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【論文摘要】到院前高級救護技術員接受到院前創傷救命術（PHTLS）訓練前後對到院前救護時間及患者接受創傷處置的影響：一項觀察性研究
【論文摘要】The Impact of Prehospital Trauma Life Support (PHTLS) Training for Emergency Medical Technician-Paramedics (EMT-P) on Prehospital Time and Managements: An observational study
摘要
研究背景：近年來PHTLS課程已被認為對救護技術員的外傷處置有很大的幫助。自2020年1月起至2022年12月，桃園市政府消防局（TYFD）的高級救護技術員（EMT-P）共計有20位EMT-P接受PHTLS訓練。本研究希望釐清高級救護技術員接受PHTLS訓練前後對到院前救護時間及患者接受創傷處置的影響。研究方法：我們在桃園市政府消防局進行了一項回顧性研究，蒐集從2020年到2022年的數據並分析。收案對象為符合收案定義的有送醫的創傷案件（Fig.1），且現場至少一名於2022年12月前已完成PHTLS的EMT-P。以接受PHTLS訓練前後作為分組，使用Mann-Whitney U Test及Chi-Squared Test方法評估受訓前後的差異，主要結果為到院前救護時間差異，次要結果為患者接受創傷急救處置及後送創傷中心比率差異。使用重複測量方式，通過廣義估計方程式模型（GEE）評估EMT-P年資、服務區域、取得PHTLS證照與主要結果及次要結果的相關性。研究結果：Table.1為納入收案的高級救護技術員背景資料。Table.2描述院前救護時間及患者接受創傷急救處置及後送創傷中心比率差異。院前反應時間、院前救護總時間兩者達到統計顯著，現場處置時間及轉送時間則無統計顯著。創傷處置比率僅骨針注射有達到統計顯著，其他創傷處置及後送創傷中心比率無統計顯著。Table.3描述使用GEE模型針對個人重複測量下分析，PHTLS取證對於氧氣治療、骨針注射比率增加、縮短到院前總時間有達到統計顯著，EMT-P年資對於維持呼吸道暢通比率增加有達到統計顯著，郊區與市區相比則對於維持呼吸道暢通、氧氣治療、給予靜脈輸液、施打止血帶、給予骨盆固定帶比率增加及到院前救護總時間有增加且達到統計顯著。結論：過去的研究顯示接受PHTLS訓練能縮短現場救護時間及降低院前及院後整體死亡率，且在汎亞創傷登陸系統研究中，亦發現縮短創傷患者接受確切治療的時間，有更高的存活率及神經學良好預後，特別是在重大創傷的患者中。本研究驗證EMT-P接受PHTLS訓練能縮短嚴重創傷病患到院前救護總時間、增加給氧處置及骨針注射比率。然而本研究僅著重到院前處置未納入預後分析。高級救護技術員接受PHTLS訓練後，顯著增加重大創傷患者接受氧氣治療及骨針注射比率且縮短到院前救護總時間。
並列摘要
Background: In recent years, the PHTLS course has been proven as highly beneficial for enhancing trauma management by emergency medical technicians. Between January 2020 and December 2022, a total of 20 emergency medical technicians (EMT-P) from the Taoyuan City Government Fire Department (TYFD) underwent PHTLS training. This study aims to elucidate the effects of participation in PHTLS training on prehospital time indicators and managements for patients. Methods: We conducted a retrospective study at TYFD, collecting and analyzing data from 2020 to 2022. Inclusion criteria encompassed trauma cases meeting defined parameters (Fig.1) with at least one EMT-P who had completed PHTLS course by December 2022 was present at the scene. Using a before-after grouping, Mann-Whitney U Test and Chi-Squared Test assessed differences before and after training. Primary outcome is prehospital time indicators and secondary outcome is trauma intervention and transport to trauma center rate. Generalized Estimating Equations (GEE) examined correlations with outcomes, considering EMT-P experience, service area, PHTLS certification. Results: Table 1 presents background data of EMT-Ps who completed PHTLS course. Table 2 depicts the differences in prehospital time and the rate of trauma interventions. Response time and total prehospital time present statistically significant differences, while scene and transport time did not. In trauma interventions, only IO-access showed a significant increase. Table 3, using GEE modeling, revealed significant reductions in total prehospital time, increased oxygen therapy, and IO-access rates post-PHTLS certification. EMT-P seniority demonstrated a statistical correlation with increasing airway maintenance, and suburban service areas demonstrated influence on increased rates in various interventions and total prehospital time. Conclusions: Previous studies have emphasized PHTLS training in shortening on-scene time and lowering overall pre- and post-hospital mortality. Notably, the PATOS study indicated improved survival rates and neurological outcomes with earlier definitive trauma care. Although outcome analysis was not included, our study verified PHTLS training among paramedics notably increasing oxygen therapy and IO-access rates meanwhile reducing prehospital time for major trauma patients.