救護模式對院前心肺功能停止病患急救存活率之影響－以高雄市為例

The Impact on Survival Rate through Emergency Medical Service for Out-of-Hospital Cardiac Arrest Patients-Taking Kaohsiung City as An Example

胡奕璿(I. H. Hu) ； 沈永年(Y. N. Sheen)

《危機管理學刊》 15卷2期 (2018/09) Pp. 65-74

https://doi.org/10.6459/JCM.201809_15(2).0007

摘要

到院前心肺功能停止是否能成功拯救影響因子相當多，包含病患的身體狀況、早期的辨識與求救、民眾第一時間胸部按壓(CPR)、緊急救護技術員(EMT)的急救處置與反應時間長短、是否為可以除顫電擊的心律、醫院的急救能力等級與後續照顧等等許多因素。故針對高雄市政府消防局106年處置之到院前心肺功能停止患者為研究對象，透過文獻探討、獨立樣本T檢定、統計軟體SPSS 20.0敘述統計及卡方檢定以分析相關實際案例，將到院前心肺功能停止案件討論區分為患者屬性、EMT出勤人數與處置內容、自動體外去顫器(AED)有無去顫電擊、救護各項反應時間等多項變數，期待找出到院前心肺功能停止急救成功之最相關因子。研究結果顯示「救護反應時間」、「救護總時間」、「EMT出勤人數」、「高級救護技術員(EMT-P)給藥」、「AED去顫電擊」及「專責救護隊等級」，以上6個因子對患者到院後是否能恢復恢復自主循環(ROSC)有明顯的相關性，所以縮短救護反應時間及救護總時間、儘早使用AED去顫電擊、EMT-P給藥及增設高級專責救護隊，對於到院前心肺功能停止(OHCA)患者之ROSC可獲得最明顯的提升，值得相關單位重視及參考。

關鍵字

到院前心肺功能停止(OHCA) ； 恢復自主循環(ROSC) ； 緊急救護技術員(EMT)

並列摘要

Many factors influence OHCA (Out-of-Hospital Cardiac Arrest) patient survival outcome, including patient baseline conditions, early recognition, early access, early bystander CPR (cardiac pulmonary resuscitation), EMT (emergency medical technician) first-responding intervention and time, early defibrillation, capability of receiving hospital, and post-arrest care, etc. Based on the OHCA data-sets administrated by Kaohsiung City Fire Bureau in 2017, This research was a retrospective cohort study. By methodologies of literature review, independent sample T-test, chi-square test, and logistic regression analysis toward relevant cases via SPSS 20.0 software, these OHCA data-sets were classified into four aspects, including ＂patient demography＂, ＂dispatch mode (number of EMTs) and treatment＂, ＂AED (automated external defibrillator) defibrillation or not＂, and ＂each administrative time＂, so as to find out the factors most successful relevant to the OHCA survival. The factors significantly relevant to ROSC (return of spontaneous circulation) outcome in hospital, includes ＂responding time＂, ＂total case time＂, ＂EMT-Paramedic medication intervention＂, ＂AED defibrillation＂. Therefore, in order to improve the OHCA survival rate, it is worthy for the authorities to take a reference and focus on, how to shorten responding time as well as total case time, and how to enhance early AED defibrillation as well as EMT-paramedic medication intervention on the OHCA patient.

並列關鍵字

OHCA ； ROSC ； EMT

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