پديد آورندگان :
آهسته، حسين دانشگاه علوم پزشكي بقيه الله - انستيتو سيستم بيولوژي و مسموميتها - مركز تحقيقات آسيب هاي شيميايي , روح الهي، محبوبه دانشگاه علوم پزشكي بقيه الله - انستيتو سيستم بيولوژي و مسموميتها - مركز تحقيقات آسيب هاي شيميايي , جلالي فراهاني، عليرضا دانشگاه علوم پزشكي بقيه الله - مركز تحقيقات آترواسكلروزيس , باقري، حسن دانشگاه علوم پزشكي بقيه الله - انستيتو سيستم بيولوژي و مسموميتها - مركز تحقيقات آسيب هاي شيميايي , ثالثي، محمود دانشگاه علوم پزشكي بقيه الله - انستيتو سيستم بيولوژي و مسموميتها - مركز تحقيقات آسيب هاي شيميايي , صمدي نيا، حسين دانشگاه علوم پزشكي بقيه الله - بيمارستان بقيه الله الاعظم - واحد توسعه تحقيقات باليني , شهرياري، عليرضا دانشگاه علوم پزشكي بقيه الله - انستيتو سيستم بيولوژي و مسموميتها - مركز تحقيقات آسيب هاي شيميايي
كليدواژه :
تاب آوري , شبكه بهداشت و درمان , شاخصهاي ارزيابي , حوادث و بحرانهاي شيميايي
چكيده فارسي :
زﻣﯿﻨﻪ و ﻫﺪف: ﺷﺒﮑﻪ ﺑﻬﺪاﺷﺖ و درﻣﺎن در ﻣﻨﺎﻃﻖ ﺻﻨﻌﺘﯽ از ارﮐﺎن اﺳﺎﺳﯽ ﭘﯿﺸﮕﯿﺮي و ﻣﻘﺎﺑﻠﻪ ﺑﺎ ﺣﻮادث و ﺑﺤﺮانﻫﺎي ﺷﯿﻤﯿﺎﯾﯽ ﻫﺴﺘﻨﺪ ﮐﻪ ارﺗﻘﺎء ﺳﻄﺢ ﺗﺎبآوري آﻧﻬﺎ از اﻫﻤﯿﺖ ﺑﻪ ﺳﺰاﯾﯽ ﺑﺮﺧﻮردار اﺳﺖ. ﺑﺮاي ﻧﯿﻞ ﺑﻪ اﯾﻦ ﻫﺪف ﻧﯿﺎز ﺑﻪ روش ﮐﺎرﺑﺮدي و دﻗﯿﻘﯽ ﺑﺮاي ارزﯾﺎﺑﯽ و
ﺗﻮاﻧﻤﻨﺪﺳﺎزي اﯾﻦ ﻣﺮاﮐﺰ ﻣﯽﺑﺎﺷﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف اراﯾﻪ اﻟﮕﻮي ﺗﺎب آوري اﯾﻦ ﻣﺮاﮐﺰ در ﺣﻮادث و ﺑﺤﺮانﻫﺎي ﺷﯿﻤﯿﺎﯾﯽ اﻧﺠﺎم ﺷﺪ. روشﻫﺎ: ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﺗﺮﮐﯿﺒﯽ )ﮐﻤﯽ-ﮐﯿﻔﯽ( از ﻧﻮع ﮐﺎرﺑﺮدي اﺳﺖ. در ﻓﺎز ﻧﺨﺴﺖ ﺷﺎﺧﺺﻫﺎي ارزﯾﺎﺑﯽ ﺗﺎبآوري ﺑﺎ ﺑﺮرﺳﯽ ﻣﺘﻮن داﺧﻠﯽ و ﺑﯿﻦ اﻟﻤﻠﻠﯽ اﺳﺘﺨﺮاج ﮔﺮدﯾﺪ و ﺑﺎ اﺳﺘﻔﺎده از ﭘﻨﻞ ﻧﺨﺒﮕﯽ، ﻣﻮرد ﺗﺎﯾﯿﺪ رواﯾﯽ ﻣﺤﺘﻮاﯾﯽ ﻗﺮار ﮔﺮﻓﺖ. ﺳﭙﺲ در ﻓﺎز ﺑﻌﺪي ﭘﺮﺳﺸﻨﺎﻣﻪ ﺑﺮ اﺳﺎس ﺷﺎﺧﺺﻫﺎي اﺳﺘﺨﺮاج ﺷﺪه ﻃﺮاﺣﯽ و ﮐﻤﯽﺳﺎزي ﺷﺪ و ﻣﻮرد ﺗﺎﯾﯿﺪ ﺧﺒﺮﮔﺎن ﻗﺮار ﮔﺮﻓﺖ. در ﻧﻬﺎﯾﺖ ﺑﺎ ﻣﺸﺨﺺ ﮐﺮدن ﻣﻌﯿﺎرﻫﺎي ﮐﻤﯽ ﺑﺮاي ﺗﺤﻠﯿﻞ ﻧﺘﺎﯾﺞ ارزﯾﺎﺑﯽ ﺷﺒﮑﻪﻫﺎي ﺑﻬﺪاﺷﺖ و درﻣﺎن در ﺣﻮادث و ﺑﺤﺮانﻫﺎي ﺷﯿﻤﯿﺎﯾﯽ، اﻟﮕﻮي ارزﯾﺎﺑﯽ و ﺗﻮاﻧﻤﻨﺪ ﺳﺎزي ﺳﯿﺴﺘﻢ ﺑﻬﺪاﺷﺖ و
درﻣﺎن در ﺣﻮادث و ﺑﺤﺮانﻫﺎي ﺷﯿﻤﯿﺎﯾﯽ ﻃﺮاﺣﯽ و اراﯾﻪ ﮔﺮدﯾﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﺑﺮ اﺳﺎس ﺑﺮرﺳﯽ ﻣﺘﻮن و روش ذﮐﺮ ﺷﺪه، 12 ﺷﺎﺧﺺ ﺑﺮاي ارزﯾﺎﺑﯽ ﺗﺎب آوري ﺷﺒﮑﻪﻫﺎي ﺑﻬﺪاﺷﺖ و درﻣﺎن در ﺣﻮادث و ﺑﺤﺮانﻫﺎي ﺷﯿﻤﯿﺎﯾﯽ اﺳﺘﺨﺮاج ﺷﺪ. رواﯾﯽ ﻣﺤﺘﻮاﯾﯽ )CVI ﺑﺎﻟﺎي 0/875 و 1=CVR( ﻫﻤﻪ ﺷﺎﺧﺺﻫﺎ ﺗﺎﯾﯿﺪ ﮔﺮدﯾﺪ، آﻧﮕﺎه ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺸﻨﺎﻣﻪ ﻣﯿﺰان وزن ﻫﺮ ﺷﺎﺧﺺ در اﻣﺘﯿﺎز ﮐﻞ ارزﯾﺎﺑﯽ )اﻣﺘﯿﺎز 100( ﻣﺸﺨﺺ ﮔﺮدﯾﺪ. روشﻫﺎي ﮐﻤﯽ ﺳﺎزي ﺑﺮاي ﻫﺮ 12 ﺷﺎﺧﺺ اﺳﺘﺨﺮاج و ﻃﺮاﺣﯽ ﺷﺪ
و ﺳﭙﺲ ﺗﻮﺳﻂ ﮔﺮوه ﻣﺘﺨﺼﺼﯿﻦ ﺗﺎﯾﯿﺪ ﮔﺮدﯾﺪ. در ﻧﻬﺎﯾﺖ اﻟﮕﻮي ارزﯾﺎﺑﯽ و ﺗﻮاﻧﻤﻨﺪي ﺑﺮاي ﺷﺒﮑﻪﻫﺎي ﻣﺬﮐﻮر ﺗﺪوﯾﻦ ﺷﺪ. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﻃﺒﻖ ﻧﺘﺎﯾﺞ ﺑﻪ دﺳﺖ آﻣﺪه، اﻟﮕﻮي ﺗﺎب آوري ﺷﺒﮑﻪﻫﺎي ﺑﻬﺪاﺷﺖ و درﻣﺎن در ﺣﻮادث و ﺑﺤﺮانﻫﺎي ﺷﯿﻤﯿﺎﯾﯽ، در ﺗﻔﮑﯿﮏ ﺳﻪ ﻣﺮﺣﻠﻪ ﭘﯿﺶ، ﺣﯿﻦ و ﭘﺲ از ﺑﺤﺮان در 12 ﺷﺎﺧﺺ ﺷﺎﻣﻞ: ﻣﺨﺎﻃﺮات و ﺗﻬﺪﯾﺪات ﺷﯿﻤﯿﺎﯾﯽ، وﺿﻌﯿﺖ ﺳﺎزهﻫﺎ، ﻣﺴﺘﻨﺪات )دﺳﺘﻮراﻟﻌﻤﻞﻫﺎ و ﭘﺮوﺗﮑﻞﻫﺎ(، ﻇﺮﻓﯿﺖ و اﻣﮑﺎﻧﺎت، آﻣﻮزش، ﻣﺎﻧﻮر )ﺗﻤﺮﯾﻨﺎت(، ﺳﺮﻣﺎﯾﻪﻫﺎي اﻧﺴﺎﻧﯽ، ﺳﯿﺴﺘﻢﻫﺎي ﻣﺪﯾﺮﯾﺘﯽ، اﺗﺎق ﻓﺮﻣﺎﻧﺪﻫﯽ و ﻣﺪﯾﺮﯾﺖ ﺑﺤﺮان،ارﺗﺒﺎﻃﺎت، ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﺣﻮادث و ﻣﻤﯿﺰي و ﭘﺎﯾﺶ ﺑﺎ زﯾﺮﮔﺮوهﻫﺎي ﻣﺮﺑﻮﻃﻪ اراﯾﻪ ﮔﺮدﯾﺪ.
چكيده لاتين :
Background and Aim: Healthcare networks in industrial areas are the main pillars of preventing and coping with chemical accidents and crises, which are of great importance in improving their level of resilience. In order to achieve this goal, it is necessary to apply a precise method for assessing and empowering these centers. The purpose of this study was to provide a resiliency pattern for these centers in accidents and chemical crises.
Methods: The present research is a combined study (quantitative - qualitative) study of the applied type. In the first phase, the indicators of resilience assessment were extracted from internal and international literature and confirmed by content validity. Then, in the next phase, the questionnaire was designed and computed based on the extracted indicators and was approved by the experts. Finally, by designing quantitative criteria for analyzing the results of healthcare networks assessment in disasters and crises, a model for assessment and empowerment of the health system in disasters and crises was presented.
Results: Based on the literature review and the methodology, 12 indicators were extracted for assessing healthcare networks in chemical accidents and crises. Content validity (CVI = 0.85 and CVR = 1) of all indicators was confirmed, then using the questionnaire on the weight of each indicator was identified in the score of the total score (100 points). The quantification methods of the 12 indicators developed by the expert group were confirmed. Finally, an evaluation and capability model for these networks were developed.
Conclusion: According to the results, the pattern of healthcare networkschr('39') resilience in chemical disasters and crises was divided into three stages before, during and after the crisis in 12 indicators of chemical hazards, structure status, documentation analysis, capacity and facilities, training, exercises, human capital, management systems, crisis management, communications, accident analysis, and audit and monitoring with relevant sub-groups.
