• 1.四川大學(xué)華西醫(yī)院中國循證醫(yī)學(xué)中心（成都 610041） 2.四川大學(xué)華西公共衛(wèi)生學(xué)院流行病學(xué)教研室 3.四川大學(xué)華西公共衛(wèi)生學(xué)院勞動(dòng)衛(wèi)生學(xué)教研室 4.衛(wèi)生部醫(yī)政司（北京 100044） 5.中國醫(yī)師協(xié)會(huì)（北京 100054）;

目的 　剖析美國颶風(fēng)風(fēng)險(xiǎn)管理的經(jīng)驗(yàn)和教訓(xùn)，為我國醫(yī)療風(fēng)險(xiǎn)監(jiān)測與管理系統(tǒng)和機(jī)制的建立提供參考與借鑒模式。
方法　 計(jì)算機(jī)檢索EI數(shù)據(jù)庫（1969～2005）、OVID數(shù)據(jù)庫（1966～2005）、超星電子圖書館、官方網(wǎng)站如聯(lián)邦緊急事務(wù)管理局、美國國家海洋與大氣管理局和疾病預(yù)防控制中心等。由兩人盲法按既定的納入和排除標(biāo)準(zhǔn)獲取并評價(jià)文獻(xiàn)質(zhì)量。
結(jié)果 　共納入分析文獻(xiàn)227篇，電子圖書1本。其中風(fēng)險(xiǎn)預(yù)測文獻(xiàn)占73.13%。從1886年起有颶風(fēng)相關(guān)記錄；1950年制定了《災(zāi)害救濟(jì)法》，之后形成各類政策；1979年成立了聯(lián)邦緊急事務(wù)管理局，在颶風(fēng)風(fēng)險(xiǎn)管理中發(fā)揮關(guān)鍵作用。美國颶風(fēng)風(fēng)險(xiǎn)實(shí)行分級預(yù)警，預(yù)測預(yù)報(bào)主要由國家海洋與大氣管理局負(fù)責(zé)。政府和非政府組織都積極參與應(yīng)急反應(yīng)，關(guān)注不同人群的生理和心理健康。Katrina颶風(fēng)風(fēng)險(xiǎn)管理的失誤在于決策失誤和政治環(huán)境因素。
結(jié)論　 美國颶風(fēng)風(fēng)險(xiǎn)監(jiān)測與管理體系較為成熟，但在風(fēng)險(xiǎn)防范方面仍存在某些不足。其經(jīng)驗(yàn)和教訓(xùn)對尚處在初期階段的我國醫(yī)療風(fēng)險(xiǎn)監(jiān)測與管理體系的建立和運(yùn)作具有一定的參考與借鑒價(jià)值。

引用本文： 文 進(jìn),謝 瑜,高曉鳳,孫 丁,李幼平,曠翠萍,謝逸瓊,王 羽,張宗久,趙明鋼,陸 君,柳琪林. 美國颶風(fēng)風(fēng)險(xiǎn)管理的循證評價(jià)及其對我國醫(yī)療風(fēng)險(xiǎn)管理的啟示——醫(yī)療風(fēng)險(xiǎn)系列研究之三. 中國循證醫(yī)學(xué)雜志, 2006, 06(3): 209-217. doi: 復(fù)制

1. 趙明鋼, 柳琪林. 加強(qiáng)我國醫(yī)療風(fēng)險(xiǎn)監(jiān)管, 確保病人醫(yī)療安全. 中國醫(yī)院, 2005; 9(5): 24-26.
2. 王羽. 建立和國家醫(yī)療質(zhì)量保障體系與持續(xù)改進(jìn)體系的探討. 中國醫(yī)院, 2005; 9(9): 1-7.
3. 謝瑜, 文進(jìn), 高曉鳳, 等. 國外航空風(fēng)險(xiǎn)管理方法及績效的循證評價(jià). 中國循證醫(yī)學(xué)雜志, 2006; 6(2): 131～138.
4. 佩塔克, 阿特金森. 自然災(zāi)害風(fēng)險(xiǎn)評價(jià)與減災(zāi)政策. 向立云, 程曉陶, 譯. 北京: 地震出版社; 1993.
5. Petak WJ, Atkinson AA. 向立云, 程曉陶, 譯. 自然災(zāi)害風(fēng)險(xiǎn)評價(jià)與減災(zāi)政策. 北京: 地震出版社; 1993. 36～39.
6. 王羽. 建立醫(yī)療風(fēng)險(xiǎn)監(jiān)測預(yù)警體系, 提高醫(yī)療質(zhì)量, 保障病人安全. 中國循證醫(yī)學(xué)雜志, 2006; 6(1): 1-2.
7. To Err is Human: Building a Safer Health System. Institute of Medicine, National Academies Press; 2000.
8. Xie Y, Wen J, Gao XF, et al. Evidence-based Evaluation on the Oversea Aviation Risk Management and Its Performance. Chin J Evid-based Med, 2006; 6(2): 131-138.
9. Petak WJ, Atkinson AA. Natural hazard risk assessment and public policy. Translated by Xiang LY, Cheng XT, Beijing: Earthquake Publishing House; 1993.
10. Average number of tropical cyclones which reached storm and hurricane strength for various periods. Available from: http://www.aoml.noaa.gov/hrd/Landsea/deadly/Table6.htm.
11. A Chronology of Major Events Affecting The National Flood Insurance Program. Available from: http://www.fema.gov/pdf/nfip/chronology.pdf.
12. Nuemann CJ, Hope JR. A diagnostic study on the statistical predictability of tropical cyclone motion. J. Applied Meteorology, 1973, 12(1): 62-73.
13. FEMA history. Available from: http://www.fema.gov/about/history.shtm.
14. Petak WJ, Atkinson AA. Translated by Xiang LY, Cheng XT. Natural hazard risk assessment and public policy. Beijing: Earthquake Publishing House; 1993. 36-39.
15. Emergency Preparedness & Response. Available from: http://www.bt.cdc.gov/.
16. Hurricane Research Division. Available from: http://www.aoml.noaa.gov/hrd/.
17. Disaster Services. Available from: http://www.redcross.org/services/disaster/0,1082,0_319_,00.html.
18. Landsea C. How are Atlantic hurricanes ranked? Available from: http://www.aoml.noaa.gov/hrd/tcfaq/D1.html.
19. Disaster Mental Health Resources. Available from: http://www.bt.cdc.gov/mentalhealth/.
20. Update on CDC’s response to hurricane. Available from: http://www.cdc.gov/od/katrina/.
21. Disaster Mental Health Primer: Key Principles, Issues and Questions. Available from: http://www.bt.cdc.gov/mentalhealth/primer.asp.
22. National Hurricane Center Forecast Verification. Available from: http://www.nhc.noaa.gov/verification/verify2.shtml?.
23. National Hurricane Center Forecast Verification. Available from: http://www.nhc.noaa.gov/verification/index.shtml?.
24. National Hurricane Center Forecast Verification. Available from: http://www.nhc.noaa.gov/verification/verify5.shtml?.
25. Gagnon EB, Aboutanos MB, Malhotra AK, et al. In the wake of Hurricane Isabel: a prospective study of postevent trauma and injury control strategies. Am Surg, 2005; 71(3): 194-197.
26. Walter GP, Samuel DB, Wes H. Hurricane risk perceptions among Florida’s single family homeowners. Landscape and Urban Planning, 2005; 73 (2-3): 120-135.
27. DeMaria M, Kaplan J. Statistical hurricane intensity prediction scheme (SHIPS) for the Atlantic Basin. Wea Fore, 1994; 9(2): 209-220.
28. DeMaria M, Kaplan J. Updated statistical hurricane intensity prediction scheme (SHIPS) for the Atlantic and eastern North Pacific basins. Wea Fore, 1999; 14(3): 326-337.
29. DeMaria M, Mainelli MS, Lynn K, et al. Further improvements to the Statistical Hurricane Intensity Prediction Scheme (SHIPS). Wea Fore, 2005; 20(4): 531-543.
30. NOAA raises the 2005 Atlantic hurricane season outlook. Available from: http://www.noaanews.noaa.gov/stories2005/s2484.htm.
31. Hurricane preparedness for New Orleans. Available from: http://www.answers.com/topic/hurricane-preparedness-for-new-orleans.
32. Hurricane Katrina hits southern US. Available from: http://www.wsws.org/articles/2005/aug2005/hurr-a30.shtml.
33. Experts Available to Comment on Aftermath of Hurricane Katrina. Available from: http://www.newswise.com/articles/view/514168.
34. David A, Ernest MM. Left behind: the legacy of hurricane Katrina. BMJ, 2005; 331(7522): 916-918.
35. The Man-Made Disaster. The New York Times. Available from: http://www.neilrogers.com/news/articles/2005090313.html.
36. Wang Y. Establishing medical risk monitoring and early warning system for quality improvement and patient safety. Chin J Evid-based Med, 2006; 6(1): 1-2.
37. Zhao MG, Liu QL. To enhance supervision of medical risk and prove patient’s medical safety. Chinese Hospitals, 2005; 9(5): 24-26.
38. WANG Y. Discuss on developing national medical quality and continuous improvement system. Chinese Hospitals. 2005; 9(9):1-7.
39. James MS, Jill R, Zelde E. Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development. Epid Rev, 2005; 27(1): 21-35.
40. Hudson P. Applying the lessons of high risk industries to health care. Qual Saf Health Care, 2003; 12(Suppl 1): i7–i12.
41. Bartoo, G. Risk management [medical devices]. IEEE Eng Med Biol Mag, 2003, 22(4):166-172.
  1. 1. 趙明鋼, 柳琪林. 加強(qiáng)我國醫(yī)療風(fēng)險(xiǎn)監(jiān)管, 確保病人醫(yī)療安全. 中國醫(yī)院, 2005; 9(5): 24-26.
  2. 2. 王羽. 建立和國家醫(yī)療質(zhì)量保障體系與持續(xù)改進(jìn)體系的探討. 中國醫(yī)院, 2005; 9(9): 1-7.
  3. 3. 謝瑜, 文進(jìn), 高曉鳳, 等. 國外航空風(fēng)險(xiǎn)管理方法及績效的循證評價(jià). 中國循證醫(yī)學(xué)雜志, 2006; 6(2): 131～138.
  4. 4. 佩塔克, 阿特金森. 自然災(zāi)害風(fēng)險(xiǎn)評價(jià)與減災(zāi)政策. 向立云, 程曉陶, 譯. 北京: 地震出版社; 1993.
  5. 5. Petak WJ, Atkinson AA. 向立云, 程曉陶, 譯. 自然災(zāi)害風(fēng)險(xiǎn)評價(jià)與減災(zāi)政策. 北京: 地震出版社; 1993. 36～39.
  6. 6. 王羽. 建立醫(yī)療風(fēng)險(xiǎn)監(jiān)測預(yù)警體系, 提高醫(yī)療質(zhì)量, 保障病人安全. 中國循證醫(yī)學(xué)雜志, 2006; 6(1): 1-2.
  7. 7. To Err is Human: Building a Safer Health System. Institute of Medicine, National Academies Press; 2000.
  8. 8. Xie Y, Wen J, Gao XF, et al. Evidence-based Evaluation on the Oversea Aviation Risk Management and Its Performance. Chin J Evid-based Med, 2006; 6(2): 131-138.
  9. 9. Petak WJ, Atkinson AA. Natural hazard risk assessment and public policy. Translated by Xiang LY, Cheng XT, Beijing: Earthquake Publishing House; 1993.
  10. 10. Average number of tropical cyclones which reached storm and hurricane strength for various periods. Available from: http://www.aoml.noaa.gov/hrd/Landsea/deadly/Table6.htm.
  11. 11. A Chronology of Major Events Affecting The National Flood Insurance Program. Available from: http://www.fema.gov/pdf/nfip/chronology.pdf.
  12. 12. Nuemann CJ, Hope JR. A diagnostic study on the statistical predictability of tropical cyclone motion. J. Applied Meteorology, 1973, 12(1): 62-73.
  13. 13. FEMA history. Available from: http://www.fema.gov/about/history.shtm.
  14. 14. Petak WJ, Atkinson AA. Translated by Xiang LY, Cheng XT. Natural hazard risk assessment and public policy. Beijing: Earthquake Publishing House; 1993. 36-39.
  15. 15. Emergency Preparedness & Response. Available from: http://www.bt.cdc.gov/.
  16. 16. Hurricane Research Division. Available from: http://www.aoml.noaa.gov/hrd/.
  17. 17. Disaster Services. Available from: http://www.redcross.org/services/disaster/0,1082,0_319_,00.html.
  18. 18. Landsea C. How are Atlantic hurricanes ranked? Available from: http://www.aoml.noaa.gov/hrd/tcfaq/D1.html.
  19. 19. Disaster Mental Health Resources. Available from: http://www.bt.cdc.gov/mentalhealth/.
  20. 20. Update on CDC’s response to hurricane. Available from: http://www.cdc.gov/od/katrina/.
  21. 21. Disaster Mental Health Primer: Key Principles, Issues and Questions. Available from: http://www.bt.cdc.gov/mentalhealth/primer.asp.
  22. 22. National Hurricane Center Forecast Verification. Available from: http://www.nhc.noaa.gov/verification/verify2.shtml?.
  23. 23. National Hurricane Center Forecast Verification. Available from: http://www.nhc.noaa.gov/verification/index.shtml?.
  24. 24. National Hurricane Center Forecast Verification. Available from: http://www.nhc.noaa.gov/verification/verify5.shtml?.
  25. 25. Gagnon EB, Aboutanos MB, Malhotra AK, et al. In the wake of Hurricane Isabel: a prospective study of postevent trauma and injury control strategies. Am Surg, 2005; 71(3): 194-197.
  26. 26. Walter GP, Samuel DB, Wes H. Hurricane risk perceptions among Florida’s single family homeowners. Landscape and Urban Planning, 2005; 73 (2-3): 120-135.
  27. 27. DeMaria M, Kaplan J. Statistical hurricane intensity prediction scheme (SHIPS) for the Atlantic Basin. Wea Fore, 1994; 9(2): 209-220.
  28. 28. DeMaria M, Kaplan J. Updated statistical hurricane intensity prediction scheme (SHIPS) for the Atlantic and eastern North Pacific basins. Wea Fore, 1999; 14(3): 326-337.
  29. 29. DeMaria M, Mainelli MS, Lynn K, et al. Further improvements to the Statistical Hurricane Intensity Prediction Scheme (SHIPS). Wea Fore, 2005; 20(4): 531-543.
  30. 30. NOAA raises the 2005 Atlantic hurricane season outlook. Available from: http://www.noaanews.noaa.gov/stories2005/s2484.htm.
  31. 31. Hurricane preparedness for New Orleans. Available from: http://www.answers.com/topic/hurricane-preparedness-for-new-orleans.
  32. 32. Hurricane Katrina hits southern US. Available from: http://www.wsws.org/articles/2005/aug2005/hurr-a30.shtml.
  33. 33. Experts Available to Comment on Aftermath of Hurricane Katrina. Available from: http://www.newswise.com/articles/view/514168.
  34. 34. David A, Ernest MM. Left behind: the legacy of hurricane Katrina. BMJ, 2005; 331(7522): 916-918.
  35. 35. The Man-Made Disaster. The New York Times. Available from: http://www.neilrogers.com/news/articles/2005090313.html.
  36. 36. Wang Y. Establishing medical risk monitoring and early warning system for quality improvement and patient safety. Chin J Evid-based Med, 2006; 6(1): 1-2.
  37. 37. Zhao MG, Liu QL. To enhance supervision of medical risk and prove patient’s medical safety. Chinese Hospitals, 2005; 9(5): 24-26.
  38. 38. WANG Y. Discuss on developing national medical quality and continuous improvement system. Chinese Hospitals. 2005; 9(9):1-7.
  39. 39. James MS, Jill R, Zelde E. Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development. Epid Rev, 2005; 27(1): 21-35.
  40. 40. Hudson P. Applying the lessons of high risk industries to health care. Qual Saf Health Care, 2003; 12(Suppl 1): i7–i12.
  41. 41. Bartoo, G. Risk management [medical devices]. IEEE Eng Med Biol Mag, 2003, 22(4):166-172.