背景:紧急护理系统(ECS)在运输期间和医疗机构组织并提供救生护理。在诸如冲突后设置之类的不确定环境中,对ECS的了解不够。这篇综述旨在系统地确定和总结已发表的关于在冲突后环境中提供紧急护理的证据,并指导卫生部门的规划。
方法:我们搜索了五个数据库(PubMedMEDLINE,WebofScience,Embase,Scopus,和Cochrane)于2021年9月确定冲突后环境中ECS上的相关文章。纳入的研究(1)描述了冲突后的背景,受冲突影响,或受到战争或危机的影响;(2)检查了紧急护理系统功能的交付;(3)有英文版本,西班牙语,或法语;(4)于2000年1月1日至2021年9月9日期间出版。使用世界卫生组织(WHO)ECS框架中确定的基本系统功能提取和映射数据,以捕获受伤或疾病现场的基本紧急护理功能的发现,在运输过程中,并通过急诊室和早期住院护理。
结果:我们确定了一些研究,这些研究描述了疾病的独特负担和向这些州人群提供服务的挑战。指出院前护理交付中的特殊差距(无论是在现场响应期间还是在运输期间)。常见的障碍包括基础设施差,挥之不去的社会不信任,缺乏正规的急救护理培训,缺乏资源和物资。
结论:据我们所知,这是第一项在脆弱和受冲突影响的环境中系统确定ECS证据的研究.使ECS与现有的全球卫生优先事项保持一致将确保获得这些关键的挽救生命的干预措施。然而,人们担心前线紧急护理缺乏投资。对冲突后环境中ECS的状态的理解正在出现,尽管目前与最佳实践和干预措施相关的证据极为有限.应认真注意解决ECS中常见的障碍和与环境相关的优先事项,例如加强院前护理,分诊,和转诊系统,并在紧急护理原则方面培训卫生人员。
Emergency care systems (ECS) organize and provide access to life-saving care both during transport and at health facilities. Not enough is known about ECS in uncertain contexts such as post-conflict settings. This review aims to systematically identify and summarize the published evidence on the delivery of emergency care in post-conflict settings and to guide health sector planning.
We searched five databases (PubMed MEDLINE, Web of Science, Embase, Scopus, and Cochrane) in September 2021 to identify relevant articles on ECS in post-conflict settings. Included studies (1) described a context that is post-conflict, conflict-affected, or was impacted by war or crisis; (2) examined the delivery of an emergency care system function; (3) were available in English, Spanish, or French; and (4) were published between 1 and 2000 and 9 September 2021. Data were extracted and mapped using the essential system functions identified in the World Health Organization (WHO) ECS Framework to capture findings on essential emergency care functions at the scene of injury or illness, during transport, and through to the emergency unit and early inpatient care.
We identified studies that describe the unique burden of disease and challenges in delivering to the populations in these states, pointing to particular gaps in prehospital care delivery (both during scene response and during transport). Common barriers include poor infrastructure, lingering social distrust, scarce formal emergency care training, and lack of resources and supplies.
To our knowledge, this is the first study to systematically identify the evidence on ECS in fragile and conflict-affected settings. Aligning ECS with existing global health priorities would ensure access to these critical life-saving interventions, yet there is concern over the lack of investments in frontline emergency care. An understanding of the state of ECS in post-conflict settings is emerging, although current evidence related to best practices and interventions is extremely limited. Careful attention should be paid to addressing the common barriers and context-relevant priorities in ECS, such as strengthening prehospital care delivery, triage, and referral systems and training the health workforce in emergency care principles.