改善救護技術員救護技術的方法

Closed Interlocking Nailing for Treatment of Segmental Fractures of the Femoral Diaphysis

林朝順(Chaou-Shune Lin) ； 廖茂為(Maou-Wei Liaw) ； 洪士炫(Shi-Shen Hon) ； 張吳欽(Wu-Chin Chang) ； 張珩(Hang Chang)

《中華民國急救加護醫學會雜誌》 12卷2期 (2001/06) Pp. 63-69

https://doi.org/10.30018/JECCM.200106.0003

摘要

雖然近年來台灣救護技術員之訓練有長足之進步，但在執行救護時，卻有相當的落差。我們擬出一套解決問題的模式(醫療品管計劃)，本研究有評估這套模式是否可改善救護技術員的救護技術，尤其是創傷病人的照顧。我們選新竹市為試辦地點，並且設計一張評估表，以評估救護技術員對創傷比人的照顧的表現，執行評估的人是新竹市四家醫院的急診室檢傷護士。評核項目分別為感染控制，通訊，病人評估，通氣處理，頸圈使用，抽吸技術，呼吸道暢通，心肺復甦，脊椎固定，骨折固定及包紮。每一項技術又包含五個執行步驟，列顧評估表上，若救護技術員每一個步驟都執行正確，則該項技術得5分，若做錯或未做一個步驟則扣1分，直至0分。並非每個病人都需要執行十項技術，我們將應該執行技術項目之得分給予計算總合，並加以平均，此平均分數代表救護技術員的表現。在研究開始的第一個月，我們只是收集護士對救護技術員的評估表，未做任何改進品質的措施。第二個月開始，我們採取下列下法以改進到院前照顧之品質：(1)聘請受過救護技術員的急診醫師為醫療顧問，每月一次至各消防分隊驗收訓練成果；(2)各分隊每月舉辦二次的在職教育訓練；(3)每月公佈七個分隊的評核分數，並做為分隊長考核升遷之參考；(4)舉辦全市救護技術員技術比賽，以激勵學習動機。結果救護技術員的表現分數在計劃實施前為2.8 ± 2.0，實施後為4.0 ± 1.6，有顧著之進步。

關鍵字

緊急醫療網 ； 創傷 ； 救護技術員

並列摘要

Backround: At present, Taiwan has no paramedics. Ambulances are staffed by EMT-I or EMT-II level fire fighters, requiring 60 and 264 hours of training, respectively. Taiwanese EMS systems lack medical oversight resulting in poor quality of prehospital care.
Objective: To assess the impact of a medical control program on the EMT performance in trauma care.
Methods: A prospective study was conducted from January to June 2000 in a large a Taiwanese city with a population of 350,000, and 7 fire stations staffed with a total of 81 EMTs. Triage nurses in 4 receiving hospitals were instructed to evaluate the EMTs’ performance upon patient arrival at the emergency department by means of a special review sheet drafted by the authors. The assessment uses a 6-point scale (0-5) to measure skill performance and includes the following: infection control, communication, patient assessment, ventilation management, cardiac arrest arrest management, spinal immobilization, splinting, and bandaging. Non-trauma ambulance runs were excluded. In the first month the system was evaluated with no interventions; then starting in February 2000, an indirect medical control program was implemented. It included protocol development, continuing education, and competition using prehospital skills with monthly meetings in each fire station directed by a fully trained emergency physician for trouble shooting and problem solving. The overall performance before and after the implementation was compared using the Wilcoxon signed-rank test.
Results: The mean scores were 2.8 ± 2.0 (n = 234) and 4.0 ± 1.6 (n = 900) before and after implementation of the indirect medical control program. Before-and-after performance differences were significant (p ＜ 0.001).
Conclusions: The medical control program was successful in improving the EMTs’ trauma skills. A need exists to extend the program to include non-trauma areas in the future.

並列關鍵字

emergency medical service system ； trauma ； emergeny medical technician