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The author:(作者)归海一刀published in(发表于) 2014/1/30 6:31:39 Guiyang cottage ambulance
"The core reading"
On January 13, was reported in this version of big hospitals to join first aid network, emergency issues such as resource constraints (the University Hospital: join the 120 power not enough). Meanwhile, in many places, the gate of the hospital, cottage ambulance business is thriving. Is a regular ambulance resources under the market gap the patient helpless choice, while the nonconformity of the rescue equipment's potential threat to patient safety, why so? Conducted a survey of journalists in Guiyang.
Spring Festival is a hospital ambulance a busy period. However, the eve of the Spring Festival, saw reporters in Guiyang City, some taped to the humble minivan "first aid" logo was in the ambulance business. These both money and probably fatal cottage ambulance, why can walk his way through a matter of?
Spray "first aid", "ambulance" apartments
On January 19, the Guiyang Medical College Hospital (hereinafter referred to as expensive Fuyuan) behind the emergency room floor, a hanging bijie plates from old Jinbei van has been converted into "ambulance" lazily basking in the Sun. Blue alert light and the Red Cross logo and the front of "first aid" two characters, at first glance, no different than an ordinary ambulances.
Reporter to patients ' family members dialed the owner posted in place of the rear window "car phone".
"My car was a regular car, and worry. "The owner said.
"Which hospital? ”
"Which hospital you will forget it. Cars are new cars, ran less than a year, facilities of all kinds. ”
According to the ambulance industry standard, regular ambulance stretchers and oxygen tanks in addition to outside, also should be equipped with fast blood glucose Tester, electrocardiograph, ECG monitor and other diagnostic equipment and rescue equipment, and reporters in the car did not see these devices.
"This is definitely a fake ambulance. "Under Yu your medical attached homes of Guizhou province emergency rescue Center staff Chen Li (pseudonym) said," most cottage ambulance is by cheap of second-hand micro van or business car transformation and into, equipped with crude, and inferior rescue equipment, even no rescue by required of oxygen, no professional medical personnel, loaded Shang alert lamp, spray Shang ' ambulance ', and ' first aid ', words, on dry up has ' ambulance ' Shiners. ”
Reporters asked to bijie city of zhijin County price, the man first asked for 1600, at a press conference after hesitating too expensive "minimum for you down to 1280".
Journalists and patients case more serious, hope, accompanied by one of the medical staff, the owner immediately indicated no problem, but to pay 200 bucks.
Chen Li believes that the owners promised health care personnel cannot be hospital doctors and nurses, "generally start some wear white coats, or are an experienced nurse".
Chen Li often seen parked at work a few cottage ambulance. Your doctor and hospital security staff responding to reporter's question, said that hospital car parks belonging to the outsourcing, pay hospital parking, as long as money can come in, "only know parking cottage ambulance, but can not tell which is the stronghold of which is normal."
Regular and cottage ambulance cars there is a difference, Chen Li said: "our Center has a unified identity, apart from ' first aid ' and red ' ten ', a spray '96999', ' first-aid center of Guizhou province ' message. Apart from the marked car brands, and there is also a part of this car's code. ”
Profitable hospital nurses involved in the win over customers
Why cottage ambulance is widespread in the hospital? Your hospital affiliated hospital, chief physician of Urology Sun Fa believes the main reason is that the regular ambulance carrying capacity and the huge gap between existing demand.
By the standards of 50,000 people is equipped with an ambulance in 2012, nearly 4.5 million of the total population of Guiyang City, ideally should be equipped with 90 ambulances. Emergency Center Director Chen introduced in Guiyang City, Guiyang is currently about 70 ambulances in the pre-hospital medical emergency. These ambulances are well enough, and sometimes non-car-available basis.
Survey found that if patient's family ambulance dial or 120 will not bring the cottage because ambulances are regular ambulance deployment of 120 system, the cottage was put in an ambulance. When cottage ambulance mainly in patient discharges, transfers, internal or issued a small card to win over customers. Patients the choice of cottage ambulance, one is formal enough, and then there are faux-car bargain.
"Patients discharged home, transfer, did hire a car, health care workers must master these conditions, to be given at some black ambulance ', can collect wouldn't from the inside. "Chen Li thought behind it all has become a huge interest. "Experienced care workers direct buy for someone to drive, themselves working facilities to tourists, as far as I know, such a car would be 3-5. For patients introduced vehicles, 95% per cent of nurses are involved in. "But the patient was not informed, and also does not know what is the regular ambulance.
Not just parties wooing tourists in hospital, cottage ambulance card or directly into the wards of the hospital bed. Your medical report of 15-story Orthopedic Surgical building corridors on a vacant single bed, reporters found a cottage ambulance card, side vehicle photos, and contact information, the described vehicle configuration on the back, including imported emergency ventilator, ECG monitor, electric devices, such as sputum. Internal door glass panels at the bottom of the building, also was stuffed with a variety of cottage ambulance information cards.
Regulate access to prevent bothered
Early in December 2013, a cottage on the expensive high-speed ambulance collided with the truck, ambulance 2 killed and 3 wounded. Although accident responsibility truck driver, but because a vehicle is a black ambulance patients difficult to activist.
Cottage ambulance not only hidden danger, but also interfere with the normal medical order. Sun Fa have seen anything like this, when he was treating a patient is in critical condition, faux-ambulance operators for profit, inciting patients abandon treatment home prepared directly funeral. Medical staff promptly stopped, operators have failed. Now, four or five years later, the patient is still alive.
Management involves a number of departments of cottage ambulance, ambulance personnel qualification and health sector management, modification of vehicles owned by public security departments, pricing price management operation. However, although there are several sectoral regulators, but no one sector can really guard, "look anyone can pipe, actually caused can be whatever. "Chen Li said.
In June 2010, the Guizhou Provincial Health Department joint public Security Bureau did not obtain relevant qualification in the province's vehicle, emergency medical workers work of rectifying the situation. And now, in front of many hospitals and cottage ambulance depots should continue to solicit business.
Sun Fa in your Fuyuan, a professor for many years, and his cottage ambulance made a deeper study and research, as the CPPCC proposal he had purposely done this year. He recommended strict approval for ambulances, "by a public security organ and the administrative departments of health ambulances re-register finishing, and regulate the local hospital ambulances use RADIUS for long distance transport of patients in two hospitals will be given a strict registration, ensuring a smooth docking, preventing cottage ambulance bothered."
Sun Fa also suggested that "taking on the premise of strictly regulated access system for opening up markets, is State-owned, private and other social capital owned or participated in, in order to meet the market demand."
Chen believes that should increase investment in ambulance resources, improving first aid network. Under the existing conditions, there is need to harmonize the appearance of ambulances, paramedics and case writing. At the same time, he recommended a public formal ambulance vehicle identification number, so that the public tell the ambulance.
【核心阅读】
1月13日，本版报道了大医院不愿加入急救网络，急救资源紧缺等问题(《大医院：加入120动力不太足》)。与此同时，在许多地方，一些医院门口，山寨救护车生意很是兴旺。一边是正规救护资源的市场缺口之下病人的无奈选择，一边是不合规的救护设备给病人生命安全带来的潜在威胁，为何出现如此情形？记者在贵阳进行了调查。
春节将是医院救护车忙碌的时期。然而，春节前夕，记者在贵阳市看到，一些简陋的面包车竟然贴着“急救”的标识，正做着救护生意。这些既要钱又可能要命的山寨救护车，为何能大摇大摆地做着生死攸关的事？
喷上“急救”，就干起“救护”营生
1月19日，贵阳医学院附属医院(以下简称贵医附院)急诊楼背后，一辆挂毕节地区车牌号，由旧金杯面包车改装而成的“救护车”懒懒地晒着太阳。蓝色警报灯、红十字标识、车头的“急救”二字，乍看之下，与普通救护车没什么区别。
记者以患者家属身份拨通了车主在后车窗位置贴出的“用车电话”。
“我的车是医院的正规车，放心吧。”车主说。
“哪个医院？”
“具体哪家医院你就不要管了。车是新车，跑了一年都不到，各种设施配备都有。”
根据救护车的行业标准，普通救护车除了担架和氧气瓶之外，还应配备快速血糖测定仪、心电图机、心电监护仪等诊断设备和抢救设备，而记者在车内没看到这些仪器。
“这肯定是山寨救护车。”隶属于贵医附院的贵州省紧急救援中心工作人员陈立(化名)说，“大多数山寨救护车是由廉价的二手微型面包车或者商务车改造而成，配备简陋、劣质抢救设备，甚至没有抢救所必需的氧气，没有专业医护人员，装上警报灯，喷上‘救护’、‘急救’等字样，就干起了‘救护’营生。”
记者询问去毕节市织金县的价格，该男子起先要价1600，在记者犹豫嫌贵之后表示“最低给你降到1280”。
记者提出病人情况比较严重，希望可以有一名医护人员陪同，车主当即表示没问题，不过要加付200块钱。
陈立认为，该车主允诺的医护人员不可能是医院的医生护士，“一般是随便找个穿白大褂的，或者是有经验的护工”。
陈立上班时经常看到院内停着几辆山寨救护车。贵医附院保卫处一名工作人员回应记者质疑时说，医院停车场属于外包，院内付费停车，只要交钱车就可以进来，“只知道停车场肯定有山寨救护车，但也分不清哪些是山寨的哪些是正规的”。
正规救护车和山寨车还是有差别的，陈立说：“我们中心的车都有统一标识，除了‘急救’和红‘十’字外，还喷涂了‘96999’、‘贵州省急救中心’的字样。除了标注出车牌号外，还有一个属于这辆车的代码。”
有利可图，医院护工参与拉拢客源
山寨救护车为何普遍存在于各医院之间？贵医附院泌尿外科主任医师孙发认为最主要的原因在于正规救护车的运载能力和现有需求之间的巨大缺口。
按照5万人配备一辆救护车的标准，2012年贵阳市总人口将近450万，理想状态下应配备90辆救护车。而贵阳市急救中心主任陈勇介绍，目前贵阳市约有70辆救护车从事院前医疗急救工作。这些救护车远不够用，有时候会出现全网无车可用的情况。
调查发现，如果病人家属拨打120或96999不会招来山寨救护车，因为120系统调配的救护车都是正规救护车，山寨救护车是插不进来的。山寨救护车主要是在病人出院、转院时，利用内部关系或者发放小卡片来拉拢客源。病人选择山寨救护车，一个是正规车不够用，再就是山寨车可以讲价。
“病人出院回家、转院，有没有叫车，这些情况医护人员肯定都掌握，到时给病人介绍一些‘黑救护车’，可以从里面收取好处费。”陈立认为这背后已经形成了一个巨大的利益链。“有经验的护工直接买车来找人开，自己利用工作便利去找客源，单就我所知，这样的车就有3—5辆。至于为病患介绍车辆，95%以上的护工都有参与。”但是病人却不知情，也分不清楚哪些是正规救护车。
不只是靠医院内部人士介绍拉拢客源，山寨救护车的卡片还直接发到了各病房的病床上。在贵医附院外科大楼15层骨科病房走廊一张空置的单人床板上，记者就发现了一张山寨救护车的卡片，正面是车辆的照片和联系方式，背面则是介绍车辆配置情况，包括进口急救呼吸机、心电监护仪、电动吸痰器等设备。内科大楼进门处的玻璃展板底部，同样塞满了各种山寨救护车的信息卡片。
规范准入，防止见缝插针
2013年12月初，贵毕高速上一辆山寨救护车与货车相撞，救护车上2死3伤。虽然事故责任在货车司机，但由于事故车辆是黑救护车，病人难以维权。
山寨救护车不仅暗藏危险，而且还干扰到了正常医疗秩序。孙发就曾经碰到这样的事，他在救治一个垂危病人时，山寨救护车的运营者为了牟利，煽动病人家属放弃治疗直接拉回家准备后事。经医护人员及时制止，运营者没有得逞。现在四五年过去了，患者依然活着。
对于山寨救护车的管理涉及多个部门，救护人员的资质归卫生部门管理，改装车辆归公安交警部门管理，运营定价归物价部门管理。然而，虽然有多个部门肩负监管职责，却没有一个部门能够真正把关，“看上去谁都可以管，实际造成了都可以不管。”陈立说。
2010年6月，贵州省卫生厅曾联合公安厅对全省未取得相关资质的车辆、人员擅自开展医疗急救工作的情况进行整顿。而如今，在不少医院门口，山寨救护车仍在招揽生意。
孙发教授在贵医附院工作多年，他对山寨救护车做了较深的研究和调研，作为政协委员他今年特意为此做了提案。他建议严格救护车的审批，“由公安机关及卫生行政主管部门对救护车进行重新登记整理，并规范地方医院救护车的使用半径，对于要进行长途转运的患者，在两级医院都要进行严格登记，确保顺利对接，防止山寨救护车见缝插针”。
孙发还建议，“可以考虑在严格规范准入制度的前提下开放市场，可以是国有、民营及其他社会资本独资或者参与，以满足市场需求”。
陈勇认为，应当加大救护资源的投入，完善急救网络。在现有条件下，有必要统一救护车的外观、医护人员着装和病例书写。同时，他建议公开正规救护车的车牌号，以便公众辨别真假救护车。
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