派遣員線上指導心肺復甦術政策成效評估之研究

本研究是派遣員線上指導心肺復甦術(DA-CPR)政策成效評估之研究，研究標的限縮於108年度高雄市政府消防局執行之DA-CPR案件。當病患呈現到院前心肺功能停止(OHCA)時，旁觀民眾最重要的處置就是即時施予心肺復甦術(CPR)，而DA-CPR就是透過119派遣員線上指導報案者進行CPR的過程。本研究採質性研究方法，透過審核員進行DA-CPR品管時的文字回饋，總計回收1229筆文字回饋資料，總字數高達三萬五千餘字，經歷開放編碼、主題編碼歸納過程次數分析後，搭配DA-CPR品管評量指標與時間績效指標統計結果相互參照，繪製文字雲與概念模型後提出研究結論與結果。研究發現，本局除了所有電話的OHCA辨識率低於內政部消防署建議目標外，其他指標均表現良好。故本研究從審核員報案階段、辨識階段、指導階段、監測階段與鼓勵性質的文字回饋中，提出研究模型與結論建議。結論包含派遣員應確實依照DA-CPR作業流程詢問關鍵問題；指導時要善用電子節拍器輔助指導速率並避免CPR的延遲與中斷；監測階段除了鼓勵報案人持續施作CPR外也必須持續監測CPR品質，不宜詢問過多問題以免影響報案人操作CPR；在受理報案時應避免隧道視野效應，在排除之前每通報案電話都要視為OHCA，以增加OHCA案件辨識率。建議包含落實AHA提出的六點DA-CPR品管建議執行項目；發展高雄市特有的DA-CPR作業流程與檢核表並建立審核員與派遣員的共學機制。對於未來相關研究則是建議提升研究規模至各區域，或以派遣員、DA-CPR教育為本及科技化的DA-CPR研究。

關鍵字

派遣員線上指導CPR ；到院前心肺功能停止；政策執行成效評估；緊急醫療救護

並列摘要

This study aims to policy evaluation of DA-CPR, in this paper, we focus on DA-CPR cases from Kaohsiung City Fire Bureau in 2019. This study is based on a qualitative research approach, which utilizes auditors' text feedbacks during DA-CPR quality control. We derive our conclusions and results by drawing out the word cloud and conceptual model, using inductive analysis data and statistical analysis data. Conclusions: (1) Reporting stage, dispatchers should ask key questions following the standard operating procedure of DA-CPR. (2) Guiding stage, dispatchers should utilize the assistance of electronic metronomes, preventing delays and interruptions when reporters perform CPR. (3) Monitoring stage, in addition to encouraging the reporter to continuously perform CPR, the CPR quality must be simultaneously monitored, redundant questions are prohibited for fear of disrupting the reporter's CPR performance. (4) Recognizing stage, to increase the OHCA recognition rate, tunnel vision effect should be avoided, every reporting call must be concerned as OHCA before being excluded. Suggestions: (1) Fulfill the six DA-CPR guidelines proposed by the American Heart Association. (2) Develop Kaohsiung City's unique SOP for DA-CPR and establish a co-learning mechanism for auditors and dispatchers.