去年10月6日，朝阳医院抢救室，医生正在查看病人。16张标准配置的抢救床位，多数滞留着合并多种慢性病的老人，每天新到的危急重症患者只能加床抢救。资料图片/新京报记者 王嘉宁 摄

October 6,,Intensive care to chaoyang hospital,The doctor is to check the patient.16 a standard configuration of the rescue beds,The majority of detention to combine multiple chronic diseases of the old man,Every new to emergency and severe cases in the patients with extra bed only rescue.Material pictures/Beijing news reporter WangJiaNing perturbation

　　上周一，微博名人“急诊科女超人于莺”发帖称：“120拉着意识不清的病人连跑5家医院，都因为急诊没床位住不进去。找床位靠运气，北京急救资源该联网了。”几日后，这名在急救车上辗转颠簸了5个小时、最后被协和医院加床留观的老人去世。

Last week,Micro bo celebrity"In the emergency department superwoman"Post said:"120 took the unconsciousness of patients even run 5 hospitals,Because emergency didn't live not in bed.Looking for bed luck,Beijing emergency resources the networking the."After several,This name in an ambulance toss bump for five hours/Finally be union medical college hospital extra bed staying the old man died.

　　该事件凸显院前急救与院内急诊床位信息无法实时传递的“积怨”，也“拉爆”了公众对大医院急诊床位爆满的问号。是急诊床位太少？还是被无效占用？在床、患比严重供求失衡的状况下，急诊抢救床究竟应该收治什么样的病人？近日，本报记者走访了急救中心和三甲综合医院，调查北京急救资源的信息互通和使用现状。

The incident highlights of prehospital emergency treatment and hospital emergency beds information can't real-time transmission"grudges",also"La explosion"The public hospital emergency beds of full of question marks.Emergency beds is too little?Or be invalid occupancy?In bed/Suffer from serious than under the condition of unbalanced supply and demand,Emergency rescue bed were what should be what kind of patients?recently,Our reporter interviewed first aid center and 3 armour general hospital,Survey Beijing emergency resource information interchange and use present situation.

　

　无奈的急救转运和“押床” But the emergency transshipment and"And the bed"

　　并非所有医院的急诊科床位都紧张，“急诊科床位爆满，病人又趋之若鹜”的现状集中于知名度高的三甲大医院。一名急救医生说，我们经常会收到一些医院发来的短信或电话，如“安贞医院无床”、“中日友好医院无床”，但这些信息都不能动摇患者或家属要去大医院求治的决心。

Not all the hospital emergency department beds are nervous,"Emergency department full bed,The patient and scramble for"The present situation of the focus on the top three high reputation big hospitals.A first aid the doctor said,We often will receive some hospitals message from or telephone,if"Anzhen hospital no bed"/"The sino-japanese friendship hospital no bed",But these information could shake patient or family member to go to large hospital QiuZhi determination.

　　“您家老人是骨折，普通医院都能治，咱们就近去旁边的××医院？”

"Your house old man is fracture,General hospital can cure,Let's go to the nearby next to xx hospital?"

　　“不行，还是去积水潭（医院）吧，其他的医院我们不信任。”

"no,Or go to ji shui tan(hospital)it,Other hospital we don't trust."

　　“我们刚接到积水潭医院急诊科的电话，那儿急诊爆满，咱们现在过去，路上堵车不说，到那儿还得排队等着，老人受罪啊！”

"We have just been ji shui tan hospital emergency department telephone,There emergency full,Let's now in the past,Not caught in the traffic jam,There still have to wait in line with,The old man suffer ah!"

　　“还是去积水潭吧，说不定到那儿就有床了呢。我们宁愿等，不然到别的医院治坏了，还不是让老人受两茬罪！”

"Or go to ji shui tan it,Perhaps there have bed now.We would rather, etc,Or to other hospital cure is broken,Not just let the old man by two stubble sin!"

　　在120和999的急救车上，这是最常见的一段医患对话。一方面是大医院的急诊科不断告知床位已爆满，另一方面是患者及家属不信任有床位的普通医院，非三甲医院急诊科不去。

In 120 and 999 ambulance,This is the most common a doctor-patient dialogues.On the one hand is big hospital emergency department constantly told bed already full,On the other hand is the patient and family to distrust can be bed general hospital,The 3 armour hospital emergency department not to go.

　　一名120急救医生说，急救转运的原则是“就近、就急、就（医院）能力、就（患者）意愿”，但目前前三项均难以落实，家属执意要去碰运气，我们只能硬着头皮去。

A 120 emergency doctors say,Emergency transfer principle is"nearby/nasty/it(hospital)ability/it(patients)Intend to",But at present are difficult to implement the three,Determined to family members to take a chance,We have to bite the bullet and go.

　　患者躺在急救担架上，在大医院急诊走廊上无预期地等待、调度中心又不断向急救车发出新的急救转运指令——无奈，只能“押床”。向患者家属收取500元押金，将急救车上的担架床借给病人，急救车换上备用担架，奔向新的呼救病人。

Patients lie in emergency stretcher,In the big hospital emergency corridor without expected to wait/Dispatching center and then continuously to the ambulance in a new emergency transport instruction, helpless,Can only"And the bed".To the patient for family 500 yuan deposit,Will first aid the stretcher to the patient,Ambulance stretcher put on standby,Run to the new distress patients.

　　一名急救医生表示，在大医院门口，急救车经常一等就是20多分钟甚至两三个小时，有些病人听从急诊医生的建议转投其他医院，但大多数情况下是担架床被整宿“押”。

A first aid doctors say,In front of the hospital,Ambulance often chop is more than 20 minutes or even two or three hours,Some patients listen to emergency doctor's advice heading for the other hospitals,But in most cases is stretcher is whole lodge"he".

　　“押床”带来的问题，不仅是急救资源被浪费。“急救车上的担架床与普通病床构造不同，使用不当翻床很可能给病人带来二次损伤。”该急救医生称，“押床”前他们不得不跟家属签一份协议书，注明在担架车自行使用中出现问题由家属承担，“但这也不能影响患者家属执意等待大医院一张床的决心。”

"And the bed"The problem of the,Is not only the emergency resources are wasted."The ambulance stretcher and common bed structure is different,Improper use of double bed very likely to bring secondary injury patients."The emergency doctors say,"And the bed"Before they have to sign an agreement with family members,In DanJiaChe indicate on its own problems in use by families assume,"But it also cannot affect patients would wait for the big family hospital bed determination."

　

　“被扩张”的大医院急诊科 "Be expansion"Big hospital emergency department

　　来自北京市卫生局医政处的监测，全市66家三级医院中半数存在急救床位紧缺的问题。医政处相关负责人分析，人口老龄化带来复杂的老年慢性病人增多，津冀重症患者来京求诊与日俱增。另外，由于找不到合适的转诊出口，很多度过急性期的老人只能“赖”在三级医院急诊抢救室。

From the municipal bureau of health medical administration place monitoring,The whole city 66 tertiary hospital half exist the problem of shortage of emergency beds.The relevant person in charge of medical administration in the analysis,An aging population brings complex old age chronic patients increased,In severe cases, the hebei Beijing increasing concerns.In addition,Unable to find appropriate referral export,Spend a lot of the acute phase of old man can only"lama"In tertiary hospital emergency intensive care.

　　11月22日深夜，中日友好医院急诊科抢救室，10张固定的抢救床位一直满员，陪护家属们在抢救室外的过道上展开铺盖席地而睡。

On November 22 at night,The sino-japanese friendship hospital emergency department intensive care,10 a fixed rescue beds have been full strength,Accompanying family members in the rescue outdoor the aisle spread blanket on the ground and sleep.

　　“今晚算是反常的”，值班副主任医师郭诗东指着睡满家属的地板，“就上周，抢救室一夜最多收18个。病情已经稳定的病人转不出去，新送来的危重症患者只能在这个通道里加床，医生只能从不到一米宽的床缝里挤过去救治”。

"Tonight is abnormal",Duty of doctor of vice director of GuoShiDong pointed to sleep with the families of the floor,"Last week,One night the most intensive care is 18.The illness has stable patients turn not to go out,New delivery of the critically ill patients in this channel only the extra bed,The doctor can only never to one meter wide bed joint way through treatment".

　　中日友好医院急诊科主任张国强认为，多种因素导致复杂慢性病病人滞留在三级综合医院的急诊科。一是现在医院的专科越来越专，从专科到专病，对复杂的多脏器慢性疾病患者不愿收治或无力收治；二是公众对大医院盲目信赖，很多人已被明确诊断为终末期疾病，但家属不信任基层医院的医疗水平，“其实他们需要的是安静的临终关怀，而不是待在抢救室天天靠呼吸机和高级抗生素维持。”

The sino-japanese friendship hospital emergency department director zhang guiquan think,Many factors lead to chronic diseases patients complicated trapped in tertiary general hospital emergency department.A specialized hospital is now more and more special,From the specialized subject to ZhuanBing,For complex multiple organ chronic disease were treated to or weakness;The second is to public hospitals blind trust,A lot of people has been clear for end-stage disease diagnosis,But families don't trust grassroots hospital medical level,"The truth is, they need to quiet hospice care,Rather than stay in intensive care every day on the breathing machine and senior antibiotics to maintain."

　　在这不足百平方米的空间，加上患者、医务人员，每天要塞进五六十人，滞留最长的患者已经在抢救床上住了5个月。年龄偏大、病情复杂、合并多种并发症，是目前所有三级综合医院急诊科滞留病人的突出特征。

In the more than square meters of space,Plus patients/Medical personnel,Every fortress into 60 people,Retention of patients have the longest in salvage bed lived five months.older/Is difficult to/To combine multiple complications,Is at present all tertiary general hospital emergency department retention the patient's prominent feature.

　　“这些滞留病人，至少无效占用了1/3的急救资源。”张国强说，急诊科原本的床位使用率指标：抢救床24小时轮转、留观床72小时轮转，“基本无法实现”。

"These retention patients,At least invalid occupied a third of the emergency resources."Said zhang guiquan,Emergency department originally bed utilization rate index:Salvage bed 24 hours of rotary/Staying bed 72 hours of rotary,"Basic unable to realize".

　　中日友好医院、协和医院的急诊科曾想推行急诊的分级检诊标准，通过“总调度”医生根据病人状况作出初步评判，给出抢救、留观等建议，“但多数患者不认可，公众也不允许我们的判断出一点点意外。”张国强坦言，最近10年，由于病人的急剧增多，是急诊科快速发展的10年。但由于医院内外合理转诊的“绿色通道”迟迟未建立，导致病人的无序滞留，急诊科正在“被扩张”。

The sino-japanese friendship hospital/The union medical college hospital emergency department wanted to implement emergency classification inspection diagnosis standard,Through the"Total scheduling"The doctor according to patients condition to make preliminary evaluation,Given the rescue/Suggestions such as staying,"But the majority of patients do not acknowledge,The public has not allowed our judgment out a little bit accident."Said zhang guiquan,In recent 10 years,Because the patient's sharp increase,Is emergency department rapid development of 10 years.But due to the hospital inside and outside of the reasonable referral"Green channel"Didn't set up,Lead to the patient's disordered retention,Emergency department is"Be expansion".

　

　治标不治本的“信息平台” Take temporary solution not effect a permanent cure of"Information platform"

　　郭诗东说，如果参照商场、写字楼智能停车引导的做法，将医院急诊科的床位占用情况实时传送到转运急救车上，情况也许会好一点。实际上，市卫生局也有建立院前和院内急救资源信息联网平台的打算。据悉，市卫生局应急办正在为建设这样的“急救信息平台”争取立项。

GuoShiDong said,If the reference market/Office building intelligent parking guide practice,Will the hospital emergency department bed occupancy situation real-time transmission to transfer an ambulance,Circumstances may a bit better.In fact,The municipal bureau of health, also have established before school and hospital emergency resources information networking platform plan.It is reported,The municipal bureau of health emergency to do is to build such"Emergency information platform"For project approval.

　　带家属参观拥挤嘈杂的急诊科，甚至坦言这里交叉感染风险大，是郭诗东劝走那些可以不到大医院苦等床位的急诊患者最后的办法，“成功率也只有一半”。郭诗东摇摇头。

Take family members to visit the crowded and noisy emergency department,Even said here cross infection risk is big,Is GuoShiDong go to those who can not big hospital beds in the bitter emergency patients final approach,"Success rate was only half".GuoShiDong shook his head.

　　据主管院前急救工作的市卫生局副巡视员赵涛介绍，几年前，市卫生局曾发文要求二级以上医院急诊科设急救电话专线，随时与120和999急救中心保持联系，告知急诊床位使用情况和接治能力。

According to the director of prehospital emergency work city health bureau deputy inspector ZhaoTao is introduced,A few years ago,The municipal bureau of health, was deemed requirement level 2 above hospital emergency department set up emergency telephone line,Feel free to 120 and 999 emergency center keep in touch,Inform emergency beds use situation and the joint governance ability.

　　“电话联系确实不能确保信息的实时通畅，所以还是要搭建一个信息平台，确保急救车在转运病人途中，可以在车载电子屏幕上看到全市二级以上医院的急诊床位实时使用状态。”赵涛说。

"Telephone connection does not ensure the information flow in real time,So still want to set up an information platform,Ensure that ambulance during the transfer the patient on the way,Can be in vehicle electronic screen to see the second class above hospital emergency beds real-time operating condition."ZhaoTao said.

　　赵涛坦言，这样一个信息共享平台，对于解决大医院急诊床位爆满、无力收治新病人的老问题还是“治标不治本”，“如果今后平台建成了，屏幕上三甲医院急诊科全亮红灯，患者还是执意要去等等看，送还是不送？病人到门口了，急诊科能因为没床位就干脆地拒绝吗？”但他同时认为：“行动，哪怕前进一步，即使不能解决根本问题，也比不行动要好。”

ZhaoTao said,Such an information sharing platform,For solving large-scale hospital emergency beds full/Unable to new patients were old or"Take temporary solution not effect a permanent cure","If the future platform built,Screen 3 armour hospital emergency department full bright red light,Patients are determined to go to wait and see,Send still don't send?The patient to the door,Emergency department can because no bed to be squarely rejected?"But he also think:"action,Before even further,Even if it does not solve the fundamental problems,Also ratio not better action."

　　“急诊科医生多数是不怕吃苦的，只要接治的是危重症病人，哪怕跪在过道上抢救，我们也会去做”。张国强希望政府能够通过医改重新配置医疗资源，在大医院和基层医院之间搭建起让患者信任的急诊、治疗、康复、护理（或临终关怀）相衔接的“绿色转诊通道”。

"The emergency clinician majority is not afraid of hardship,As long as the joint governance is critically ill patients,Even if kneeling in the aisle rescue,We will also do".Zhang guiquan hope the government can through the reform, reconfiguring medical resources,In large hospitals and grass-roots hospital set up between let the patient trust emergency/treatment/rehabilitation/nursing(Or hospice)The coherent"Green referral channel".

　　本版采写/新京报记者 魏铭言

This collection &composition/Beijing news reporters wei MingYan