急重症兒童直昇機轉診之研究分析

Characteristics of Pediatric Patients Transported by Helicopters to a Medical Center in Taiwan

張玉喆(Yu-Che Chang) ； 施美秀(Mei-Hsiu Shih) ； 黃睦舜(Mu-Shun Huang) ； 高偉峰(Wei-Fong Kao) ； 顔鴻章(David Ht Yen) ； 王立敏(Lee-Min Wang) ； 黃俊一(Chun-I Huang) ； 李建賢(Chen-Hsen Lee)

《中華民國急救加護醫學會雜誌》 15卷3期 (2004/09) Pp. 110-116

https://doi.org/10.30018/JECCM.200409.0003

摘要

目的：分析台北某醫學中心收治直昇機運送兒童病患之資料，以瞭解兒童病患直昇機緊急醫療救護的特質。
材料與方法：回溯性收集本院自1990年3月至2002年9間，所有18歲以下由直昇機運達本院之兒科病患，調閱其病歷，以預先設計之直昇機病患資料記錄單，取得病歷中之相關資料，加以統計分析。
結果：自1990年3月至2002年9月間，本院共接受386人次直昇機轉送，其中18歲以下兒童病患85人佔22.1%，其中有11位因資料不全，留下74位為有效樣本做統計分析，男性有48位，女性有26位，年齡由1天大的嬰兒至18歲。年紀小於一歲有46人，佔62%；小於一個月有29人，佔39%，年齡最小的為一天大。74位兒童病患當中，由東部轉來的有51位，離島轉來的有23位，都是醫院之間的轉送。住院科別人數最多者為小兒心臟科，有19人，佔25.7%，其次依序為一般兒科，神經外科，新生兒科等。轉送前有氣管內管輔助呼吸者共29人，佔39%。轉送前後有接受CPR者共有14人(19%)，其中有6人在停留本院急診室期間持續接受CPR。在病患之動向上，51人住進加護病房，佔69%； 15人住普通病房，佔21%； 5人直接送開刀房接受手術，3人由急診出院。預後方面，44人完全康復出院，佔60%； 15人有神經或肢體方面缺陷，佔21%；瀕死出院或死亡者共14人，佔18%。
結論：本研究兒科病患經直昇機轉送的比例較國外高，嬰幼兒及新生兒直昇機轉送所佔的比率比國外高出許多，嚴重度也比國外高出許多，因此，強化兒科病患轉送設備，及訓練具兒科急救經驗之醫療人員護送是必要的。此外，經由強化偏遠離島兒科次專科，可減少直昇機轉送的頻率。

關鍵字

直昇機 ； 緊急醫療救護 ； 兒科

並列摘要

Objectives: To investigate the specific medical characteristics of pediatric patients transported by helicopter to a medical center in Taipei.
Method and sampling: By using a standardized data-abstraction form, we extracted relevant information from case files of pediatric patients (under the age of 18) who were transported by helicopters to this medical center between March 1990 and September 2002 inclusively, and then statistically interpreted these data.
Results: Between March 1990 and September 2002 inclusively, this medical center admitted a total of 386 patients that had been transported by helicopter, 85 (22.1%) of whom were under the age of 18. Because the data for 11 of the 85 pediatric patients were incomplete, only 74 individuals (48 males) were used as our test sample. The ages of the patients ranged from one day to 18 years, with 46 (62%) younger than one year old and 29 (39%) less than a month old. Of the 74 pediatric patients, 51 were transported from eastern Taiwan and 23 from outlying islands, and all were examples of inter-hospital transfers. In terms of the departments to which these patients were admitted, the pediatric cardiac section ranked number one with 19 patients (25.7%) being directed there, followed by the general pediatric section, neurosurgery section, and neonate section, etc. At time of transport, 29 patients (39%) relied upon endotracheal tubes for assistance with breathing prior to their being transferred to our hospital, and 14 patients (19%) received CPR during their transfer, including six patients who continued to receive CPR whilst remaining in the emergency unit at our medical center. Subsequent to their having been transported to our hospital, 51 patients (69%) were admitted to the intensive-care units, 15 (21%) to general wards, five directly to operating rooms although three were promptly discharged from our emergency department. Subsequent to treatment, 44 patients (60%) recovered completely and were then discharged from our hospital, 15 (21%) featured ongoing neurological/physical deficits, and 14 (18%) were either discharged on the verge of death or passed away whilst in our hospital.
Conclusion: The proportion of all pediatric patients that were transported to a hospital by helicopter in Taiwan would appear to be greater than the corresponding figure for some other countries. In view of these findings, it is essential that the staff of facilities that are responsible for the transportation of pediatric patients to hospital by helicopter are reinforced. In addition, the strengthening of pediatric departments within hospitals on outlying islands would likely be helpful as regards reducing the need for inter-hospital helicopter transportation of pediatric patients.

並列關鍵字

helicopter ； emergency medical services ； pediatrics