Aaron D. Kugelmass 美国Baystate心血管中心

　　International Circulation：今天您的演讲内容是关于“STEMI治疗团队协作：如何缩短door to balloon的时间”，其主要内容是什么？　
　Dr Kugelmass: My talk today was not science; it was about how to create a team and make things work. It is more about football coaching than it is about science. There is no science involved.
　　Kugelmass：我今天的演讲无关乎科学，而是有关如何创建一个团队，使得事半功倍，这与科学无关，而更加像足球团队训练。
　　International Circulation: But isn’t that part of being a cardiologist?
　　《国际循环》：这不是成为心脏病学家的必经之路？
　　Dr Kugelmass: Of course. It is the practical part. It is a lot easier to say it than it is to do it. The real challenge lies in execution.
　　Kugelmass：创建团队当然是必须的，这是实践部分。说比做容易，真正的挑战在于执行。
　　International Circulation: What are the problems you run into?
　　《国际循环》：是您遇到什么问题呢？
　　Dr Kugelmass: It’s organization. It’s commitment. It’s the challenge of collaboration. It is the interdisciplinary nature of things including the emergency room， the cardiologist， and the interventional cardiologist. The thing you have to do is remove the competition from the equation: so you have to get the cardiologists to work together; you have to get the cardiologists to work with the emergency room; and I am not sure if it applies in China， but in the United States you have to get hospitals to agree that they are going to give their business to another hospital in order to improve the overall profits. What is different about the area I work in is that there is really only one hospital that does primary angioplasty and there is a governmental mandate that they organize themselves to get patients to that hospital. It is not a law; but it is a mandate.
　　Kugelmass：问题在组织、承诺，这是一种跨学科协作的挑战，包括急诊医学、心脏病学和介入心脏病学，必须消除学科之间的竞争：心脏科医生共同努力，心脏科医生与急诊科医生共同努力。不知道这是否适用于在中国，但在美国一家医院必须输送业务给另一家医院，以提高整体利润，而我工作的地区存在不同的是，仅有唯一一所医院具备基本的血管成形技术，使患者及时就诊是政府的任务，虽然不是一个法律，但它是一个任务..
　　International Circulation: So part of the driving force is actually this governmental regulation?
　　《国际循环》：所以这种挑战的部分推动力实际上是政府监管吗？
　　Dr Kugelmass: Well the driving force is actually getting the right care to the patient rather than letting market forces prevent that from happening.
　　Kugelmass：推动力实际是使患者得到正确的护理，而不是市场推动力。
　　International Circulation: How representative of the United States is your situation?
　　《国际循环》：美国的情况又如何呢？
　　Dr Kugelmass: I think it is highly variable. In some urban areas that are densely populated you can get centers that refer patients from one neighborhood to another. Half of these patients walk into the emergency room in the United States， so they are going to end up where they end up regardless. Certainly with advanced technology whereby you can make the diagnosis in the patient’s bedroom or living room or in the ambulance allows us to direct patients by ambulance to where they need to get their care. Also the real key to this is harder to explain to the Chinese， is that you are really doing processes in parallel. Because you are diagnosing in the ambulance， as the patient is being driven in， the doctors and the cathlab staff are driving in at the same time. Things are not been done sequentially but being done in parallel. Registration is occurring before the patient even gets there.
　　Kugelmass：我认为充满变数。在人口稠密的城市，急救中心彼彼相邻，美国的患者中有一半是自己走进急诊室的。当患者在家中卧室或客厅发病时，先进的技术可以帮助我们及时作出诊断，在救护车上即可决定需要进行何种治疗。在中国急救过程的真正关键是向患者进行解释。在救护车上已经对患者作出诊断，医生和导管室工作人员同时从家中出发，事情并非按顺序执行而是并行完成，甚至患者到达之前已经完成注册。

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