台灣東部離島與西部離島空中緊急醫療轉送之流行病學比較

Epidemiological Comparisons of Emergency Air Medical Transportation between Eastern and Western Remote Islands in Taiwan

高健仁(Chien-Jen Kao)

指導教授 ： 蔡行瀚

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00187

摘要

研究背景
我國自2002年10月成立空中轉診審核中心，至今已有二千餘人次的離島病患經由空中轉送，相關的資料非常豐富, 深具研究價值. 本研究將空中轉診的主要地區分為三組: 1. 為西部大型離島: 如澎湖(不含七美, 望安), 金門, 馬祖; 2.西部小型離島: 如澎湖縣的七美鄉,望安鄉及屏東縣的琉球鄉與3.東部小型離島: 蘭嶼與綠島。本篇論文比較東部離島之綠島與蘭嶼(簡稱東部離島)與澎湖,金門及馬祖西部大型離島及七美,望安及琉球的西部小型離島在空中醫療轉送各項資料之差異性。
研究方法
採用回溯法收集2004年1月1日至2008年12月31日，所有空中緊急醫療轉送的資料庫，包括東部離島:綠島與蘭嶼地區216人次, 西部小型離島: 七美,望安跟琉球地區的109人次以及西部大型離島:澎湖,金門及馬祖地區的994個案。收集轉診單、空勤總隊記錄、急診與出入院記載及空中轉診審核中心追蹤記錄做為統計分析。統計方法使用WINDOWS XP EXCEL套裝軟體以及SPSS17.0軟體進行敘述性資料處理以及統計分析。

研究結果
(1) 由高而低, 04~08年間年度每千人口轉送率在綠島蘭嶼為3.3~6.6人次, 澎湖,金門及馬祖為0.7~1.3人次; 七美,望安跟琉球為0.4~1.4人次, 綠島蘭嶼地區轉送率偏高, 但有逐漸降低趨勢. (2)綠島蘭嶼所轉送的本地病患主要疾病分別是骨科33人次, 神經內科30人次, 神經外科25人次; 澎湖,金門及馬祖所轉送的本地病患主要疾病分別是心臟內科189人次, 神經外科158人次, 神經內科149人次; 七美,望安跟琉球所轉送的本地病患主要疾病分別是神經內科19人次, 神經外科16人次, 骨科15人次. (3) 病患年齡的老化以澎湖,金門及馬祖地區最為明顯: 老人病患比例由04年的28.8%到08年的40.9%, 轉送病患平均年齡也由04年的43.9歲增加到08年的52.6歲.
結論
本研究將東部小型離島綠島與蘭嶼與西部大型離島及小型離島的轉送資料分別比較發現: (1)綠島與蘭嶼居民死亡率是三個地區最低, 但年度每千人口轉送率卻反而高於其他兩個地區. 其可能原因為澎湖,金門及馬祖當地擁有地區醫院, 醫療能量及資源遠比僅有衛生所的綠島蘭嶼來得充足,故在綠島蘭嶼地區轉送的需求較高; (2)七美望安跟琉球之所以未如綠島蘭嶼般有較高轉送頻率, 可能是當地對於七美,望安的重症病患船運至馬公就醫的病患補助而這一部份並未列入空中轉送的計算. (3)相較於台灣本島持平的死亡率, 綠島蘭嶼跟澎湖,金門及馬祖的居民死亡率出現下降, 代表當地包括轉送系統在內的公共衛生政策具有成效. (4)各地區所轉送的病患比例不盡相同, 但顯示東西部離島跟有地區醫院的離島醫療需求的差異,本研究資料可以作為改善當地醫療環境及公共衛生政策的參考.

關鍵字

空中轉診 ； 離島 ； 流行病學

並列摘要

Research Background
National Aeromedical Approval Center's (NAAC) has been set up in our country since October 2002, to build aerial ambulance system in remote areas and off-shore islands. Currently, the three main areas provide aerial ambulance included: 1. Western major islands: Penghu (including Chimei, Wangan), Kinmen (including Lieyu, Utiu), Matsu (including Tungyin, Chukuang); 2.Western remote / minor islands: Cimei Island, Wangan Island and Liuqiu Island; 3. Eastern remote islands: Lanyu and Green Island. Since November 2002, there had been hundreds of patients from the eastern part of remote islands and more than 2000 of patients from the three major areas. The relevant information is very rich, worthy of great research value. In this thesis, this study analyzed the aeromedical transport from Green Island and Lanyu areas (the Eastern Islands for short) and the differences of the other two areas, such as transmit frequency, transporting season, age distribution, and disease classification.

Research Method
From January 1, 2004 to December 31, 2008, we used retrospective method to collect all the databases of aeromedical emergent transport, including 216 cases from Green Island and Lanyu, 994 cases in Penghu, Kinmen, and Matsu areas, and 109 cases from Cimei, Wangan and Liuqiu islands. We collecting referral orders, records of National Airborne Service Corps, records of emergency treatment and leaving and going to hospital, and NAAC track records as the statistical analysis. For the statistical methods, I used WINDOWS XP EXCEL package software and SPSS17.0 software to do descriptive data processing and statistical analysis.

Research Results
(1) Ranking from higher frequency, The transporting frequency was 3.3~6.6 people per thousand each year of Green Island and Lanyu; 0.7~1.3 of Penghu, Kinmen and Matsu; 0.4~1.4 of Cimei, Wangan and Liuqiu. Green Island and Lanyu had higher transporting frequency but decreased in past years. (2)In disease classification, the major divisions of aeromedical transport in Green Island and Lanyu includes 33 people of orthopedics, 30 people of Neurology, and 25 of Neurosurgery; 189 people of Cardiology, 158 people of Neurosurgery, 149 people of Neurology in Penghu, Kinmen and Matsu; 19 people of Neurology, 16 people of Neurosurgery, 15 people of Orthopedics in Cimei, Wangan and Liuqiu. (4) The aging trend was most obvious in Penghu, Kinmen and Matsu area: the percentage of older patients increased from 28.8% upto 40.9%; the median age of patients increased from 43.7 y/o upto 52.6 y/o.

Conclusion
Comparing EAMT data of Green Island and Lanyu Island from other two areas, and obtained the following results: (1) The mortality rate in Green Island and Lanyu was lower than other two areas, but the transporting frequency was higher than others. The results maybe due to Penghu, Kinmen and Matsu area had regional hospitals, be able to perform more operations and treatments than Green Island and Lanyu, which only had local health stations. (2) Not calculating the patients transported by ships made the transporting frequency of Chimei, Wangan and Liuqiu lower than other areas. (3) Comparing the stable mortality rate of Taiwan, areas of Green Island and Lanyu; Penghu, Kinmen and Matsu got decreased. It can be see achievements of public health effect. (4) The patients ratio of each divisions were different in each area, but it also revealed different medical demands. Data and information nof this study can be useful for planning further public health policy.

並列關鍵字

Emergency Air Medical Transportation ； Remote Islands ； Epidemiology

參考文獻

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