Monitoring Field Performance of Emergency Medical Service in the Tainan Region

目前在台灣地區約有百分之八十的消防隊員接受過知級救護技術員訓練，並有一半亦接受過中級救護技術員的訓練。然而台灣至今尚無對這些訓練成果是否落實於平日的救護工作，做過正式的評估報告。本研究仍藉各責任醫院急診室之檢傷護士對經由緊急救護系械所送的病患做現場記錄，再與救護技術所填寫之救護記錄出勤表中各種施救舉措做比較，以探詢這當中的落差，為日後的複訓與品質改進提供參考。在我們於617例中發現當救護技術員在救護記錄出勤表中記載曾在現場為病患上頸圈，鼻管給氧、施以骨折固定與心肺復甦術施行等項目與急診檢傷人員所觀察到是一致的。但其他項目如：止血、包紮、維持呼吸道、面罩給氧、心理支持與無任何舉措等五項則統計上明顯不同於急診護理人員的報告。本調查指出當前在台灣發展到院前急救說的障礙是救護技術員對於救護出勤記錄表的填寫並不確實，這對欲改善緊急救護服務品質的決策形成上是有很大的防礙的。台灣今後嘗試發展急救現場的救護品質監控人員，不失為值得考慮的方向。

關鍵字

到院前緊急救護；品質保證；現場舉措

並列摘要

At present, approximately eighty precent of firefighters are at EMT-︱ level, and of these 50% are at EMT-Ⅱ leavel in Taiwan. However, no formal assessment program has measured the real impact of MET training on practivce behavior. The purpose of this study is to investigate the discrepancy in field performance reports between the METs and triage nurses in the receiving hospitals.From December 22,1997 to January 21,1998, a total of 617 run reports and special review sheets were collected from 8 receiving hospitals. Ninety precent of the franctional response times in the city and county were within 6 and 10 minutes respectively. Average on-scene time and average total transport time in the city was 5.5, and 15 minutes, and in the county 5 and 25 minutes. Motor vehicle accidents comprised 64%of run requests. Procedures such as applying a neck collar, nasal cannula, splinting of fractured limbs ans CPR attempts were consistent with emerency room(ER) nurse’s observation. Categories such as controlling bleeding and bandaging, keep ing an open airway, mask ventilation, comforting patients and no specific intervention required were inconsisitently reported by staffs of the receiving Ers. We concluded that incomplete recording of pre-hospital run reports is a major barrier to deprrier to depicting the status of EMS care quality in Taiwan and it must be rectified quickly. Field preformance assessments reviewed by ER triage nurses might serve to monitor as well as evaluate the care given by EMTs. However, validation of the present review process by a designated field inspector is mandatory to carry out continuous quality improvement for future EMS in Taiwan.

並列關鍵字

emergency medical service ； quality assurance ； fields performance

國際替代計量

Monitoring Field Performance of Emergency Medical Service in the Tainan Region

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