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【論文摘要】提升救護品質：通過確認AED貼片位置提高電擊成功率－以永利分隊為例
【論文摘要】Improving Emergency Medical Quality: Enhancing Defibrillation Success Rate by Verifying AED Pad Placement - A Case Study of Team Wing Lee
摘要
研究背景：在OHCA救護中，確保正確的電擊貼片位置對於電擊成功率至關重要。然而，我們是否真正充分了解貼片位置對電擊成功的影響呢？在這個案例中，我們將探討如何透過理性行動和計畫行為論，以及一系列策略來減少貼片位置貼錯的情況，從而提高電擊成功率。案例描述：在2022年1月至10月期間，永利分隊面臨了57起院外心跳停止（OHCA）的患者救護案例。在這些案例中，有17位患者的心律被確認為可電擊，然而令人遺憾的是，僅有2例成功地在院前恢復自主心跳（ROSC）。為了深入了解並改善這種情況，我們參考了相關文獻，並藉由救護品管的檢視，對每一例可電擊心律的現場影像進行了仔細分析，旨在找出現場電擊失敗的可能原因。透過參考文獻的支持，我們致力於探究電擊失敗的背後因素，並期望透過這項研究能夠改進我們的救護作業，提高可電擊心律的成功率。通過品管檢視，我們將逐一分析每一次現場電擊的過程，以確定其中可能存在的問題，並尋找解決方案以減少電擊失敗的機會。案例討論：我們發現，在電擊時可能存在一個關鍵問題：貼片位置。為了解決這個問題，我們採取了一個簡單的改善措施，要求救護人員在使用電極貼片前確認正確的位置。這項措施在2023年1月至7月的救護案例中取得了顯著的成效，有7位患者的心律被確定為可電擊，其中3例成功通過電擊恢復自主心跳（ROSC）並康復出院。除此之外，在救護訓練中，我們強調了理性行動和計畫行為論的原則，著重確保救援人員培養出確認貼片位置的正確習慣。我們強調在實際操作中時刻意練習，確保每次電擊都能按照正確步驟執行。此外，我們強調了救援團隊內的主觀規範的重要性，鼓勵彼此提醒和確認貼片位置，以確保每次救援達到最佳效果。在高壓情況下，Team Resource Management（TRM）原則可以幫助我們有效地溝通和協作。返隊後的品管也是關鍵一環，我們對電擊過程進行回顧，確保每一步符合要求並學習改進。改進貼片的設計也是重要策略之一，能夠幫助救援人員更迅速地確認正確的貼片位置，從而減少錯誤。透過這些策略的結合，我們最大限度地減少貼片位置貼錯的情況，提高電擊成功率。我們呼籲大家共同努力，確保每次救援都能達到最佳效果，為每一位需要幫助的人帶來更多的希望和生命。
並列摘要
Background: In OHCA resuscitation, ensuring accurate placement of defibrillation pads is crucial for achieving a successful shock. However, do we truly comprehend the impact of pad placement on defibrillation success? In this case study, we will delve into how rational action and the theory of planned behavior, along with a series of strategies, can be employed to mitigate the occurrence of incorrect pad placement, thereby enhancing defibrillation success rate. Case presentation: During the period from January to October 2022, Yongli Team encountered a total of 57 out-of-hospital cardiac arrest (OHCA) cases. Among these cases, 17 patients had rhythms confirmed as defibrillatable, but unfortunately, only 2 cases achieved successful return of spontaneous circulation (ROSC) prior to hospital arrival. In order to comprehensively understand and address this situation, we referred to relevant literature and conducted a meticulous analysis of on-scene defibrillation attempts for each defibrillatable rhythm through EMS quality assurance, aiming to identify potential reasons for failed defibrillation attempts. With the support of referenced literature, our focus is on uncovering the underlying factors contributing to defibrillation failures. We aspire that this study will lead to improvements in our EMS practices and enhance the success rate of defibrillation for shockable rhythms. Through quality assurance review, we will systematically analyze each on-scene defibrillation process to pinpoint potential issues and seek solutions to minimize the likelihood of failed defibrillation attempts. Case Discussion: We identified a critical issue during defibrillation: the placement of pads. To address this concern, we implemented a simple improvement measure, requiring EMS personnel to confirm correct pad placement before using electrodes. This measure yielded significant results in EMS cases from January to July 2023, with 7 patients having shockable rhythms, of which 3 achieved successful defibrillation leading to return of spontaneous circulation (ROSC) and discharge. Furthermore, in EMS training, we emphasized principles of rational action and the theory of planned behavior, focusing on cultivating the habit of confirming pad placement accurately. We underscored deliberate practice during actual operations to ensure consistent execution of correct steps during defibrillation. In addition, we emphasized the importance of subjective norms within the rescue team, encouraging mutual reminders and verification of pad placement to ensure optimal outcomes in every rescue scenario. In high-pressure situations, principles of Team Resource Management (TRM) facilitated effective communication and collaboration. Post-rescue quality assurance played a crucial role as well. We reviewed defibrillation processes, ensuring adherence to requirements and learning from improvements. Another pivotal strategy was enhancing pad design, aiding rescuers in promptly confirming accurate pad placement and minimizing errors. Through the integration of these strategies, we minimize instances of incorrect pad placement, thereby enhancing defibrillation success rates. We call upon everyone to collaborate diligently, ensuring optimal outcomes in every rescue and bringing more hope and life to those in need.