nghiên cứu mô hình thu dung, cứu chữa nạn nhân hàng loạt do thảm họa tại bệnh viện tuyến cuối quân khu (tóm tắt tiếng anh)

1
BACKGROUND
In recent years, the disaster situation has changed complicatedly, containing
many uncertain factors. The fact that disasters occurs without warning, occurs very
suddenly increased the number of victims should be cured, transportation
always exceeds the capacity of the health sector response. To restrict to a
minimum the loss of life and material caused by the disaster, the need for
coordinated action of many forces, media synchronization, in which modern health
sector had an important role. The military zone hospital (MZH) was a general
hospital had specialist (type B), located on the strategic areas of the country,
performing tasks of treatment for soldiers and people in the area. There is
particularly important role in emergency medical response when disaster strikes.
But so far, there was no unified model, RRVMD by the military zone hospitals
was difficult. Therefore, we conducted this research subject to the following
objectives:
1. Status of receiving, rescue victims of mass disasters from military zone
hospitals in the period of 2007-2012.
2. Modeling, deployment experimental exercises and evaluate results of
model organization RRVMD in Hospital 4, Military Zone 4, in 2012-2013.
* New contributions on the practical science of the thesis:
- Has been described real operating condition, capacity of RRVMD of
military zone hospitals (MZH): There was adequate staffing organization by
decision; There are facilities, fully equipped, convenient infrastructure for
RRMVD; Have established the Steering Committee, annually implemented plan
RRMVD; In 6 years (2007-2012) the hospital had 1-2 times receiving, rescue
mass victims; Capable of sorting from 50-100 victims/hour, receiving treatment
from 30-60 victims/hour, maximum deployment 4-10 surgical teams, often held 5-
6 mobile health groups available assignment of a task; Ability to rescue specialist
early for the victims of disaster and responsive, effective for the second disaster.
- Has been developed and successfully tested model RRMVD of MZH:
Depending on the size, characteristics and extent of each type of disaster can be

implemented in one of two solutions:
+ Option 1: deployment of mobile military medical team to the field;
Organization the clinical patients in order to be ready to rescue victims.
2
+ Option 2: deployment of mobile military medical team to the field;
establishment of field hospitals; Forces remaining on duty regularly.
+ After 2 rehearsals empirical model was considered reasonable, realistic,
feasible high. 90.9% - 92.9% of experts rated on organization, staffing, use of
force in 2 alternatives was reasonable. 100% expert opinion evaluation with the
model was built, MZH capable of completing tasks in similar situations.
The layout of the thesis: The thesis consists of 132 pages include:
Background 2 pages; Chapter 1-Overview: 34 pages; Chapter 2- Objects and
research methods: 21 pages; Chapter 3-Results: 41 pages; Chapter 4-Discussion:
31 pages; Conclusion: 2 pages; Recommendations: 1; 44 tables; 11 schemes; 2
appendix ; 136 references (79 Vietnamese, 51 English, 6 Russian documents).
Chapter 1
OVERVIEW
1.1. Situation disaster, losses from disasters around the world and in Vietnam
1.1.1. The concept of disaster
According to the World Health Organization: "The disaster is the
phenomenon caused the damage, the economic upside, the loss of life, human
health, damage to health facilities with a large extent, requires the mobilization of
relief especially from outside to the disaster area. "
According to the Ministry Health and National Defense "Disaster is the risk
or unexpected event occurs, causing great loss of life and material."
1.1.2. Classification disaster
- According causes: natural disasters, human disasters
- As the number of victims: from 3-4 degree
- As request of medical interventions: immediate loss, lasting consequences
- In time of disaster: long, short, acute, chronic

- Geographically, regions, geography, population
1.1.3. Disaster situation in the world and Vietnam
1.1.3.1. Disaster situation in the world
Catastrophic events in the world were coming complicated and growing
rapidly. In 10 years (2002-2011), there are 3.942 worldwide natural disasters,
including floods accounted for 1.793 cases, whirlwind accounted for 1.022
3
cases The disaster caused by people common as: fire, terrorism, war, industrial
accidents, traffic accidents In 10 years (2002-2011), there were 2.622 disasters
caused by humans, killing 82.609 people and affected up to 152.900 people life,
loss of 38.112 million dollars.
1.1.3.2. Disaster situation in Vietnam
From 2003 - 2012, there were 103 big natural disasters killed 7.748 people
and 6.740 people injured, the loss of material wealth estimated thousand billions.
In Vietnam disaster caused by humans was diverse, complex and increasingly
more serious. Many disasters cause huge losses of life and materials, only traffic
accidents in 10 years (2003-2012) had 36.409 cases occurred, killing 9849 people
and 38.064 people injured.
1.2. The work of emergency medical response to disasters
- In the world: the system for emergency medical response in disasters was
organized to two trends: There were separated organizations outside the health
system or in health system sector.
- In Vietnam: based on the medical establishment to civilian and military
organize searching, rescue, treatment victims due to the line of treatment system.
1.3. Model of receiving, rescue victims of mass disasters in hospital
1.3.1. Situation of ability RRMVD in hospital
Hospitals can deploy RRMVD, depending on the severity of the disaster as
well as the number and structure of victim injury. However, hospitals have no
standard and full model for deployment RRMVD effective and systematic.
1.3.2. RRMVD model of some hospitals through rehearsal

- Rehearsal BV-06 of Hospital103: Hospital 103 in collaboration with the
forces of the military unit organization and onsite RR practice for 300 victims of
the fire disaster in the industrial area of Ha Dong District . Forces have been used
as follows: At the field using 3 surgical teams performing total rescue task with
emergency, sorting victims; Established receiver and additional emergency;
Organizations RRV in the clinical.
- Rehearsal CN-10 at BV4/QK4: From forces and tools available of a hospital,
in coordination with other forces in the area, RR for 170 victims of the collapsed
multi-storey buildings under construction in Vinh city. Organizations were
4
implemented as follows: One military medical force at the field; At the hospital
detached a force to be arranged independently of the hospital campus with RRV duty.
- Rehearsal BV-05 at Hospital175: Hospital in collaboration with the
Ministry of Defense forces organization RR for about 450 victims of fire disaster
caused by tall buildings, including victims of poisoning. Hospital organizations
deploy: Area receiving, sorting; emergency zone and shock management; victims
of severe treatment areas; Face identification and preservation of the body.
Chapter 2
SUBJECTS AND METHODS
2.1. Subjects, materials, time and location of study
2.1.1. Research Subjects
- Research subjects situation: the MZH (infrastructure, equipment, staffing
organizations, professional activities )
- Subjects intervention: military zone hospitals participation in RRVMD.
- Leadership, command hospital head of some department of the military
zone hospital directly related to the work RRVM in disaster.
- Officers and staff of the Hospital 4 - Military Zone 4 in the exercise
RRMV experimental.
- Specialist in medical, military medicine, military, political, logistical and
technical, local rescue Steering committee.

2.1.2. Material Research
- The legal documents relating to the care and protection of people's health,
the combined military and civilian medical response to an emergency condition.
- The document of the situation and the damage caused by the disaster in the
world and in Vietnam, the period from 2002 - 2012
- The document summarizes the work RRVM disaster and the results of a
number of hospitals.
- The statistical reports on infrastructure, staffing organizations, media
equipment, qualifications and professional competence of MZH.
2.1.3. Study sites
At 7 military zone hospitals, organizations 2 experimental maneuvers
(BMT-13 and NA-NĐ13) in the province of Nghe An.
5
2.1.5. Research time
- Phase 1, describes the current status surveys: from 07 2011-06/2012.
- Phase 2, experimental exercises: from 7/2012 - 12/2013.
2.2. Methodology
2.2.1. Study Design
Research describes across, the retrospective study combined quantitative
and qualitative research and intervention by experimental maneuvers.
2.2.2. Sample sizes and sampling studies
2.2.2.1. Sample sizes and sampling baseline study
- All 7 military zone hospitals of the army
- 84 leaders, commander of the military zone hospitals
- 50 experts in: medicine, military medicine, military, logistics
2.2.2.2. Sample sizes and sampling intervention studies
- Intervention model: choose intentionally Hospital 4 - Military Zone 4
- The entire staff of 110 employees in H4/MZ4
- 61 turns of experts selected for interviews, opinions (1
st

rehearsal: 33
experts, 2
nd
rehearsal: 28 experts).
2.2.3. The scope, content and index research
2.2.3.1. The scope, content and status research index
- Task and organize forces, number of beds
- Facilities and equipment of hospital
- The situation properly and heal in 6 years (2007-2012)
- Construction work plans and activities to meet the emergency medical
- Ability to organize and implement a RRVMD.
2.2.3.2. The scope, content and intervention research index
- Content RRVMD model in military zone hospitals: discipline of the model;
Depending on the characteristics of the disaster can be implemented in one of two
alternatives.
- The results of the last two experimental rehearsals: Preparation; Results
deployment model; Opinion, evaluation of expert.
2.2.4. Methods and tools to gather information
* Methods, tools for data collection in a status research
6
- Research Methods: Secondary data analysis; Observations described;
Direct interviews; Professional method.
- Research tools: form number 1, form number 2, form number 3.
* Method and tools of assessment intervention results
- Method: Empirical exercises with 2 plans
+ Option 1: the type of disaster occurs near the hospital or in the hospital
may receive direct victims.
+ Option 2: major disaster, away from the hospital, casualties, difficult
transportation conditions.
- Assessment tool: form number 4 and form number 5.

2.3. Errors and remedies
- Form design research to ensure adequate information, unified
- Conduct a pre-test, complete toolkit
- Choose enumerators, supervisors are experienced staff
- Organization of adequate training and close supervision
2.4. Methods of analysis and data processing
- Clean form before accessing computer
- Data processing using Excel 2007 software, SPSS 13.0.
2.5. Research organization
- Investigate, analysis the situation in 7 hospitals under the form
- Organizing two rehearsals corresponding to 2 plans were built.
2.6. Limitation of the thesis
- No research on: equipment, drugs, facilities, materials
- No evaluation of the ability of each forces participating in a specific way
- Not given model for each type of disaster
- No deep research on the treatment, ensure logistics
2.7. Ethical aspects of research
- The study subjects entirely voluntary
- The information only used for research purposes and to ensure security.
7
Chapter 3
RESEARCH RESULTS
3.1. Current status and operational capacity of RRVMD of MZH
3.1.1. The task, organization forces.
- Hospitals type B, general hospitals with specialist; With a payroll of 270
employees, was organized into six departments, 7surgical, 7 Internal Departments
and 6 Para clinical Departments.
- MZH had 7 tasks, including: "Ready combat, combat service and meet
emergency medical situations such as natural disasters, catastrophes" .
3.1.2. The number of employees(E) and number of beds(B)

- The MZHs were staffed from 200-250 beds, actual deployment from 250-
574 B. Served ratio is lower than specified, ranging from 0,69 to 1,30 E/B.
- Only from 2,0% -18,0% of the doctors in general level, the rest have been
trained specialist. Pharmacists have university degrees from 18.0%-38.0%. Nurses
have an intermediate level between 84.0% - 97.0%. Technicians had intermediate
level from 64.0% to 100%.
3.1.3. Status of physical facilities and equipment of the hospital research
Table 3.4: The infrastructure of the hospital in research
Index
H11
0
H10
9
H7 H4
H1
7
H7A H121
Campus area/bed (m
2
) 59 788 - 113 18 36 79
Using area/bed (m
2
) 18 60 - 30 12 19 25
Operating
rooms
Present (room) 5 4 4 4 7 3 3
More (room) 3 2 3 3 3 4 3
Total (room) 8 6 7 7 10 7 6
Empty ground of Hospital
(m

2
)
500 500 400 1500 800 500 1250
Extra beds (bed) 100 50 100 150 100 120 120
- Each hospital had from 3-7 operating rooms, when emergency medical
response can deploy more from 2-4 operating rooms. Each hospital can deploy
more from 50 – 150 B enough to properly cure the disaster 1 to level 2.
8
- The research hospitals were equipped with basically for examination,
diagnosis and treatment of patients, but the number was small, some just a single
type should not be a transfer available on mobile military medical team.
- All research hospitals had mobile equipment and materials as artificial
respiration apparatus, anesthetic machine, operating tables, mobile X-ray all type
of cars to transport patients but not enough quantity to meet if disaster happened.
- All hospitals were not equipped with the tools of preventing biological
weapons, chemical, nuclear, such as sanitation treatment systems, test facilities
and tools of personal protection, respirator protection, DDA car
3.1.4. The situation of receiving and rescue of hospitals in 6 years (2007-2012)
- Number of hospital surgery was not the same, the difference between the
hospitals quite large (2043-7981 cases per year). Individual hospitals have
relatively stable, the next year always higher.
- The targets were exceeded professional regulations: bed utilization rate
reached 116.9% - 184.0%; The rate of illness from 68.2% - 82.8%; The number of
examination/day highest from 190-1471 people/day; The number of
emergency/day highest from 14-140 people/day.
3.1.5. Current status of the organization and the ability to deploy properly and
heal victims of the mass Hospital Research
Table 3:13: The receiving ready, rescue victims of mass in research hospitals
Content
H11

0
H10
9
H7 H4 H17 H7A
H12
1
- Executive Steering Committee
RRVMD
All research hospitals had decision on
established the Steering Committee.
- Plan to mobilize forces, facilities,
supplies and medical equipment in
RRVMD
All hospitals had annual research plan on
RRVMD, mainly respond to floods, fires and
explosions, traffic accident
- Times of RRVM from 2007 to
2012
2 2 2 3 2 1 2
- The highest number of victims
was received and rescued at a time
20 25 30 32 26 17 45
9
The hospitals had executive board on emergency medical response to
disasters by the Director as its head; were planed, organized force ready to respond
to an emergency medical condition but mainly in response to floods, fire, traffic
accidents including content reserve facilities equipment, and medical supplies.
The statistics in 2007 - 2012 showed that 100% of patients had at least one
RRVMD time with highest number of victims from 17-45 victims.
Table 3:18: Ability to organize RRVM of research hospitals

Hospital
Victims
sort/hour
(people)
Operation
(cases)
Motivated
surgical team
(team)
Victims
RR/hour(peopl
e)
H110 50 10 5 50
H9 50 6 5 50
H7 100 8 5 50
H4 50 6 6 50
H17 100 6 5 60
H7A 50 4 5 30
H121 100 6 6 60
The hospital research can be classified from 50-100 victims/hour and
received treatment from 30-60 victims/hour. Regularly held 5-6 emergency groups
and can deploy 4-10 surgical team.
- 56.5% - 66.7% opinions of experts and staff that MZH only meet a part
mission of RRVMD, due to the lack of planning (53.6% - 57.5%); No RRVMD
model (65.0% - 71.4%); lack of practical training RRVMD (67.5% - 81.0%).
- Only 29.8% - 32.7% suggested that the practical ability of medical staff
had good capability in rescue emergency victims of disaster.
3.2. Building RRVMD model in MZH
3.2.1. Basic on model building
- Functions and tasks of military zone hospitals

- The need for rescue victims
- The system of legal documents related to the work TDCCNN
- Reality RRVMD ability of the hospitals.
10
3.2.2. Content of RRVMD model in MZH
* Principles RRVMD at military zone hospitals
"Use the force, available tools of hospital implemented emergency RR properly
and timely the basic wounds of the victim. Ready assist and come to emergency
disaster place. Simultaneously, ensure regular tasks of the hospital. "
Table 3:22: Comments of the research objects on model and principles RRVMD
Assessment content
Commanders(n = 84) Experts (n = 50)
Quantity Rate (%) Quantity Rate (%)
1. The need to build the model:
- Very necessary 82 97,6 48 96,0
- Necessary 2 2,4 2 4,0
- No need 0 - 0 -
2. Principles of RRVMD:
- Reasonable 82 96,4 50 100
- No reasonable, additional 3 3,6 0 -
- Other ideas 0 - 0 -
Opinion of the leaders, commanders of hospitals and research experts that
very necessary (96.0% - 97.6%) and necessary (2,4 - 4,0%) to build RRVMD
models for the MZH.
96.4% of leaders, commanders of the research hospital and 100% of the
experts believe that the RRVMD principle was reasonable, only 3.6% of
respondents need additional contributions to be fully taking advantage of the
MZH: there are professional and technical staff experienced in handling medical
conditions, surgical field, high mobility, equipment diversity, richness and
advanced modern science can treat most basic and specialist help RRVMD timely

and limited mortality disabled.
* Content model: Depending on the specific situation, organizations can deploy
RRVMD model as the following options:
11
Area field
Chart 3.2: Diagram deployed forces in place disaster
+ At the disaster site (at the field: hold a mobility medical teams (MMT)
capable of first treatment that the core is basic treatment surgical team(BTST)
enhanced sort and deliver group, maneuver quickly to the disaster field, parts was
organizing according to diagram 3.2.
+ At the hospital:
If number of victims was moderate, not continuous, can use examination
part to receive and sorting, emergency (if any), write patient records and put the
victim in the clinical with professional treatment.
First aid area
Commander
board
Death body
place
Nơi để tử thi
Delivery mild
victims
Emergency area
Delivery severe,
moderate victims
area
Sorting severe,
moderate victims area
Sorting mild victims
area

Deliver to Hospitals
12
If more number of victims, the hospitals overwhelmed, examination part not
guarantee, organizations a team for receiving and sorting (RRT) in examination
ground, pitch, garage , emergency management (if any), write patient records
and victim transported to the clinical treatment.
Simultaneously, the cumulative clinical patients who are undergoing
treatment for stable patients discharged from hospital, surgical patients were
transferred out of time to monitor internal medicine to spend some empty beds
ready to receive victims emergency treatment.
Chart 3.3: The basic deployment diagram in hospital of option 1
- Option 2: The disaster occurred huge in hospital, casualties, difficult
transportation conditions, not directly transfer the victim to the MZH.
Organizations implemented as follows:
+ At the field: Organized MMT to the field to search for victims, emergency
rescue, sorting, delivering victims to the treatment facility. MMT that the core is
BTST enhanced deliver compact ensure light, mobile and highly specialized.
+ At the hospital:
From the hospital's payroll detached a force to deploy HF for disaster
response, 10-15 km far from the field, go after MMT. Number of employees
remaining hospitals do routine tasks, but narrowing the scope of the rescue.
Chart 3.4: The basic deployment diagram in hospital under option 2
At Hospital
Clinical department
Receive and sorting
team(RST)
MZH
Mobility Medical
Team (MMT)
Hospital field

(HF)
The remaining
forces of hospital
13
Size, staffing: Decision No. 20/QĐ-TM 02/01/2009 Chief of General Staff
of the Vietnam People's Army.
3.2.3. 2 Results through two empirical rehearsals in Hospital 4 - MZ4
3.2.3.1. Rehearsals BMT-12 on 7/2012 (In accordance with option 2)
- Preparatory work;
+ Establish committees: a steering committee, organizing committee,
building committee documents, assisting part, part to ensure
+ Component in the exercise forces: Forces in hospital staff and
coordination.
+ Prepare assumption victims: cases structure like a disaster have occurred,
have more situations poisoning victims.
- Organization of practice exercises and assessment model results:
+ Coordinate with MZ Hygienic team deployed MZ sanitary treatment
+ Deployment MMT arrived the field: the core is first aid team enhanced
delivering group (including 1- 2 nurse practitioners).
+ Deployment HF as basic organizational model of military medical sector.
Table 3:24: Results of deployment hospital field model to RRVMD
Parts
Form
deployment
Content
deployment
Maneuver
time
Time
deployment

The departments, parts of
HF
Cottage,
tent
True,
enough
25’ 50 ‘
The whole sanitary part Cottage,
tent
True,
enough
25 ‘ 60 ‘
All parts of HF are fully deployed both in person as well as equipment to
RRVMD, maneuver time was 25 minutes, time to deploy parts of HF was 50
minutes, while time implementing sanitary treatment part was 60 minutes.
14
Table 3:25: Results RRVMD of HF according to the time, diagnosis and
treatment
Content Criteria Phase I Phase II Phase III Total
The number of victims 55 70 45 170
Time for a
victim
classification
Maximum 18 16 17
Minimum 4 4 4
Average
7,63
± 3,25
6,81
± 3,15

7,47
± 3,17
Diagnosis
Result
Corre
ct
SL 46 62 40 148
% 83,6 88,6 88,9 87,1
Wron
g
SL 9 8 5 22
% 16,4 11,4 11,1 12,9
Time
The earliest 10 8 10
Latest 23 20 21
Average 13,8 ± 1,8 12,5 ± 1,6 13 ± 1,7
Time to sort out a victim at least 4 minutes, maximum 18 minutes, with an
average of 6,81 ± 3,15 (min) to 7,63 ± 3,25 (min). Time moving to departments
earliest 8 minutes, latest 23 minutes, on average from 12,5 ± 1,6 to 13,8 ± 1,8
(min). There were 22/170 victims (12,9%) not diagnosed correctly when moving.
Table 3:26: Results hygienic treatment for victims contamination at MZHF
Content
Quantity
victim
Time for 1 sanitary victim(minute)
Minimum
Maximum Average
Victims must be off 8 7 19 12,15 ± 4,27
Victims can walk, bath 13 7 23 11,35 ± 5,61
15

Minimum time was 7 minutes, maximum 19 minutes, averaging 12.15 ±
4.27 for sanitary a victim off. Similarly, need 7- 23 minutes, averaging 11.35 ±
5.61 for sanitary victims can walk, bath.
Table 3:27: shock result against resuscitation for VMD in MZH
Content
Victims need anti-
shock
resuscitation(ASR)
Satisfactory
Unsatisfactory
Quantit
y
% SL %
Phase I 7 6 85,7 1 14,3
Phase II 12 11 91,7 1 8,3
Phase III 5 5 100 0 0%
Total 24 22 91,7% 2 8,3
There are 2 victims (8.3%) in group ASR unsatisfactory about: consoles
form victims, medical records, transfer process. Other contents: 100% real victims
are good at and HSCC requirements.
Table 3:28: Expert evaluation of model MZHF in RRVMD (n = 33)
Content Assessment
Good
Additional
need
Not good
Qu % Qu % Qu %
Perform tasks RR part
32 97,0 1 3,0 0 0
Perform tasks sanitary part

31 93,9 2 6,1 0 0
Perform tasks surgical HSR
33 100 0 0 0 0
Organization and staffing RRVMD
30 90,9 3 9,1 0 0
Evaluate the ability to complete
tasks similar situation
33 100 0 0 0 0
Most (90.9% - 100%) expert reviews of good evaluations all parts of the
content. Only one reviews (3.0%) that should be added: "The RR part should
16
contract with the delivery team so close to transport injured victims immediately
after sorting to help improve circulation quick follow order of priority". 2
comments (6.1%) that required additional content for sanitary station: "It should
work synergistically with internal delivery team for victims must be off".3
comments (9.1%) said that: "It should increase the number of people to transport
victims when the victim receives so many at the same time, there must be
provisions for collecting specific types of preventive stretcher, to ensure sufficient
quantities needed for transporting victims to avoid wasting time".
3.2.3.2. Rehearsals NA-ND13, June/2013 (In accordance with option 1)
- Preparation: similar to BMT-12 drills, but no force participation Hygienic
team and implemented under option 2.
+ Prepare assumption victims: victims cases structure like a disaster have
occurred, however no victims poisoned.
- Organization of practice exercises and assessment model results:
Table 3:30: Results of deployment preparation force in the field and
hospitals
Parts
Form Content
Maneuver

tine
Time
Maneuver
part
Tents, cottages Right, enough 30 min 20 min
Examination Frees hallway
Stretcher,
trolley
15 min 15 min
Clinics Arrange patients Right, enough 15 min 20 min
Para clinics
Vehicles,
consumable
supplies medicines
Right, enough 15 min 15 min
Ensure parts
Serve patients,
family
Right, enough 20 min 15 min
+ Deployment MMT arrived at the field: the core is basic treatment team
enhanced 2 delivery group (including 6 nurses).
17
+ At the hospital: established RRT, arrange beds, to be ready for RRVMD.
All parts of the hospital are fully deployed with people and equipment to RRVMD
according to the content requirements set out. Division deployed earliest was
examination part and para-clinics, after 30 minutes to re, receive, sort, transport,
test for the first victims.
The minimum time required to classify a victim as 3 minutes, maximum is
16, the average time to classify a victim from 5,81 ± 2.17 to 5,47 ± 2,15 minutes.
Table 3:31: Results RSRV in hospital in NA-NĐ13 (from the exam to clinics)

Content Phase I Phase II Phase III Total
The number of victims 10 25 20 55
Time for a
victim
classificatio
n(min)
Maximum 16 14 15
Minimum 3 3 3
Average
6,63
± 2,25
5,81
± 2,17
5,47
± 2,15
6,15
± 2,35
Diagnostic
Results
Correct
Quantity 10 24 20 54
% 100 96 100 98,2
Wrong
Quantity 1 0 1
% 0 4 0 1,8
Time
transport to
clinics
(min)
Earliest 5 8 7

Latest 15 16 18
Average
13,8 ±
3,5
16 ± 4 15 ± 3
Time transporting to clinics earliest was 5 minutes, 18 minutes at the latest.
There were 1/55 victims (1,8%) not diagnosed correctly when moved into
treatment.
In rehearsal NA-ND13 (6/2013), H4/MZ4 BTST used to maneuver the field
to organize the RRVMD, 25 km distance on 30 minutes.
18
Table 3:32: Anti-shock resuscitation results in deployment RRVMD in H4/MZ4.
Content
Victims need ASR
Satisfactory Unsatisfactory
Qu % Qu %
Phase I 3 3 100 0 0
Phase II 4 4 100 0 0
Phase III 3 3 100 0 0
Total 10 10 100 0 0
At the disaster site to coordinate medical forces Nam Dan district, first aids,
transport as indicated to Nam Dan district hospital 35 victims and 55 victims to
H4/MZ4. 100% of victims were treated ASR in hospital satisfactory in all content.
Table 3:33: The results of the expert evaluation to perform the tasks of parts in
rehearsal NA-NĐ13 (n = 28)
Content Asessment
Good
Need
addition
Not good

Qu % Qu % Qu %
Perform tasks RR part
27 96,4 1 3,6 0 -
Perform tasks ASRS part
28 100 0 - 0 -
Organization staffing and force
of RRVMD
26 92,9 2 7,1 0 -
Evaluate the ability to complete
tasks when similar situations
occur
28 100 0 - 0 -
Most (92.9%-100%) experts opinion on the forces of organization so good
and also the mission of RRVMD. Only 2 reviews (7.1%) said that: "It should add
up the number of people to transport victims in many cases the victim receives
many at a time, there must be some indication for internal transport forces to
make job easier ".
19
Chapter 4
DISCUSSION
4.1. On the capacity of RRVMD of MZH
One of the important tasks for the MZH such as: when disaster strikes, mass
casualties, then under the leadership of Commanders of military Regions and the
Steering Committee remedial disaster. Rescue forces were mobilized, deployed to
search and rescue, sorting and transporting victims as directed by the medical
establishment to medical facilities. The victim is promptly treated to reduce to the
lowest mortality, disability caused by the disaster. In some hospital researched
were general hospitals with specialist will be the receiving place, rescue for bulk
victim request.
Although the number of patients MZH was huge now and always

overloaded on the number of patients to treatment as well as a shortage of human
resources for serve, this is considerable pressure for hospital, will be more difficult
if a large number of victims at a time when a disaster occurs . But professional
forces of hospital were formal training, highly qualified, had strong command
system, experienced in handling emergency situations. Regular employees were
well trained, highly professional nature and always full meticulous planning in
response to the disaster.
In fact, the hospital has developed from 250-574B, although the payroll of
the MZH from 200-250B, bed occupancy rate always reaches 150% (2007) to
nearly 200% (2012); discharge rate from 70% (2007) to 87% (2012). So hospitals
researched receive the number of patients treated beyond all norms prescribed. As
a result, when disaster strikes in the province should undertake receive and rescue
a large number of victims, the hospital can fully implement receiving, rescue,
treatment exceeds the number of victims assigned to each hospital was entirely
possible. Although the current number of such increase but by examining the
current situation in 5 years that the MZH could deploy more from 50 to 100 beds
when a disaster occurs.
Over the 5-year statistics recently 7/7 MZH participating RRVMD at least 1-
2 times, with all type of disaster but the number of victims is not much, lowest 17
victims, maximum 45 victims. The application RRVMD model of hospitals in
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dealing with new disasters just for the experience of a number of experts, but not
the basic model that hospital can be deployed work RRVMD in situations to
emergency medical response for each type of disaster can happen to hold annual
training effective.
Through surveys state facilities, technical expertise situation, the results of
RRVMD of hospitals, found that all hospitals can receive and classify from 50-
100 victims an hour, rescue at a time on 100 victims, emergency from 30-60
victims, additional 2-3 operating table and 3-5 surgical teams to perform surgical
tasks handle foreign wounded for the victims.

In addition, most hospitals have plans to ensure health in unexpected
situations such as: have executive Steering Committee met in medical disaster;
plans to meet health in disaster; has been prepared to meet the health care plan for
each type of disaster, most especially hospitals are organized BTST, rescue teams,
military maneuver, rescue specialist and training, and additional test equipment
regularly should be able to respond quickly when there is an emergency situation.
4.2. About the RRVMD model in MZH
4.2.1. In principle RRVMD of MZH
In terms of hospital professional activities regularly, have collected a large
capacity victims in a time, to avoid the unnecessary disturbance and upset the
rhythm of the scientific work, the entire hospital board on the other hand create the
best conditions for the maximum concentration of manpower, facilities in
RRVMD and avoid other consequences related to emergency medical response,
such as task often hampered regular hospital, infecting victim when poisoned,
radioactive, infectious So RRVMD principles of MZH (hospital B) based on the
principles:
- Ensure regular professional activities of the hospital.
- Make the most of the facilities, vehicles, equipment and forces available
technical staff of the hospital.
- RRVMD based on the principle of rescue transport in lines, according to
regional military and civilian combined.
- Good organization and effective work RRVMD to reduce lowest mortality,
disability for the victims.
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- Coordinate combines maximum strength of the forces in the area,
especially to coordinate with local health workforce, good performance combining
military and civilian medical care in the emergency response to disaster for
receiving victims rescue and overcome the consequences of the disaster.
Principles RRVMD of MZH must be comprehensive, high planned, timely
and always demonstrated a deep humanity with the ultimate objective is to

receive, rescue victims, reduced to the lowest death rate and disabled victims.
4.2.2. Regarding effective model through 2 times experimental exercises
After building theoretical models of mass RRVMD at MZH, H4/MZ4
conducted two interventions by experimental maneuvers on military zones under
two schemes built: The 1
st
: RRVMD organization by deploying riot victims
contaminated with toxic chemicals in Nghi Loc district, Nghe An province
(7/2012) with the number of victims is 150 people. Development of the model
under option 2. The 2
nd
: RRVMD held rain storm caused high-rise buidings
collapsed in Nam Dan, Nghe An province (6/2013). The number of victims is 90
people, development of the model under option 1.
Both 2 rehearsals and model shows the process model proposed is
reasonable, is new, feasible, consistent with practicality, portability and flexibility
of military medical sector in order to enhance RRVMD, ready to rescue, maneuver
when disaster struck. Making the hospital staff awareness and practices in the
organization RRVMD when disaster strikes, know how to organize and
implement, understand mechanisms commander, of the Board Steering Committee
held in the disaster, search and rescue when disaster strikes.
Assayed, analysis, evaluation processes combined forces in a series held
RRVMD at MZH when a disaster. Helping leaders, commanders at all levels were
more scientific rationale for proactive planning, organizational plan, deploy
RRVMD fit the specific conditions of the hospital, ready to meet mission
requirements when a disaster occurs.
These processes were deployed in exercises that will help the hospital ready
RRVMD when disaster situation with the large number of victims has contributed
more actively in the task of building military capability in the medical defense
sector. Modeling exercises have contributed positively to the training, assistance

and retraining staff of the hospital management of organizational capacity,
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commanders, operating in situations RRCMD, team training staff technical
proficiency level of mass emergency when a disaster occurs.
With the experimental rehearsal RRVMD of hospital 4 have presented a
number of process modeling and how to implement, other hospital the same line
can refer and use as appropriate: On the level of disaster : MZH may meet with
disaster levels 1 to level 2, the highest efficiency level disaster 2. Means that it can
receive and rescue 51 to 200 victims.
The disaster near hospitals, regional hospitals may receive victims directly
from the hospital to the disaster site if within 40 km, convenient transportation,
hospitals need to be implemented under the option 1 as follows: at field used
MMT a strong team, flexibility for receiving emergency, sorting, transporting to
MZH. At the hospital with moderate number of victims, not continuous, just
enhance forces for the examination part or organize a part close to the examination
department is ready enough for picking up, sorting and transporting victims
personnel in the department of the hospital.
If disaster distance far of 40 km, transportation difficulties, not directly
move the victim to a hospital, should be implemented in accordance with option 2
as follows: at the field still use the MMT but compact because at the field, there
were other forces work together to perform tasks in place disaster. In hospital
separate a part with fully equipped forces have separate payroll to establish
hospital field- basic hospital for MMT in order to RRVMD as soon as possible.
CONCLUSION
Through researching situation and the possibilities of receive, rescue mass
victims of the military zone hospitals from 2007 - 2012 and the intervention study
by experimental maneuvers in Hospital 4 - Military Zone 4 (2012 - 2013), we
draw the following conclusions:
1. Situation and capacity of RRVMD in MZH period 2007-2012:
- The hospital has adequate staffing organization by decision. The payroll

from 260-400 people, with a scale from 200-250 beds, can deploy 400-500 beds.
- The hospital has a team of professional basic training, with nearly 85% of
doctors trained specialists, in which over 50% is surgical doctor. Do well the
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treatment techniques as assigned. In 6 years (2007-2012) targets were
overachieved professional regulations.
- The hospital has facilities, fully equipped, relatively uniform, extensive
infrastructure, facilitate deployment of RRVMD.
- Hospitals have established the Steering Committee and built plans
RRVMD. In 6 years (2007-2012) had 1-2 times of RRVMD, the number of
victims from 17-45 people.
- The hospital is capable of sorting 50-100 victims/hour, receiving treatment
30-60 victims/hour, maximum deployment 4-10 surgical teams, often held 5-6
medical mobility groups ready to accept tasks.
- The hospitals are capable of early rescue specialist for the victims of
disaster and responsive, effective for the second disaster.
2. Model of RRVMD in MZH
* Content model: Depending on the size, characteristics and extent of each
type of disaster can be organized according to 1 of 2 options:
- Option 1: disaster occurs within the hospital to ensure, not many victims,
favorable conditions for transportation, deployment:
+ The military maneuver team: the core was basic treatment surgical team is
enhanced sorting groups-delivery, arrived at the field for missions of searching,
sorting, transporting and rescue victims to the back
+ At the hospital: Organization receiving and classification team that core
are clinics; Arrange patients in the clinics to be ready picking up, rescue victims.
- Option 2: remote disaster far from hospitals, the number of multiple
victims, difficult transportation conditions and hospitals could not receive
directly victims, deployment:
+ Medical Mobility Team: core first-aid and surgical team is enhanced

sorting groups - ensuring escort compact, maneuverable; Tasked to the field to
search, sorting, transport and rescue victims to the back
+ Field hospital disaster response, deploying far disaster site by 10-15 km, to
be the basic hospital for MMT.
+ Force's remaining of MZH do routine tasks but to narrow the mission and
scope of the rescue.
* Results after two rehearsals under two experimental options:
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- The model was considered reasonable, realistic, feasible, easy to
implement. Two plans laid out properly with the actual ability of the current MZH,
close to the disaster situation that may occur in the future.
- 90.9% - 92.9% of respondents rated experts on organization, staffing, use
of force in 2 options was reasonable. 100% expert opinion evaluation model was
built, MZH capable of completing tasks when similar situations.
RECOMMENDATIONS
From the research results achieved, propose some recommendations below:
1. Department of Defense annual budget spent large enough to facilitate the
rehearsed in the model applied to MZH response to the disaster scenario happens
in the future.
2. Having a plan training human resources, expanding the scope of
professional, equipment to enhance MZH may rescue specialist for the victims.
3. Although modeling and studied the plan was very basic, but the disaster
was not predictable completely and accurately. So we need to have the following
specific research to effectively respond to each type of disaster that may occur in
the future.