My article in the BMJ on the medical response to the Tianjin blast

China’s health authorities have activated disaster response plans to send in medical teams to help treat hundreds of casualties from the massive Tianjin chemical explosion on Wednesday 12 August.

Official reports have said that at least 112 people were killed, 95 were missing, and 722 were admitted to hospital for treatment of injuries from the blast, which destroyed a wide area around a container storage area in the northeastern port city of Tianjin.

Many of the dead and wounded people were firefighters sent to tackle the blaze that triggered the huge explosion at around midnight on 12 August.

Doctors treating casualties at the nearby Taida Hospital said that most of the injuries were blast injuries such as burns and fractures, although hundreds of nearby residents were also … 

Read the rest at BMJ 

Medical school places unfilled: nobody in China wants to be a doctor, and there are three good reasons why they don't

In western countries there is fierce competition to get a place in medical school. Only straight A students with an impressive portfolio of extra-curricular activities need apply. In China, the picture is very different. Even the top medical schools in China are struggling to attract students.

This week, Professor Yang Jun a distinguished cardiologist and head of the First College of Clinical Medical Sciences, Hubei, notes that Shanghai's prestigious Fudan University has had to drop its entrance mark threshold by 58 marks this year. The same "dumbing down" has been seen at the city's Jiatong University medical school and other medical schools across the country. When China's top medical school at  Peking Union Medical College allotted 10 places to Guangzhou students, only four applications were received - and of these only one was deemed to make the grade.

What's happening? The fact is, nobody with any ambition wants to be a doctor in China right now, and you can see why. The three main reasons are poor pay, long hours and terrible working conditions - including the real possibility of abuse and violence.

Writing in the International Journal of Cardiology, Professor Yang notes that the average salary of a doctor in China is 72,000 yuan a year (US$11,600) -  and many doctors earn a lot less than that, especially if they work in unpopular specialities such as paediatrics or emergency medicine (the so-called ambulance riders).

Poor pay for doctors in China: paediatricians are at the bottom, with only 63,000 yuan a year

For this salary, doctors have to work long hours - more than 50% of doctors work more than the 'specified' 40 hours a week and 30% work more than 60 hours a week.  Doctors also face huge workloads - as many as 80 patients in a single morning shift. As Professor Yang observes, the Mayo Clinic in the US has fifteen times more staff than the Peking Union Medical College, and yet it has only half the patient numbers.

Doctors in China simply don't have time to practice adequate medicine - and the consequences are unhappy patients who take out their frustration on staff. A recent survey of almost 10,000 doctors found that 60% had recently experienced abuse from patients, and 13% had experienced physical assaults.

Doctors also have to study long and hard to qualify - up to ten years including undergraduate and postgraduate qualifications. On top of this they have to publish articles and to gain academic merit for promotion.  Doctors have lost the status and respect they once had - and only 6.8% of doctors say they would advise their children to follow  a career in medicine.

This is already causing problems in the less popular branches of the profession. On 27 July, the National Health and Family Planning Commission announced that it would be waiving the usual entry criteria for admission to the specialities of paediatrics and emergency medicine. Medical student candidates who did not achieve the usual pass mark would be allowed to become trainee paediatricians and emergency medicine doctors if their coursework was of sufficiently high standard, the NHFPC announced. This has caused outrage among  doctors currently working in these specialities, who say it is a desperate and self -defeating move that will further reduce the attractiveness of their branches of medicine.

They say there is a need to improve pay and conditions in their work rather than lowering the bar to entry. Paediatrics and emergency medicine and notoriously poorly remunerated and yet high pressure jobs in the Chinese healthcare system. Assaults on doctors in these departments are numerous as they are in the front line seeing critically ill patients - especially the treasured offspring in a one-child system.

The doctor's social network site DXY echoed many of the criticisms of the "dumbing down" move. As one doctor wrote: "We work longer hours for less pay in unsafe conditions, but we stick to our posts because of the duty we have to the little ones who thank us after we have care for them."

Bound feet, pirate hospitals and frequent flyer patients: just some of the medical news stories out of China this week

Bound feet not all bad for bones

Women who had their feet bound according to feudal Chinese tradition are more prone to osteoprosis but their enhanced balance skills mean they do not have excessive fractures, a study has found. A review of more than 250 elderly women who had bound feet by researchers at Kunming Medical University found that they had higher rates of osteoprosis than women of similar age.
However they did not seem to be in worse health or be more prone to fractures, the study found.
"This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures," the researchers said.

Trademarks use to fight pirate hospitals 

The renowned Beijing Tianlun fertility hospital has trademarked its name after finding that other hospitals around China were setting up 'Tianlun' fertility clinics and claiming to be affiliated to the famous clinic.

Frequent flyer patient

A Jiangxi endocrinologist has been called to provide emergency inflight medical help to the same woman twice in a month, according to CAAC News. The doctor treated the women on a flight to Thailand after she fainted. On the return flight he again answered a call for help and found he was helping the same woman with the same problem.

More family doctors for Henan

The Henan government claims to have re-trained almost 10,000 doctors to work as family doctors in community clinics and township-level hospitals. The government said the re-training program meant that Henan could not make family doctors available to 60% of people in rural areas and 100% of people in urban areas.

 Guangdong gets locals to sign up for GP cover

The Guangdong city of Huizhou says it has  got 30% of target patient populations to enrol with a family doctor. The city health authorities want to arrange GP cover for children under five, pregnant women, the elderly and people with chronic diseases. The authorities say they aim to have 50% of people enrolled by the end of the year.

Tianjin hospital gets Dr Weixin

A hospital in Tianjin has set up a smartphone service to allow patients to get advice, information  and book appointments via their phones. However, users said the electronic hospital system was clunky, did not allow access to many departments and they still had to queue to pay for appointments

Serious disease insurance cover to be nationwide.

China's minister for social security has said that his department will fully introduce nationwide social medical insurance for serious diseases within the year. However, critics have saod that hospitals will use the cover to claim rebates for unneccessary treatments while local governments will not have the finances to support the scheme. Meanwhile a group from Renmin University in Beijing have suggested that micro-credit schemes be used to give poor rural people access to funds to pay for their medical bills. The scheme would operate in the same way as micro-credit programs running in developing countries to provides funds for business startups.

Family planning staff become child development aides

The staff of local family planning departments may move into child development work and away from enforcing the single child policy, if a pilot program in Shaanxi is successful. The program sees family planing agency staff assisgned to follow up children up to the age of three to ensure they are meeting basic development goals in care and education, according to Caixin.


And this week's violence against healthcare workers:

Zhejiang: An armed man opened fire in a Zhejiang hospital and had to be disarmed by police after he injured one man and threatened patients and staff in the Haiyang country hospital.

Shanghai: A drunk man took a hostage at knifepoint at the emergency department of Shanghai No. 9 People’s hospital yesterday morning and injured a policeman who intervened.

Hebei: a  gang armed with machetes smashed up the emergency department of Baoding Hospital and severed the hand of a man who was being treated for minor injuries from an earlier attack. The man had been involved in an earlier altercation with the gang and they had come for payback, police said.

Liuzhou: a man got 10 days administrative detention and was fined 200 yuan for attacking a female doctor at a Liuzhou hospital. The man hit the female doctor because he was unhappy with the treatment his father was receiving for a bladder problem.

Beijing: A patient with a grudge over hand surgery assaulted a surgeon at the Jishuitan Hospital. The patient had previously had eight stitches in his  finger and was unhappy because it did not bend the way it did before the injury.

My weekly medical news blog for 7th February

There have been few takers for GP training places in Nanjing. The city's community health centres need to recruit 110 family doctors to fill their positions but have only had 49 applicants. Under new health ministry regulations, all doctors including GPs must have the 5+3 education and training (5 years undergraduate and 3 years postgraduate.) However, despite offering a masters degree and a one month placement with GPs in Taiwan, most medical graduates have given the GP training scheme the cold shoulder. The reason is the low status and poor pay of 'community doctors'. After eight years training, GPs can expect to earn only about 80,000 yuan (US$13,000) a year, which is much lower than hospital-based specialists earn. Also there is no chance of promotion or career progression and GPs are expected to move around many clinics in suburbs and villages. Health educators say the Chinese government needs to put more emphasis and resources into primary care if it is to develop a healthcare gatekeeper system similar to those used successfully in developed countries.

Most of the 'research' published by China's doctors is rubbish and there's a simple reason for this - the publish-for-promotion system. To gain promotion (and often just to stay in the job) all China's doctors have to meet a certain quota of  papers published in medical journals. The problem is that most of China's doctors are way too busy treating patients to be doing research and writing up papers. Many are simply not interested. The result is a thriving industry in academic fakery and plagiarism. It is common knowledge that doctors hire 'publishing agents' and ghostwriters to source the articles that will be published under their name. Ironically, many of the articles are written by medical students, and so there is an inverted system whereby the most knowledgeable and experienced clinicians are publishing articles written by the least knowledgeable. The going rate is about 3000-4000 yuan for a good paper - payment on publication, of course. Experts say the system has become a wasteful farce, and they are calling for reform of the one-size-fits-all quote system, to divide doctors into three categories: 'craftsmen' (no research, just treating patients), physicians (some research) and medical scientists (more  research, fewer patients).

The government says it expects to see a dramatic increase in uptake of private medical insurance before 2020, with new policies encouraging Chinese citizens to take out private cover. Ma Xiaowei, deputy head of the health ministry, the National Health and Family Planning Committee, told a news conference this week that the central and provincial government would "encourage the development of various types of commercial insurance to increase people's ability to deal with risks posed by major diseases." He said private cover was needed to help fund demand for health services, with the number of people over 60 already exceeding 200 million. However Mr Ma didn't explain how people will be enticed to take out private health insurance given that there are currently virtually no private doctors or hospitals and very few services or benefits from having insurance.

Underpaid, overworked and under fire: that's the life of an emergency medicine specialist in Guizhou province, according to a Sina article this week. In China, emergency doctors accompany ambulances and are often first on the scene of trouble, even before police. One doctor said he often had to jump in and stop bleeding in stabbing victims while people were still fighting around him. Another said emergcny doctors were often faced with physical challenges such as getting critically ill patients down stairs of apartment blocks with no lifts. Emergency doctors said they worked 24 hour shifts then had a day off during which they mostly slept, and there was no time for leisure, holidays or study. The stress of daily life as an emergency doctor meant there were high rates of burnout - and doctors were considered grizzled veterans if they lasted three years, they said.

In clinical news, new research shows that older Chinese are consuming more calories - and eating more unhealthy food - than their counterparts of the previous generation. A study from nine provinces found that the average daily energy intake had increased among older Chinese adults from 1379 total kilocalories in 1991 to 1463 kilocalories in 2009. The increases had come from greater consumption of high fat and high carbohydrate foods such as plant oil, wheat buns, and wheat noodles.

Chinese are also consuming more polluted air and it is killing them as much as smoking. A study carried out by the School of Public Health in Peking University found that there were
257,000 premature deaths related to PM2.5 pollution in 31 major Chinese cities. This made air pollution a major killer equivalent to smoking. Conditions such as lung cancer and stroke triggered by air pollution killed about 18,000 people in Beijing alone in 2013, the researchers said.

And finally, a study from Shanghai as shown that the number of cervical cancer diagnoses in the city has increased six fold in the last decade. Data from 13,518 women with gynaecological cancers  from 2003 to 2013 showed that the number of women with diagnosed gynaecological cancers increased by almost sixfold with the increase largely due to the increase of women with newly diagnosed cervical cancer. The study also showed that the age of diagnosis of cervical cancer had increased.

Baby for sale to pay medical bills | Ambulances misused by non-urgent callers | Avian flu returns more virulent

 

Rural migrant sells baby to pay medical bills

A rural migrant women from Sichuan has been trying to sell her baby on the street of Fuzhou to raise money to pay medical bills for the baby's father. Police were called when the women displayed a sign saying "Boss fled after industrial accident and we don't have the money for treatment; I'm willing to sell my child to save her father." The woman said she had already paid Y7000 in medical bills for treatment of her husband who had injured himself after falling from a construction site. Some sympathetic passers-by gave the women some money before she was persuaded to end her 'sale.'

Beijing ambulances used for non-urgent cases

Ambulance services in Beijing are overstretched because 80% of cases they transport are non-urgent and do not need to attend the emergency department, a survey has found. Only 20% of the people brought in to hospital by ambulances had life-threatening conditions, according to a report from the Beijing's Health Planning Commission, which found that most of the ambulance patients could be treated in the outpatients department. The commission has suggested that patients are triaged before being taken to hospital as many critically ill patients are left without transport while ambulances are dealing with non-urgent calls.

Avian flu returns more lethal

The severity of H7N9 avian flu in China increased with the "second wave" last winter and the virus may return in an even more virulent and lethal form this winter, researchers have warned. The lethality of the H7N9 virus increased by 48% from the first wave in 2013 to the second wave in 2014, according to Dr Li Feng and colleagues at the Key Laboratory of Surveillance and Early-warning on Infectious Disease at the China CDC, Beijing. In the latter part of the first wave the death rate among hospitalised patients was 17% for young people under 60 and 42% for people over 60. In the second epidemic the death rate was 36% in people under 60 years, and 59% in people aged 60 years or above.
"If another epidemic of human infections with influenza A(H7N9) virus occurs in the winter of 2014/15, proactive control measures on the poultry-human interface may be preferable to reactive measures," the researchers suggested.

Why don't Chinese bystanders assist in medical emergencies?

by Michael Woodhead

A frail women collapses at a train station but passers by do nothing. She lies there for almost an hour before emergency services arrive, by which time the woman has died. This was a real incident at Shenzhen railway station in February this year. 

Why do mainland Chinese people not act as Good Samaritans? asks Dr Dan Xiuli of the nearby Faculty of Medicine at the Chinese University Hong Kong, Shatin. Writing in the Emergency Medical Journal this week, he asks, is it because would-be helpers in China have a fear of being wrongly blamed by victims as perpetrators and subject to demands for compensation?

A recent survey found that only 14% of mainland Chinese would be willing to provide assistance to a stranger who needed medical assistance. And that reflects what happens in real life: most bystanders don't get involved, they hover and watch or they scuttle past without offering help. This reluctance to help has major implications for the 1.2 million Chinese who have accidents in public and require assistance each year, he says. Heart attacks, sudden illness in public, traffic accidents, natural disasters etc all require people who are willing to step forward and provide first aid skills. Is there any possibility of this happening in the People's Republic?

Groups such as the Red Cross have suggested that a minimum of 30% of the population should have first aid skills training in order to be able to provide assistance in public emergencies. In developed countries such as Norway, more than 85% have skills in First Aid, whereas in the UK only 14% of people profess to have such skills. At the time of the Beijing Olympics in 2008 the Chinese government aimed to have more than 1% of people trained in first aid, but failed to reach this target. For most Chinese the only aid they are able to provide is notifying the 'relevant authorities' such as by dialling 120.

Not surprising then, that studies have estimated that 87% of deaths from accidents in China are due to the lack of first aid. And shockingly, even staff entrusted with the care of the vulnerable, such as infants have no training or skills in first aid - fewer than 4% of kindergarten teachers could achieve even basic knowledge in first aid.

Dr Dan concludes by saying that "First aid is not merely a skill but an act of humanity." He notes that China has a culture of many thousands of years, but most Chinese seem to have forgotten the traditional call to virtue of: ‘To rescue one person from death is better than to build a seven storeyed Buddha pagoda’ .

Update: Some interesting research on Australian bystander reactions to medical emergencies from Flinders University.

Three reasons why you shouldn't have a heart attack in China

by Michael Woodhead
This week's major new research findings on heart attack in China have been reported as showing a four-old increase - as if China is simply catching up with the west in terms of heart disease. The media reports missed the more important message from this study, which is that treatment of heart attack in China still has a long way to go.
To understand the findings of the Chinese research you need to know a bit of context. In western countries such as the UK and the US there has been a real revolution in the way that heart attacks are treated - and some very real progress in surviving a heart attack. Just a few decades ago, a heart attack was a death sentence - few people survived them, and those who did often were crippled by the ongoing coronary disease or killed off by recurrent attacks. These days, all that has changed because coronary arteries can be unblocked. With early recognition of the signs, and swift transport to hospital (with early rescue treatment started in a cardiac-equipped ambulance), a heart attack can be a survivable event with a reasonably good prognosis for the person who has their blocked coronary arteries cleared and kept open with a stent and or a 'clotbuster' (thrombolytic). Long term prospects are also improved for those who take the right medical therapies such as anti-platelet drugs, beta-blockers and statins - and of course for those who make the necessary lifestyle changes of stopping smoking, doing more activity and eating healthily.
What the report in the Lancet shows is that China is still decades behind the west when it comes to these basic steps - and the survival rates for heart attacks reflect this. The report from the so-called 'China PEACE—Retrospective Acute Myocardial Infarction Study' is one of the first national snapshots of heart attack treatment to come out of China. It sampled about 4% of all coronary treatment units, and found that  - as reported, rates of ST-segment Elevation Myocardial Infarction (STEMI) heart attack rose about four-fold (from 4 per 100 000 in 2001 to 16 in 2011). It also showed that in many aspects there had been little progress in treatment of heart attack over the last decade. Firstly, most people who have a heart attack in China take far too long to get to hospital - averaging about 12 hours. Compare that to western countries, where the average time from the onset of coronary symptoms to actually going under the knife is now as little as three to four hours (remember there can be delays of hours between being admitted to hospital and getting into the catheter lab, the so-called 'door to balloon time').
These long delays in getting to hospital mean that Chinese people with heart attacks are missing out on the 'treatment window' for re-opening those blocked coronary arteries - this is best done within the first few hours of a heart attack before cardiac tissue starved of oxygen dies. The study results showed that less than half of Chinese patients qualified for treatment, and only about a quarter got reperfusion procedures, whereas in western countries about 80% of heart attack patients have treatment such as angioplasty and stenting to re-open occluded coronary vessels.
And in terms of additional medical treatments, Chinese patients also miss out. While most now are prescribed blood-thinning aspirin and a statin (lipid lowering) drug, only about 60% get the recommended cardiovascular drug treatments such as beta-blockers and ACE inhibitors. With these continuing 'treatment deficits' it's not surprising that survival rates for heart attack have improved little in China over the last decade.
The Lancet commentary thus concludes by saying:
"Major emphasis must be placed on early patient presentation (requiring public education of acute myocardial infarction symptoms and prompt response), followed by rapid diagnosis and reperfusion therapy in all appropriate patients (ultimately with primary percutaneous coronary intervention or a pharmacoinvasive strategy). Equally important is establishment of high-quality continuity of care and efforts at secondary prevention after hospital discharge."
In other words, Chinese patients need three things:
1 To recognise signs of a heart attack and get to a hospital immediately.
2. To get early coronary reperfusion treatment from a cardiac unit.
3. To be prescribed the basic drugs to preserve and maintain coronary function.
(I haven't even touched on things like the lack of cardiac rehab and the sky-high smoking rates in China).
The question is: does China have the paramedics, cardiologists and hospital facilities to achieve a Great Leap Forward in coronary care?

Daily Mail fake miscarriage | 120 seconds per patient | Dogs a hepatitis risk | Atrial fibrillation untreated

The Daily Mail has been running a fake story claiming that a pregnant Changsha nurse had 'lost her baby' after being attacked by relatives of a cancer patient who died. Chinese media reported the attack but said she was fortunate to have avoided a miscarriage.

A doctor at a Guangzhou hospital could only spend an average of one and a half minutes per patient when he was the only clinician on duty and had a waiting room of 100 patients to see in one morning.

About 20% of dogs and 6% of cats in Guangzhou are infected with hepatitis E, a new study has shown. The high rates of hepatitis infection should raise concern about the eating of dogs, warn researchers from the South China Agricultural University.

China should not copy the US private model of healthcare according to Nobel prize winning economist Daniel McFadden, of the University of Southern California. Professor McFadden said that when looking at healthcare systems around the world, the most efficient are those where the community medical providers are either employed by the government or employed by companies that are largely contracting to the government and not operating as private businesses.

Hospital staff in the Muslim Xinjiang province have been told not to fast during Ramadan. The request was made at a meeting on upholding ethnic minority unity, “in order not to affect normal work and life." Muslim hospital staff members were requested to sign their pledge of compliance in a “responsibility book.”

One in ten emergency department patients leave without being seen by a doctor, according to a study carried out in Chengdu hospitals. Those who left tended to be families who arrived on foot with children who had less serious problems.

Most Chinese people with atrial fibrillation go untreated, with only 40% receiving anticoagulants, according to a study from Fuwai Hospital and Peking Union Medical College, Beijing.The study also showed that only 26% of people treated for  atrial fibrillation received adequate treatment.

Reform of the medical school curriculum is needed in China as many medical schools are still using outdated and ineffective teaching methods that fail to keep pace with developments in medicine, according to a study from Tongji University, Shanghai.

Iron deficiency anaemia is common in rural parts of central China, where only about 40% of infants have an adequate diet, a study by the UNICEF Office for China, Beijing, shows. Malnutrition and anaemia was more of a risk for ethnic minorities and for those living in poor mountainous areas.

China medical news for Saturday 1 February

Light news day today as most Chinese are no doubt at home enjoying (or enduring) the New Year with family...

Ambulances must not refuse penniless patients
The Global Times reports that ambulance and first-aid teams will be forced to treat patients regardless of whether they can pay. A new regulation on management of emergency medical services was adopted by the National Health and Family Planning Commission which bans emergency services from refusing or delaying treatment because the patients cannot pay. The new rules also prohibit ambulances being used for purposes other than offering emergency medical service.

Indemnity insurance to be mandatory
The Chinese government is also said to be planning a move to make medical indemnity insurance compulsory for all doctors. The head of the China Insurance Regulatory Commission, said one goal this year would be to promote compulsory medical liability insurance, with medical institutions and doctors required to purchase such cover. This would ensure that victims of medical malpractice can be assured of compensation, thus stamping out violence in medical establishments.

Say no to cigs
Health groups in China have urged people not to give cigarettes as gifts this New Year and to refuse them if offered. Groups including the Chinese Center for Disease Control and Prevention and the Chinese Medical Association made the plea just prior to the arrival of the Year of the Horse, according to CRI.

H7N9 explained
In the New Scientist Debra McKenzie explains the background to the H7N9 avian influenza virus outbreaks at a molecular as well as epidemiological level. She also provides some ideas of what the solution to possible pandemics might be.

In Shanghai, doctors shun ambulance service

If you are wondering why it may take more than an hour for an ambulance to arrive when you dial 120 in Shanghai, the head of the city's emergency response centre can give you several good reasons - and lack of ambulances isn't one of them.
Shanghai has more than enough ambulances, but not enough qualified 'first responder' emergency specialist doctors to staff them, according to Dong Jun, deputy director of the city's emergency service said.
The city of 24 million has only 164 qualified ambulance staff to cover the city centre and a quarter of them resigned last year. Two years ago the city ambulance service had 311 doctors but 234 of them have since resigned and only a few replacements could be recruited. Many of these are trainees and cannot yet operate as emergency physicians on ambulances, Dr Dong said.
The ambulance service finds it hard to recruit emergency doctors because the work is seen as low paid, high pressure and with long hours. It is also seen as having poor career prospects, he added.
The city therefore has introduced a triage system in which 'first aiders' are sent out in ambulances when the operator believes it is a less urgent illness. The service also tries to dissuade the public from using the ambulance service as an 'efficient taxi service' for people with minor illnesses, he adds.
Doctors are reserved for more serious cases, but there still are not enough to cope. Dr Dong says it has been impossible to recruit local doctors to the service since the year 2000, and they now advertise nationwide.
According to a report in the Eastern Daily, the Shanghai ambulance service is under such pressure that staff often have to exceed their shifts by several hours to catch up on paperwork and to help clean and disinfect the vehicles. Dr Dong himself has had to step in and act as a driver or even to carry stretchers, he admits.
However, there are still delays and this is the source of many complaints from the public. Staff are sometimes assaulted when they arrive late to a call. Without adequate resources and better career structures, it will continue to be difficult to provide medical staff for Shanghai's ambulance services, he concludes.

Free emergency medical treatment to be provided for the poor

China will set up funds to subsidize emergency medical fees incurred by the poor and patients whose identities are unclear, the State Council said in a guideline issued Friday.
The move came amid the government's efforts to help patients whose inability to pay medical bills has resulted in hospitals ignoring them or refusing treatment.
The funds will be used to cover emergency medical treatments for acute illnesses or serious injuries among the poor and patients whose identities have not been confirmed, said Sun Zhigang, director of the health reform office of the State Council.
However, it is not yet clear who would qualify for such financial assistance. Sun said specific criteria to determine whether a patient qualifies need to be worked out by governments and medical institutions based on local conditions.
The Ministry of Health will lead efforts to determine which illnesses and injuries can be covered, as well as develop compensation standards, according to the guideline, which did not include a timeline.
Provincial and prefecture-level governments are required to set up such funds, which will be jointly financed by government revenue and public donations, the guideline says.
The funds, described by the State Council as an important guarantee for establishing an emergency assistance system in China, will be operated by provincial and prefecture-level government health departments.
The health departments will be supervised by a special committee of legislators, political advisors, medical experts, donors and media representatives.
Expenditures will also be subject to public supervision, according to the guideline.
Source: Xinhua

Beijing hospital staff accused of using ambulances for personal errands

by Ernest Kao

Beijingers claim that ambulances are being used by hospital staff for private trips

With sirens wailing, a Beijing ambulance headed for the hospital was not rushing a patient back at all. It was returning from a noodle restaurant where staff members had dinner that night.
It was Friday evening in Beijing and along Haidian Dong San Jie, an ambulance could be seen hurtling down the street – the vehicle's blue and red lights flashing and sirens wailing.
The ambulance from the Beijing Emergency Medical Centre in Haidian was not rushing a sick or injured patient to the hospital, however. In fact, it was not carrying any patients at all.
The ambulance crew was heading back from dinner at a nearby noodle restaurant. Onboard were other hospital staff, all dressed in their white medical coats.
A netizen who claimed to be in the area snapped a photo of the ambulance as it returned to the hospital and reported the incident on his Sina Weibo account @BG2RHY.
“I frequently see ambulances from the Haidian hospital parking lot drive over to a restaurant for meals. They will then turn on their sirens and head back to the hospital. I’d like to ask 1) aren’t these ambulances under the management of the hospital? 2) Are these acts even allowed?”
His post spread across social media, sparking debate over emergency-staff work ethics and non-compliance issues.
As of Monday morning, the thread “should [drivers] give way to ambulances?” has been trending on weibo, racking up more than 7.8 million mentions and  more than 3,300 shares.
“So even doctors lack ethics and discipline now...this is sad,” wrote one user on weibo.
The Haidian hospital acknowledged the incident and launched its own investigation.
"Only in the case of an emergency would the use of a siren be permitted...ambulances are not 'privilege cars' and any private use would prompt investigation," one hospital official told the Beijing News on Sunday.
The hospital announced its findings at a news conference on Monday and, on its official weibo account, said the ambulance crew would be handed the “appropriate punishments”.
The Haidian hospital does not have a cafeteria, and staff members frequently went out to dine at nearby restaurants.
Beijing’s emergency services have become the subject of much public attention recently, especially after a woman died in the back of an ambulance in early December, when a supposedly short three kilometre trip to the hospital took more than 40 minutes in the city’s manic rush hour traffic.
Source: SCMP

Ambulances will get priority, Ministry of Health decrees

Traffic must give priority to ambulances, Ministry of Health says, but laws must wait two years

Following the death of a patient in a traffic jam on December 7, the Ministry of Health (MOH) and Beijing Health Bureau have announced new regulations to ease ambulances' passage through traffic in emergency cases.
The ambulance was only able to move 3km in 40 minutes.
Public opinion on the MOH Pre-hospital Emergency Medical Treatment was already solicited in October and November of 2011 and will soon be released as a ministerial edict, said the ministry's spokesperson Deng Haihua at a press conference held in Beijing on Wednesday.
The fifth draft of the Beijing Emergency Treatment Medical Service Regulation, which began to be discussed in 2007, has been handed over to the local legislative body, the Beijing News reported on Thursday.
The Beijing regulations will be published within two years, according to reports.
 They will stipulate that ambulances have traffic priority in emergency treatment and while transferring patients in critical condition.
Other drivers that refuse to give way to ambulances will be punished and be held legally accountable if the patients die, Legal Mirror reported Thursday.
Traffic jams are a common obstacle for city ambulances, with drivers complaining that fewer than half of all vehicles give way to them.
According to the statistics from the Beijing Emergency Medical Center, the average speed of ambulances in urban areas is less than 40 kilometers per hour during the daytime when they transfer patients, said the Beijing News.
According to the updated version of the Law of the People's Republic of China on Road Traffic Safety, implemented in 2011, ambulances have priority and can't be limited by driving routes, speed, directions and traffic lights.
However, some Beijing residents argued that the punishment for cars who block ambulances would be difficult to confirm.
After collecting public opinions, law makers in Beijing will consider whether ambulances should be exempt from penalties if they scrape or collide with other cars during emergency treatment, said the Beijing News. 
Laws alone cannot solve all the traffic problems confronted by ambulances, Li Jianren, director of the emergency center, told the Global Times on Thursday.
"Tragedies won't happen if people obey traffic rules and respect others' lives," he said during a phone interview.
Source: Global Times

Patient dies after ambulance stuck in Beijing traffic

Ambulance got stuck in Beijing's gridlock traffic

A cyclist who was injured in an accident in Beijing died en route to the hospital after vehicles in rush-hour traffic didn’t yield to the ambulance carrying him, the Beijing Evening News reported.
The victim, a man in his 50s, was critically injured after a collision with a heavy truck in west Beijing on Dec. 7, according to the newspaper. The ambulance crew performed emergency resuscitation and was transporting him to the nearest hospital about 3 kilometers (2 miles) away when they encountered heavy traffic, the newspaper reported, citing the accompanying doctor surnamed Wang.
The journey took 40 minutes because all but four vehicles yielded to the ambulance despite repeated sounding of the siren, the newspaper reported. Most motorists also didn’t give way when the ambulance driver tried to get back in line after trying the bicycling lane and finding the path blocked by an illegally parked car, according to the report.
Beijing’s municipal government said in August it plans to build a system for imposing road-congestion charges on motorists, adding to caps on vehicle registrations as China’s capital seeks to ease traffic jams.
Source: Bloomberg

Death highlights need for emergency department database

A real time database would allow patients to be allocated to the nearest emergency department with available beds

by Li Dong
Recently, a patient died after being transferred five times during an emergency rescue in Beijing. 
The incident triggered discussion on what we should do to enhance the efficiency of the current medical emergency rescue system and avoid such things from happening again.  Feng Shilan a 66-year-old woman had chronic leukemia. She fainted in the evening of November 18 and her family called the emergency rescue center.
An ambulance came soon, but she still died after being transferred to five hospitals. Li Zhigang, Feng's son recalls the story.
"The first hospital was the 263 Hospital, then, the Civil Aviation General Hospital. They both say they are not specialized hospitals and don't have the facilities to treat my mom's illness. They recommended that we go to go to the Military General Hospital. But doctors there said their emergency rescue rooms were already packed. Then we went to the Dongzhimen Hospital of Chinese Medicine. They said they don't have rooms. In the end, the ambulance took us to Xiehe Hospital. But doctors at Xiehe Hospital also said they don't have space. That's the last option we tried and my mom died there."
Li was very upset about his mom's death and really wonders why his mom was transferred five times and still died.
"I really don't know why we can't find even one hospital to save my mom's life. It's too complicated to understand. I don't dare imagine. If my mom was treated properly on time, she would not have died."
This incident triggered heated discussion on whether a transparent platform should be established where emergency centers and patients can see what available medical resources are available and where the best hospital is to send a patient. It could save precious time and lives.
One of the reasons frequently mentioned in the incident is the hospitals don't have enough beds. It is true. Statistics show that all the beds in all the top level hospitals across the country have been fully occupied for the past five years.
According to health authorities, there is an emergency rescue information network which began building two years ago but has not been completed.
Huang Chun, director of the Emergency Rescue Administration Office of the Beijing Medical Bureau, says Feng's tragedy will speed up the building of the system.
"I think the system can be in trial operation by 2013. Hopefully the system can be in full operation in 2014."
Some doctors also say efforts should be made to train doctors at lower-level hospitals to improve their ability to treat emergencies.
Read more: CRI

Weibo-blogging doctor raises alarm over Beijing hospital ER overcrowding

 
A Beijing emergency physician has drawn attention to emergency department 'bed block' and overcapacity through the microblogging site Weibo.
In a post of the site this month, the female doctor dubbed "superwoman of the emergency department" said patients using the 120 emergency department service were being diverted from the top  five hospital emergency departments because they had no capacity. She said all five affiliated hospital five hospitals were full due to the emergency department, with beds, equipment or timely ambulance retrieval possible.

Her Weibo post rapidly attracted onlookers, and within a few hours, was forwarded more than 8,000 times and received over 1600 comments. The microblogging  raised doubts among the public: it was asked why hospital emergency departments are advancing technology, and why information can not be shared via technology? It was asked why it is so hard to see an emergency doctor in Beijing, and in an emergency, why is finding a hospital bed a matter of luck?
In response, a Beijing Municipal Health Bureau official said there were plans to build a real-time shared electronic database reflecting hospital bed availability and usage, so the information can guide the emergency centres to dispatch ambulances in a more targeted and more timely way and patients transported to the first available hospital.
　　But insiders admitted that construction of this "emergency resource sharing platform" still faces a number of challenges and needs joint efforts of several hospitals.

Read more: China Medical Tribune