我國校園緊急醫療救護之研究

A Survey of School Emergency Medical Services in Taiwan

陳坤詮(Kun-Chuan Chen) ； 張新(Hsing Chang) ； 黃彥達(Yen-Ta Huan) ； 許智偉(Chih-Wei Hsu) ； 楊久滕(Giou-Teng Yiang) ； 胡勝川(Sheng-Chuan Hu)

《Journal of Emergency Medicine, Taiwan》 8卷2期 (2006/06) Pp. 37-48

摘要

背景：國內校園瀕傳安全意外事件，每每造成重大社會新聞事件，校護又常成為眾矢之的，成為各方責難的焦點。為瞭解各級學校重大緊急傷病的發生機率及種類；學校校護的能力及緊急醫療救護(EMS)設備的現況及應付重大緊急傷病的反應流程，故思做此研究。
方法：自93年l月l日至93年12月31日期間將問卷發到每一縣市的具代表性的校護手中。並將學校分成大專、完全中學、高中、國中、國小等5類，分別做統計分析。
結果：總共發出問卷2210份，有效回收問卷數為1549份(70.1%)。研究學校數佔各類學校總數的比率分別為大專25.4%、完全中學67.2%、高中職20.6%、國中49.5%、國小40.1%。我國校園EMS現況及特徵為：(1)近5年來校園發生猝死的案件，於1549間學校中共36件，平均每5年每間學校才0.02件。(2)學校最常見的創傷事件依序是不嚴重的出血、骨折、灼傷。(3)絕大多數學校沒有救護車、急救箱、急救背包、傻瓜電擊器(AED)。(4)絕大多數學校沒有醫師駐診，但39%的大專及32.4%的高中有醫師駐診。(5) 40%-84%的學校沒有給學生辦理急救訓練，44%-70%的學校有給教職員辦理急救課程，有辦理的訓練中最常開辦的課程是CPR訓練課程，其次是CPR加止血固定包紮課程。雖有辦急救課程，35%學校稱來參加的學生不到30%。(6)大部份校護接受過類似EMT的訓練（包括：CPR、止血固定包紮、頭頸部固定）。25%-45%的校護接受過ACLS訓練，但只有10%-20%的人對治療心臟停止和危急心律不整有自信。會操做AED的比率也只有20%。對創傷的到院前救護技術和CPR技術，大部份護士都有自信。(7) 26%-48%的學校距消防分小隊在5分鐘內，2.6%的國民小學離最近的消防分小隊車程為30-60分鐘。20%-44%的學校離最近醫院的車程在10分鐘之內。(8)如果校園內發生緊急意外或傷病事故，校護又不在學校，其作業應變流程，大多數學校都是教導學生先通知老師或教官。規定直接打119的，於大專院校有45%，於其它學校則為22%-26%。如校護有在學校，規定先通知校護再打119的學校佔31%-53%, 23%-43%的學校則規定先打119，再通知校護評估。
結論：(1)絕大多數學校校護有能力處理創傷個案，但無法處理猝死的病人；(2)大多數學校所制定的緊急應變流程不符EMS的原則；(3)大多數學校必須在校內實施早期電擊，而有中等量學校必須在校內實施早期ACLS。

關鍵字

緊急醫療救護服務 ； 救護技術員 ； 高級心臟救命術

並列摘要

Background: In the past decade, the accidental events in the school of this country were heard very often, which usually cause a major social event in the newspaper. In the mean time, the school nurses were the targets to be blamed. What is the real problem since we have practiced the emergency medical services (EMS) system around the island since 1990. As a matter of fact, we have many reports regarding the EMS on special situations such as high mountains and remote area or mass gathering etc. The purpose of this study is to realize the prevalence of major emergency events and its present status of emergency medical services in schools, so as to establish a feasible and realistic emergency medical system by which we can save life of a sudden cardiac arrest victim in school.
Materials and Methods: An observational survey through questionnaires was conducted from January 1, 2004 through December 12, 2004. We divided the schools into the following categories: university and college (UC), complete middle school (CMS), high senior school (HSS), junior school(JS), elementary school (ES). The data of each category was analyzed respectively.
Results: 1549 of 2210 samples were responded with a rate of 70.1%. The percentage of response school was 25.4%; 67.2%; 20.6%; 49.5% and 40.1% in UC; HSS; JS; ES, respectively. The characteristics of EMS around the schools in this island were as follows. (1) The majority of school have no ambulance, first aid kit, rescue back pack or automated external defibrillators (AED); (2) 40%-84% of schools did not open the emergency training course for student, only 44%-70% having the training course for teachers and employees. The most common opened training course were CPR course, followed by CPR plus partial EMT course. Less than 30% of students attend the first aid course reported by 35% of UC schools. (3) Most school nurses received EMT-like training course and had the confidence to treat trauma case prehospitally. 25%-45% of school nurses received ACLS training with 10%-20% of them having the confidence to treat cardiac arrest and life threatening cases. 20% know the AED procedures. (4) 26%-48% of schools reported that the distance between their school and firefighter squad were less than 5 minutes despite that 2.6% were 30-60 minutes. 20%-40% of schools reported that the distance between their schools and the nearest hospital were less than 10 minutes. (5) The emergency medical response system in most schools(when school nurses are absent) stipulate that notify teachers or military training officers first, then 119, in stead of 119 first, which is the rule in 45% of UC and 22%-26% of other schools. However, when school nurses are present, 23%-43% of school call 119 first then call nurses, and 35%-53% of school call nurses first then call 119. (6) The sudden deaths in 1549 schools in recent 5 years were 36 with an average of 0.02 per school yearly. (7)The most common seen trauma events in schools was minor bleeding(occurred every day in 21%-35% of schools), fracture(1-3 per term reported by 50-70% of schools),burn(one per month in 415-47% of schools except only 22% of elementary schools).
Conclusions: (1) The majority of school nurses are capable to handle trauma cases, but not sudden cardiac death patients; (2) The emergency medical response algorithm most hospitals have are not in accordance with the principle of international EMS; (3) Most schools have to do early AED and moderate schools have to do early ACLS within schools.

並列關鍵字

emergency medical services EMS ； emergency medical technicians EMT ； advanced cardiac life support ACLS