- 期刊
花蓮區緊急醫療救護之特徵及品質保證方法
Monitoring of Quality Assurance of Emergency Medical Technicians (EMTs) in the Emergency Department
摘要
目的：為瞭解花蓮地區緊急醫療救護的特質及驗證以急診室護理人員評估119人員執行到院前救護做為品質保證措施之可行性。病人與方法：89年1月1日至89年12月31日期間內進入慈濟醫院急診室之119送來所有病人，由研究助理或檢傷護士評估並記錄病人到院前所有資料，然後由助理將以下資料輸入電腦：呼叫時間、到現場時間、離現場時間、到醫院時間、離醫院時間、呼叫原因、應該做何種救護、實際有做何種救護或沒做救護以及有無測生命徵象。每三個月做一次小統計，並於緊急醫療救護諮詢會議中宣讀，並將結果呈給消防局長。統計方法為one-way analysis of variance（ANOVA）並以Student-Newman-Keuls作事後檢定分析。結果：在12個月的研究期間內，我們共收到有效記錄單1,541份，平均每月128件，平均年齡為44.7 ± 11.9歲，男與女之比為1.6：1.0，平均反應時間為5.3 ± 5.5分，在現場停留時間為4.8 ± 2.6分，平均運送時間為21.1 ± 14.7分。機車禍是最常見的呼叫原因：466／1541（30.3%），其次是汽車禍：143／1541（9.3%），頭暈頭痛：92／1541（6.0%）、肢體無力疼痛：83／1541（5.4%）。理論上應做的救護技術依序為止血包紮：655／1541（42.5%），維持呼吸道通暢：544／1541（35.3%），鼻管給氧：359／1541（23.3%），夾板固定：249／1541（16.1%），上頸圈：153／1541（9.9%）。實際上有做的救護技術依序為維持呼吸道通暢：133／376（35.4%），止血包紮：130／376（34.6%）、夾板固定：66／376（17.6%），鼻管給氧：62／376（16.5%）。有做的救護技術佔應該做該項技術的比率依序為：哈姆立克急救術：4／6（66.7%），上短背板：5／10（50%），去除頭盔：5／11（45.5%）。應做救護而未做救護的百分比為64.1 ± 25.3%，29.6 ± 25.4%的記錄單未填寫各項時間點，9.7 ± 15.0%未填呼叫原因，23.7 ± 24.1%的呼叫原因填寫不正確，至於生命徵象的測量，幾乎是大多數的人（98%）未在現場測量生命徵象。以不同季節比較救護技術的實行情況（第一季Vs第四季），發現大都有改善但未達有統計意義的程度。應做而有做救護的比率自25.5 ± 25.5%升至33.8 ± 25.5%、未填時間點的比率自32.6 ± 28.0%降至24.7 ± 26.5%、未填呼叫原因的比率則自13.9 ± 25.2%降至6.8 ± 7.6%。唯一的例外為呼叫原因填寫不正確的比率自13.1 ± 8.9%升至24.0 ± 24.8%。結論（1）花蓮地區EMS做的並不理想；（2）花蓮地區EMS特徵是運送時間太長、交通意外事件居多；（3）止血包紮、給氧氣，夾板固定是最常用到的到院前救護技術；（4０以病人到達急診室後，由護理人員做評估，並填相關資料，做為品質保證方法，的確可以改善到院前救護的品質。
並列摘要
Objective: To understand the characteristics of Emergency Medical Services (EMS) and the performance of prehospital care by Emergency Medical Technicians (EMTs) in Hualien. Patients and Methods: A prospective study was con-ducted from Jan. 1, 2000 through Dec. 31,2000. Patients sent to the Emergency Department (ED) of Tzu Chi General Hospital-Hualien by Hualien EMTs during this period were studied. The performance of EMTs was evaluated via prechospital records and evaluation of the patients by triage nurses or research assistants. The sex and age of the patients; the time the call was received; the time of arrival and leaving the scene; the time of arrival in the ED; the reason for the call; which prehospital skills should have been used theoretically; which skills were actually used; and vital signs were evaluated and keyed into the computer. Results: Altogether or 1,1541 cases were collected during these 12 months. The patients’ average age was 44.7 ± 11.9 years. The male to female ratio was 1.6:1.0. The response time on average was 5.3 ± 5.5 minutes. Time spent on the scene averaged 4.6 ± 2.6 minutes. Transportation time on average was 21.1 ± 14.7 minutes. The most common reason for calling the EMS was motorcycle accidents (30.3%, 466/1541), followed by car accidents (9.3% 143/1541) and dizziness or headaches (6.0%, 92/1541). The three leading prehospital skills which should have been used theoretically on the scene were bleeding control and packing (42.6%, 655/1541), main-taining airway (35.4%, 544/1541), and oxygenation through a nasal cannula (23.3%, 359/1541). The three top prehospital skills EMTs actually used on the scene were maintaining airway (35.4%, 133/376), bleeding control and packing (34.6%, 130/376), and splinting (17.6%, 66/376). The percentage of prehospital skills actually done among the same skills theorectically needed were as follows: Heimlich maneuver (66.7%, 4/6), short board (50.0%, 5/10), and removal of helmet (45.5%, 5/11). The percentage of prehospital skills that should have been done but were not done by EMTs was 64.1 ± 25.3%. In about 29.6 ± 25.4% of prehospital records the time were not recorded completely. In 9.7 ± 15.0% of prehospital recoreds, no reason for calling was recorded. In about 23.7 ± 24.1% of cases, the reasons for calling were not correctly recorded. Almost all EMTs (98.0%) did not record the vital signs at the scene. In comparing the perfor-mance of EMTs between the first three months and the last three months of the study, there was improvement in prehospital skills on the scene (25.5 ± 25.5% Vs 33.8 ± 25.5%), no time spot recorded (32.6 ± 28.0% Vs 24.7 ± 26.5%), no reason for calling recorded (13.9 ± 25.2% Vs 6.8 ± 7.6%). The reasons for calling which were incorrectly recorded increased (13.1 ± 8.9% Vs 24.0 ± 24.8%) during this time, and the recordings of vital signs (0% Vs 6.7%) increased as well. Conclusions: We conclude that the performance of the EMS in Hualien is poor. Evaluating the characteristics of patients and checking the prehospital records upon arriving at Ed by triage nurses are good methods of improving quality assurance in the EMS.