State releases medical protection program for new coronary in rural areas

In order to do a good job of medical services for the new crown pneumonia in rural areas, to protect the people's lives and health, the State Council to deal with the new coronavirus pneumonia epidemic joint prevention and control mechanism comprehensive group has studied and formulated the "relying on the county medical *** body to enhance the capacity of medical protection of the new crown pneumonia in rural areas," the details are as follows:

Relying on the county medical *** body to enhance the capacity of medical protection of the new crown pneumonia in rural areas

The new crown Pneumonia medical security capacity work program

In order to do a good job in rural areas of the new crown pneumonia medical services, to ensure that the elderly combined with basic diseases and other infected people with a high risk of serious illness in a timely manner, in rural areas, the county medical **** body as a carrier, to enhance the county hospitals critical treatment capacity, play the role of township health centers and village health clinics health monitoring, and to maximize the possibility of reducing the rate of serious illnesses, the rate of death, the development of this program.

First, the overall requirements

In order to adapt to the new situation of the prevention and control of the new crown pneumonia epidemic, to strengthen the new crown pneumonia medical service capacity building, to play the county medical **** body led by the county hospital (including the county people's hospital, the county hospital of traditional Chinese medicine, hereinafter the same) in the rural areas of the leading role in the health care system, to guide the township health centers and village health offices to do a good job in the jurisdiction of elderly people combined with the underlying disease and other special people to implement the Health monitoring, the formation of county, township and village three-level linkage of the medical service system. Coordination of urban and rural medical resources, in accordance with the principle of zoning package, the establishment and improvement of urban second-class and above comprehensive hospitals and county hospitals to help mechanism, smooth city and county referral mechanism, enhance the capacity of the rural areas of critical care, and make every effort to safeguard the lives of the people in rural areas and physical health.

Second, improve the counterpart support mechanism, the formation of the new crown pneumonia medical services in urban and rural linkage

Based on the relationship between urban and rural hospitals in the province counterparts, the selection of urban cities in the province of the stronger comprehensive strength of the second level and above the general hospitals (in principle, for the third level of general hospitals, hereinafter referred to as the "urban counterparts to support hospitals"), in accordance with the subdistrict On the basis of the principle of "packet area", establish a counterpart support mechanism with each county (city), with "one-to-one" close support as the basis and "one-to-many" flexible support as the supplement, and set up an urban-rural linkage working group on medical services for NKP covering all the rural areas under its jurisdiction (hereinafter referred to as the "working group"). (hereinafter referred to as the "Working Group"), to enhance the medical service capacity of rural areas for new coronary pneumonia by means of downstream medical rounds, stationing of specialized personnel, and establishment of a telemedicine collaboration network. County hospitals, sentinel hospitals, and sub-sentinel hospitals led by the county medical **** body should join the working group to jointly do a good job of grading and classifying the treatment of patients with new coronary pneumonia in rural areas.

Third, to enhance the medical treatment capacity of new coronary pneumonia in the county

Accelerate the grid layout of the county medical **** body, to ensure coverage of all resident population in the county.

(a) Strengthen the construction and preparation of medical resources for critical and infectious diseases in county hospitals.

County hospitals leading the county medical **** body should achieve the following goals by the end of December:

1. Prepare medical resources for critical care. County hospitals that are tertiary hospitals should accelerate the completion of integrated ICU monitoring unit construction and upgrading, to ensure that the number of integrated ICU beds used for the treatment of various types of critically ill patients infected with the new coronavirus is not less than 4% of the total number of beds actually open in the hospital, and that the various intensive care units can be used at any time. At the same time, immediately start in addition to comprehensive ICU other specialized intensive care beds expansion and transformation work, with reference to the comprehensive ICU standards, its power supply, oxygen system transformation, equipped with ventilators, monitors, etc. to meet the needs of comprehensive intensive care treatment of monitoring and treatment equipment, to ensure that the need at any time can be put into the medical treatment of critically ill patients.

County hospitals are secondary hospitals, should be set up independently of the Department of Intensive Care Medicine, in accordance with the comprehensive ICU standards for the construction and renovation of intensive care unit, to ensure that the intensive care unit is readily available at any time. The working group's urban counterpart hospitals should guide and accept the construction and renovation of critical care units in county hospitals.

2. Do a good job of preparing medical personnel related to the specialty of critical care medicine. Hospitals should be based on the total number of comprehensive ICU and other specialized ICU beds, 1 ICU beds equipped with 1 doctor and 2.5-3 nurses, 8-12 hours per shift. On the basis of the regular allocation of medical and nursing staff, 20-30% of medical and nursing staff are added as a reserve force. The specialized ICU, internal medicine, pediatrics, and emergency medicine medical staff will be trained in comprehensive ICU expertise, and a mixed group work mode will be established consisting of medical and nursing staff specializing in critical care medicine and medical and nursing staff trained in other specialties.

Urban counterpart hospitals should send critical care medical professionals to carry out professional training for county hospitals in critical care, internal medicine, pediatrics, emergency medicine and other medical personnel to enhance their ability to identify critical illnesses, emergency response and comprehensive treatment.

3. Strengthen the construction of buffer wards. The hospital specialties in this ward in the relatively independent area set up buffer wards, which county hospitals for tertiary hospitals, can be combined with the need to choose the appropriate number of buffer wards equipped with the necessary oxygen and monitoring, treatment equipment, upgrading and reconstruction of critical care patients treatment beds.

4. Do a good job in the construction of infectious diseases. In the inpatient department in an independent area or independent building set up infectious diseases, ventilation, access, partitioning in line with the requirements of infectious diseases hospital infection prevention and control, each bed unit equipment with power supply, oxygen supply conditions.

(B) improve the township health center medical service capacity.

1. Strengthen the township health center fever clinic (outpatient) set up. before the end of December, the conditions of the township health centers to open fever clinic (outpatient), and have the ability to start within 24 hours, normal operation, and effectively strengthen the pre-screening and triage work. Accelerate the construction of fever clinics (outpatient clinics), and strive to increase the coverage rate to about 90% by the end of March 2023. Fever clinic (outpatient) medical personnel should be relatively fixed, in principle, the fever clinic should be open 24 hours a day, and the fever clinic is equipped with at least one physician with the qualification of a licensed (assistant) physician, and a good emergency plan. According to the number of visits to increase the allocation of the appropriate medical personnel, improve sterilization, inspection and testing, emergency rescue and other appropriate equipment and drug configuration. Each area should be in accordance with the township health center service population of 15-20% of the full allocation of full allocation of traditional Chinese medicine, antipyretic, cough and other symptomatic treatment drugs and antigen detection kits.

2. Strengthen the training of primary health care personnel. Strengthen the county health care personnel coordination and deployment and echelon preparation, county hospitals should strengthen the county medical **** within the township health center medical staff training, through telemedicine and other ways to improve the grass-roots physicians on the identification of high-risk populations, diagnosis and treatment capacity. Expand the staff of township health centers through multiple channels, and attract retired medical personnel to practice in township health centers. Playing the supporting role of county hospitals leading county-level hospitals in county medical **** body, sending respiratory, infection, traditional Chinese medicine and other related professional physicians and hospital infection management personnel to township health centers within the county medical **** body, stationed in the clinic, guidance, but also can be strengthened through the remote way of guidance.

(C) Enhance the village health center medical service capacity. Township health centers distribute traditional Chinese medicines and antigen detection kits for village health rooms, strengthen the training of rural doctors, and improve the ability of rural doctors to provide antigen detection guidance, home health monitoring, and drug symptomatic treatment for people at high risk of severe cases of new crown pneumonia.

(d) Give full play to the supporting role of information technology. Localities should make full use of information technology to strengthen the command and control of the graded and classified treatment of people infected with new crown pneumonia in their jurisdictions. Within the county medical **** body to realize the township health hospital fever clinic (outpatient) telemedicine full coverage, higher hospitals through remote consultation, remote diagnosis, remote training and other ways to improve grass-roots capacity. The working group coordinates the promotion of county medical **** body and fixed hospitals, sub-fixed hospitals, urban counterparts to help hospitals between the information **** enjoy, to ensure that patients receive timely and effective treatment.

Fourth, clear county hierarchical diagnosis and treatment process

(a) to township health centers as the main implementation of grass-roots first diagnosis and home treatment. Give full play to the local epidemic prevention and control community (grass-roots) work mechanism of the organization, mobilization, guidance, service, protection, management role. Township health centers should work with the relevant member units within the county medical **** in accordance with the requirements of the "medical consortium as a carrier to do a good job of graded diagnosis and treatment of new coronary pneumonia work program", the implementation of graded health management of residents under the jurisdiction, timely guidance of the emergence of the new coronary pneumonia-related symptoms of the key groups of people to conduct antigen testing, receive residents to self-test of abnormal reports of antigens, antigen test positive people for preliminary diagnosis, if necessary, guiding the residents for further Nucleic acid test, guide home treatment or referral work.

Asymptomatic infected people without serious underlying diseases, light cases of treatment and observation, take home treatment, township health centers in conjunction with the village and village health center to do a good job of distributing medicines, guidance and health monitoring. Elderly mobility, in the case of the condition allows, the principle of home or in the nursing institutions in the local treatment, if necessary, medical personnel to provide door-to-door service, not transferred out of the centralized treatment. Beyond the township health center service capacity, in the county medical **** body lead county hospitals under the guidance of timely referral of patients.

(ii) the implementation of designated hospitals, sub-designated hospitals for the classification of admission and treatment. Ordinary cases, advanced age combined with serious underlying diseases (heart disease, tumors, etc.) but stable asymptomatic infected and light cases, referral to sub-sentinel hospitals for treatment. To new coronary pneumonia as the main manifestation of heavy, critical type cases and the need for hemodialysis cases, referral to the county-level designated hospitals infectious diseases, intensive care medicine or urban designated hospitals centralized treatment.

(C) the implementation of the county medical **** body lead county hospitals for the treatment of critical illnesses. The basic disease-based heavy, critical cases, as well as the underlying disease beyond the township health centers, sub-sentinel hospitals medical treatment capacity, referral to the county medical **** body lead county hospitals in the appropriate specialties or intensive care medicine treatment, the emergency can be directly to the appropriate diagnostic and treatment capacity of the medical institutions. If the county hospital is not a tertiary general hospital or its capacity does not meet the patient's treatment needs, the patient will be promptly referred to the urban counterpart hospital. If the patient does not have the referral conditions, the urban counterparts to help hospitals to send experts down to the county hospital to guide the treatment.

(d) Do a good job of patient referral articulation. Strengthen the county coordinated scheduling, to ensure the timely transfer, admission and treatment of patients with new crown pneumonia in the county. The working group should determine a special post dedicated person, responsible for and township health centers, county medical **** body lead hospitals, designated hospitals, sub-determined hospitals, urban counterparts to help hospitals, transfer vehicles, etc. to do a good job of referral articulation, the establishment of a clear process of receiving and treatment and green channel. Various types of medical institutions at all levels should strictly implement the system of responsibility for the first diagnosis and emergency rescue system, shall not use any reason to shirk or refuse to new coronavirus infected patients.

V. Organization and implementation

(a) Strengthen organizational leadership. Localities should attach great importance to the work of rural areas to enhance the medical service capacity of the new coronary pneumonia, in accordance with the principle of "fill in the blanks", increase investment to strengthen the critical care capacity of county hospitals and township health centers fever clinic (outpatient) construction, to ensure that the completion of the construction tasks on schedule. Local health administrative departments to improve the county medical **** body grid layout, the development of county hospitals and township health center construction program, clear classification referral process.

(ii) Strengthen the command and scheduling. Provincial health administrative departments should guide the counties (cities) under their jurisdiction, strengthen the county medical resource coordination and command and control, with the county medical **** body as a carrier, give full play to the leading role of county hospitals and urban and rural ties, strengthen the urban and rural new coronary pneumonia medical service convergence. It is necessary to guide county-level hospitals and urban counterpart hospitals led by the county medical **** body to make good preparations for critical care, urge the lead hospitals to implement the responsibility of guiding township health centers in medical treatment, health monitoring and infection prevention and control, and continuously improve the ability of township health centers to detect and dispose of infected persons. The National Health Commission will carry out regular scheduling and supervisory inspections of the implementation of the localities, and inform the progress on a regular basis.

(C) Strengthen publicity and guidance. Strengthen the publicity of rural areas to enhance the capacity of medical and health services and hierarchical diagnosis and treatment work arrangements, widely carry out health education, guide the people to correctly understand the new coronary pneumonia hierarchical diagnosis and treatment work, set up a scientific concept of medical care, and promote the formation of an orderly pattern of medical care.