Current Status of Flight Emergency Medical Services in Taiwanese Airline Companies and International Airports

我國飛航旅行之緊急醫療救護

張新(Hsing Chang) ； 陳坤詮(Kuen-Chiun Chen) ； 許智偉(Chic-Wei Hsu) ； 楊久騰(Giou-Teng Yiang) ； 胡勝川(Sheng-Chuan Hu)

《Journal of Emergency Medicine, Taiwan》 8卷3期 (2006/09) Pp. 89-98

摘要

目的：本研究的目的是在瞭解我國飛航旅行中的緊急醫療救護(EMS)資源與現況，並試圖建立一個務實可行的飛航旅行中的EMS制度。
方法：自94年4月1日至94年9月30日期間。選擇中華及遠東二家航空公司、中正及高雄國際機場為研究場所。審閱此期間內的飛行途中緊急醫療事件記錄，和機場的緊急醫療救護記錄，並將之整理成主訴、傷病種類、治療、處置、有無醫師在場等五項。同時發問卷詢問所有空勤人員、座艙長代表一人、機場代表一人等相關問題。內容包括：在飛行途中所發生的猝死、急救設備、個人所受的訓練、公司所規定的作業流程、個人所敢或所能做的急救技術、機場離最近消防分小隊和區域醫院的車程、機場有無醫師駐診、有無護士服務等。
結果：共收到中華航空及遠東航空的問卷各964及174份，但有效卷數各為956及173份。各公司均規定空服員只能做基礎救命術，如果病人堅持要服某些藥物，但又無醫師在機上時，由空服員向病人解釋後，由病人簽署切結書，則空服員可以給該藥物予病人。大多數空勤人員沒有接受自動體外電擊(AED)的訓練(81.93%),約一半的人接受過心肺復甦術(CPR)加止血固定包紮的訓練(53.41%)。空勤人員最有自信會做的急救技術是CPR (91.8%)和哈姆立克急救法(82.17%)，但只有67.09%會對無脈搏的旅客做CPR。飛行途中之緊急醫療事件中創傷只占7.53%。當空服員廣播醫師時，醫師出現的機率為63.38%。93件飛行中之緊急醫療事件，主訴排名前4名依序為：昏倒(15.05%)、腹痛／胃痛(10.75%)、呼吸困難(7.53%)、發燒(6.45%)、頭痛(6.45%)、頭暈(6.45%)。各有30.93%的病人接受藥物治療和心理支持，19.6%被給予氧氣治療。所給藥物中止痛退燒藥最常給(46.67%)、其次是胃藥(30%)、止暈藥(16.67%)。30%的病人在落地後被送往最近的責任醫院。航站內旅客或職員遇緊急傷病，由機場醫護人員先評估處理，視需要再呼叫119送醫。航空站共收到555筆資料，非創傷有398位(71.71%)。非創傷病人的主訴前5名是：發燒(42.21%)、腹脹／腹痛(16.83%)、頭痛／頭暈(10.80%)、呼吸困難(6.03%)、疼痛(5.53%)。處置方面，34.77%、22.70%、21.62%、13.15%病人分別被施以衛教、開藥後離去、提供到院前救護、後送到醫院。
結論：我國目前的飛航途中及機場之緊急醫療救護流程尚稱合理，但如配置EMT人員於機場較符合經濟效益，唯尚須加強空勤人員的EMT-1訓練、醫藥箱內急救藥物及器材的充實及AED的配置於國際機場。

關鍵字

緊急醫療救護 ； 飛航急症 ； 空中旅行 ； 到院前救護

並列摘要

Purpose: The purpose of this study was to realize the emergency medical services (EMS) resources and present status in order to establish a feasible and cost-effective EMS system while traveling by air. Materials and Methods: A prospective observational study was conducted from April 1, 2005 through September 30, 2005, using the emergency medical event (EME) report from China Airline and Far Eastern Air Transport corporations, as well as the medical records from the Chung Cheng and Kao-Hsiung international airports. Questionnaires were sent to all air-service personnel (ASP), one representative from each company and airport involved. The key information such as chief complaint, treatment, doctor on board, cardiac arrest case, resuscitation equipment, personnel training, EMS algorithm, response time, transportation time, and number of doctors or nurses staffed at the airport, were reviewed and analyzed.
Results: Of the 1148 questionnaires collected, 964 and 174 were from the China Airline Corporation and the Far Eastern Air Transport Corporation, respectively. The usable questionnaires were 956 and 173, respectively. Both aviation companies regulate that flight attendants (FA) are legally obligated to do basic life support such as CPR and prehospital first-aid skills. If passengers insist on asking for some medication but no doctor was on board, the two companies state that the FA are allowed to give the drugs after giving a full explanation and an agreement must be signed by patients. Most (81.93%) of the ASP did not receive AED training, half (53.41%) received CPR plus prehospital first-aid skills training. The FA felt the most confidence in the prehospital skills of CPR (91.8%) and Heimlich maneuver (82.17%), while 67.09% of responders would perform CPR on a cardiac arrest passenger. Of the 93 EME during flight, 92.47% were non-trauma cases. The rate of physicians being available after paging during cases of EME was 63.38%. The top four chief complaints were syncope (15.05%), abdominal pain/epigastralgia (10.75%), dyspnea (7.53%), fever (6.45%), headache (6.45%), and dizziness (6.45%). In addition, 30.93%, 30.93% and 19.59% of the total EME underwent medication therapy, psychotherapy and oxygen therapy, respectively. The medication given included antipyretic or analgesic (46.67%), antacid (30%), and anti-vertigo drugs (16.67%). The emergency medical technicians sent 30% of the EME patients to the nearest hospital after landing. The standard operating procedure at the airport upon emergency includes that doctors or nurses take care of the patients first when the passengers come to the first aid station, followed by calling the emergency number 119 for transporting patients to the nearest community hospital when necessary. Of the 555 cases collected and analyzed from airports, 398 (71.71%) were non-traumatic cases. The leading five chief complaints were fever (42.21%), abdominal distension/ pain (16.83%), headache/dizziness (10.80%), dyspnea (6.03%), and pain (5.53%). Among them, 34.77%, 22.70%, 21.62%, and 13.15% were treated with education, medication, providing the prehospital first-aid skills, and transportation to the hospital, respectively.
Conclusions: The standard operating procedure upon emergency during travel by air in Taiwan is reasonable. Staffing with emergency medical technicians (EMT) instead of doctors or nurses is cost-effective and feasible. Enhancing the training of FA, adding some resuscitation drugs in the medical kit, and deployment of AED in the international airport are needed.

並列關鍵字

emergency medical services EMS ； in-flight emergency ； air travel ； and prehospital care