the nurse will come to the bedside of the patient, look up at the data on the monitoring instrument, and look down at the patient.
"One, two, go!" In the intensive care unit of Peking University People's Hospital, medical staff turned over a 200-pound patient and performed prone position ventilation. The patient's blood oxygen saturation rose from 93% to 94%. 100%.
Similar work is done every day.
After ventilation in the prone position, it is beneficial to discharge the deposited inflammatory fluid and improve the ratio of lung ventilation and blood flow.
It is understood that the hospital has established a 24-hour online consultation treatment expert group to formulate treatment plans for critically ill patients in the form of multidisciplinary collaboration.
With the increase in the number of infected people, critically ill patients with underlying diseases or advanced age have appeared one after another.
Mr. Shi, a 73-year-old patient who lives in Ciqu, Tongzhou, underwent heart bypass surgery ten years ago.
Two doctors in the Yizhuang District of Tongren Hospital quickly started rescue, intubated, put on a ventilator, continued to press cardiopulmonary resuscitation, and repeatedly defibrillated... This lasted for 3 hours, and the doctors, nurses and patients persisted.
Slowly, Mr. Shi's breathing and heartbeat gradually stabilized.
In the following day, Mr. Shi developed a ventricular tachycardia and a ventricular fibrillation again, and was transferred to the EICU for further treatment, and the doctors and nurses started rescue immediately.
During the two-day rescue process, Mr. Shi received more than a dozen cardiopulmonary resuscitations and more than 20 defibrillations.
He was intubated and unable to speak, so the doctors and nurses used their mobile phones to type and communicate with him, constantly giving him confidence and strength.
During his stay in the hospital, the medical staff also gave Mr. Shi symptomatic treatment for the new crown infection.
Today, Mr. Shi has recovered and was discharged from the hospital.
"The virus is really not friendly to vulnerable groups such as the elderly. The condition changes rapidly, and sometimes it is almost too late to respond. Our medical staff are overloaded. As doctors, we definitely want to save as many lives as possible. As long as there is a frontline Hope, we will never give up." Cao Qiumei, director of the emergency intensive care unit of Beijing Tongren Hospital, said.
(China Discipline Inspection and Supervision News)