在中国建立基于高级医疗救护员的院前急救体系：来自国际搜索与救援咨询团医疗工作组前任主席的建议

Trevor Glass

邓朝阳 翻译，郭 晓，郭海涛 审校

• 读者来信| LETTERS TO THE EDITOR •

在中国建立基于高级医疗救护员的院前急救体系：来自国际搜索与救援咨询团医疗工作组前任主席的建议

Trevor Glass1,2

邓朝阳 翻译，郭 晓，郭海涛 审校

A paramedic by definition is someone specially trained to provide emergency medical care in cases of injury or illness before and during transportation to a hospital. China currently does not have a paramedic based ambulance service. In China, doctors and nurses work on the ambulances. Countries like Australia, Canada, New Zealand, South Africa, UK and the USA, to name a few examples, have well-established paramedic based ambulance services.

根据定义，高级医疗救护员是经过专门训练，为伤病员提供院前或转运途中紧急医疗护理的人员。中国目前还未建成由高级医疗救护员提供院前急救服务的体系。在中国，医师和护士们在救护车上工作。举几个例子来说，国家诸如澳大利亚、加拿大、新西兰、南非、英国和美国，已经建立了完善的由高级医疗救护员提供院前急救服务的体系。

The current staffing model in China, namely doctors and nurses, relies on expensive human resources that take a long time to train in their respective disciplines. The doctors and nurses working on ambulances are then assigned to work in an environment that they have not been specifically trained to work in. There is a severe shortage of nurses in China, and the rest of the world for that matter, and having nurses working on ambulances places even further human resources demands on the hospitals that are already struggling to fulfill their own nursing requirements. The situation is very similar with doctors. Both the doctors and nurses assigned to ambulances could in fact be more effectively utilized inhospitals. Neither the doctors nor the nurses have been specifically educated to work on ambulances. However, until there is a suitable and appropriate alternative, the situation of doctors and nurses working on ambulances in China will continue. A paramedic is the ideal alternative as it places someone with a specific interest in out-of-hospital (also referred to as pre-hospital) emergency medical care, and who has been specifically educated and trained in prehospital emergency medical care, on ambulances. It will obviously take several years before paramedics could take over the role of the doctors and nurses currently working on ambulances, however, the sooner one starts the paramedic system, the sooner there will be Chinese paramedics that can enter the system and the sooner the doctors and nurses will be able to be utilized in the environment for which they have been specifically trained, i.e. hospitals, which will reduce the pressure of staffing shortages.

中国目前的人员配置模式，即医师和护士模式，依赖昂贵的人力资源，他们需要在各自的学科内培训很长时间。救护车上工作的医师和护士被分配到一个未经过专业训练的环境中工作。在中国，护士严重短缺，世界上其他国家也是如此，让护士在救护车上工作，导致医院的人力资源短缺问题进一步加重，而医院本身的护士需求早已是捉襟见肘。这种情况与医师的问题非常相似。事实上被分配到救护车上的医师和护士可以在医院得到更有效利用。医师和护士都未曾接受专业的救护车训练。无奈的是，中国医师和护士在救护车上工作的状况将持续下去，直到出现一个适当的替代方案。高级医疗救护员是理想的选择，因为它将一些对院外（也称院前）紧急医疗救护服务有特殊兴趣的，并且经过专业的教育及已在院前紧急医疗救护服务中训练过的人员配置在救护车上。显然，由高级医疗救护员替代目前救护车上工作的医师和护士的角色还需要几年时间。然而，高级医疗救护员急救体系开始得越早，中国自己培养的高级医疗救护员进入体系的时间就会越早，医师和护士将会被越早配置在他们接受过专业训练的环境中，比如说医院，这将减少人员短缺的压力。

In countries with paramedic systems, when paramedic training was first introduced, it was conducted by attending a series of short courses, some are a few weeks long, others a few months . Each course led to a higher level of certification until the highest paramedic qualification was obtained. However, the education of paramedics has evolved significantly over the years. In many countries with highly developed paramedic systems, paramedic education is now university based. Student paramedics attend a Bachelor Degree run over 3 or 4 years (depending on the country) and then have the option to further their studies with a Master’s and ultimately a PhD.

在具有高级医疗救护员体系的国家，当高级医疗救护员培训被首次引入时，它是通过参加一系列的短期课程得以实施的，课程有些几周长，有些几个月长。每门课程完成后学员将被颁发一个更高水平的证书，直到取得最高级别的高级医疗救护员资格。并且，高级医疗救护员的教育在近几年有了显著进步。在许多拥有高度发达高级医疗救护员体系的国家，其教育目前是依托大学进行的。高级医疗救护学员需要参加一个为期3或4年的学士学位学习（根据不同的国家而定），然后可以选择继续攻读硕士乃至博士学位。

There are several advantages to develop a paramedic based ambulance system in China, including:

· It creates a completely new academic pathway for people wanting to obtain a university degree;

· In time it will create a new academic pathway for Masters and PhD studies;

· It creates a completely new revenue stream for universities;

·It creates a completely new employment opportunity for thousands of Chinese citizens as paramedics;

·In time it will professionalize the ambulance service in China as you will have dedicated professionals employed in the service;

·In time it will reduce the human resource burden on doctors and nurses in hospitals;

·Military personnel could also be educated as paramedics and can then be utilized by the military medical units ;

·It places China the forefront of advances and developments in the education of paramedics worldwide;

·In time, it would place China in alignment with leading paramedic systems worldwide.

中国发展基于高级医疗救护员的院前急救体系具备一些优势，包括：

·对于想要获得大学学位的人来说，它创建了一个全新的学术路径；

·它最终将创建一个新的硕士和博士学术研究路径；

·它将为大学创造一个全新的收入来源；

·它将为成千上万的中国公民创造一个新的就业机会，使其成为高级医疗救护员；

·同时，它将使中国的院前急救服务专业化，因为你将能雇佣到专职的救护服务人员提供服务；

·它将最终减轻医院里医师和护士短缺所造成的人力资源负担；

·军队人员也可以接受高级医疗救护员教育，并且被军队的医疗分队使用；

·它使中国成为世界范围内高级医疗救护员教育之进步和发展的前沿；

·它将最终让中国融入世界先进的高级医疗救护员体系。

Obviously, paramedic education forms only one piece of a larger puzzle, as is illustrated in Figure 1. There would be no point in starting a new paramedic education pathway at universities if there were no employment opportunities for graduates. Prospective graduates would need to be enticed with the prospect of a new and exciting career option. A national register would need to be established for paramedic graduates, similar to what happens currently with doctors and nurses. Then there is also the requirement to have a registration/regulation body that would stipulate the clinical scope of practice for paramedics and ensure paramedics keep up to date with new developments in emergency care and maintain their clinical skills to the required levels.

显然，高级医疗救护员教育只是急救医疗体系大难题的一部分，如图1所示。如果毕业生没有就业机会，大学就没有开设新的高级医疗救护员教育的立足点。准毕业生需要被一个新的和令人兴奋的职业选择所吸引。就像现在的医师和护士一样，高级医疗救护毕业生也需要国家建立的注册制度。而后还需要成立一个注册/管理机构，用来规定高级医疗救护员的临床实践范围，确保他们获取最新的紧急医疗救护服务知识，同时保持其临床技能符合相应水平的要求。

Therefore, there is a need to make a collective agreement among the relevant stakeholders (universities, department of health, employers) that the establishment of a paramedic based ambulance system in China is worth exploring. Once there is a collective, inprinciple agreement, work could commence, in parallel with thevarious stakeholders, on establishing the various components of a China Paramedic System Framework.

因此，利益相关者（大学、卫生部门、雇主）需要签署一个集体协议，成立基于高级医疗救护员的院前急救体系，这在中国是值得尝试的。一旦原则上的集体协议达成，建立高级医疗救护员体系的工作即可以启动，各利益相关者同步开始运作，创建中国高级医疗救护员系统框架所需的各种机构。

图1 高级医疗救护员急救体系的基石

There will be a minimum of a 3 year time-frame (maybe four years depending on the duration of the degree) in which this framework was established as the first group of graduates would only qualify and be ready to enter into the work place after graduation. It would also be advisable to run a limited pilot program initially, and once the lessons from that program had been identified and addressed, then the role out on a larger scale could begin.

建立这个框架的时限将最少是3年（可能需要4年，这取决于学位教育的时间长短），因为此时第一批毕业生已经取得资格并且准备在毕业后进入工作场所。我们建议最初开展一个有限的试点项目，一旦获得第一个试点项目的经验教训被识别和解决，那么大范围的推广工作就可以启动了。

I know that this would be an extremely large undertaking, as it requires the establishment of a completely new national system. However, China has a great vision of its future many decades ahead. Therefore, I am optimistic and confident that it can be achieved and successfully implemented over time.

我知道，这将是一个非常宏大的事业，因为它需要建立一个全新的国家体系。然而，中国对其几十年后的未来有一个伟大的愿景。因此，随着时间的流逝，这可以实现并成功实施，我对此是乐观和有信心的。

I am a paramedic by profession and this is a topic I am most enthusiastic and passionate about. Although it is a project that would have to run over many years, once implemented, it would greatly benefit the people of China. Similar to the Great Wall of China, those that initially had the idea and began the construction never lived to see the wall completed, but many, many generations benefited from their efforts. Due to the enormity of the project, it would need support very much from the highest governmental level.

我的职业是一名高级医疗救护员，这个领域让我充满了热情和激情。尽管这是一个需要运行多年的项目，但是一旦实施，它将会使全中国人民受益。如同中国的万里长城一样，那些最初有想法并开始建造的人们最终没有活到亲眼看到长城建成的那一天，但后辈们因为他们的努力而受益。由于这项工程的庞大，尤其需要得到政府最高级别部门的支持。

（2015-11-08 收稿 2016-01-04 修回）（责任编辑 郭 晓）

Trevor的院前急诊医学职业生涯开始于1988年作为一名军事作战的医护兵。当他服完兵役时已具备实施高级生命支持的paramedic资格。作为一名工作在直升机上的paramedic，Trevor具有医疗救援和直升机转运服务双重平台的多年工作经验。自2000年来，Trevor参与了医疗特别行动，被部署到阿尔及利亚，伊朗，巴基斯坦，印度尼西亚和新西兰地震现场实施医学救援。在2004年12月他辞去了南非最大的私人急救服务公司的首席执行官职务，开始作为一名国际顾问为联合国（UN）国际搜索与救援资讯团（INSARAG）工作，并在2008年初至2014年2月担任INSARAG医疗工作组（Medical Working Group, MWG）的主席。Trevor起草或参与起草了一些MWG文件，并被邀请在美国医学特种行动会议上发言。目前，他拥有并管理着一家总部设在英国的公司——DART Solutions，专门提供灾难和应急管理的咨询、培训和响应服务。Trevor是一名充满热情的活跃的临床paramedic。

Establishment of paramedic based ambulance system in China: Proposal from Former Chairman of the INSARAG Medical Working Group

Trevor GLASS1，2. 1. Chairman of the INSARAG Medical Working Group from 2008-2014; 2. Managing Director, DART Solutions (a UK-based company that provides consultancy and training services for disaster and emergency management).

10.13919/j.issn.2095-6274.2016.01.017

Trevor Glass，本科学历，E-mail: trevorglass00@gmail.com

1. 国际搜索与救援咨询团医疗工作组2008—2014主席；2. 常务董事，DART Solution 公司，一家总部设在英国的，提供灾难和应急管理咨询和培训服务的公司