出動行動急診室對到院前緊急救護民眾救活率之影響-以新北市2017年為例

Abstract

現行全世界歸納採用的三種主要救護體系之模式，我國係屬「英美緊急醫療救護體系」，其特點是由消防人員兼負擔任緊急救護技術員，執行到院前之緊急救護，將患者載至醫院的制度。101年12月全國首批3組『行動急診室(Mobile EMS Room)，簡稱MER』誕生，102年陸續建置11分隊MER，103年建置8分隊，共計有22分隊配置MER，並以四大時間急症-到院前心肺功能停止(OHCA)、ST段上升的急性心肌梗塞(STEMI)、急性缺血性腦中風(CVA)、嚴重創傷(Major Trauma)患者之急救處置及車行距離8分鐘內來執行派遣，本研究使用新北市106年1至12月OHCA救護案件救活率來分析，探討出動行動急診室影響救活率的相關因素。進行實證模型估計利用最小平方法(OLS)，探討應變數2、24、48、72小時以上救活率跟影響變數反應時間、處置時間、現場民眾是否CPR、是否AED電擊、是否使用LMA或插管、是否給予急救藥物、是否出動MER等之間的關聯性。\n在實證結果內，經扣除掉部分因素可能有內生性影響後，顯示反應時間及處置時間呈現高度負相關，AED去顫電擊亦有高度正相關的顯著性，而MER則呈現負相關性，可能是因為近年來剛推行，本研究參數案件只統計106年數據並不夠多，亦或是由於車行距離8公里內才會派遣出動MER救護車，距離較遠，MER車到達現場前已由原先的救護車急救後送去醫院、MER中途取消(未接觸到患者)或是MER車出勤其他的救護案件(無法再派MER車前往)等影響。

The current model of the three main rescue systems adopted by the world is China`s "U.S.-U.S. Emergency Medical Ambulance System." It is characterized by firefighters and urgency as an ambulance technician, performing emergency evacuation before hospitals, and transporting patients to hospitals. System. In December of the year, the first batch of 3 groups of "Mobile EMS Room" (MER) was born in the nation. In the 102nd year, 11 teams were established in MER, and in 1998, 8 teams were established. There are 22 units with MER. Time emergency - First-aid disposition and distance of 8 minutes before pre-hospital cardiopulmonary arrest (OHCA), ST-elevation acute myocardial infarction (STEMI), acute ischemic stroke (CVA), and Major Trauma (Major Trauma) Internally dispatched, this study used the survival rate of OHCA rescue cases from January to December in New Taipei City in 106 years to analyze the relevant factors that affect the survival rate of the emergency department that dispatched the operation.The empirical model was estimated using the least square method (OLS). Investigate the number of strains 2, 24, 48, and more than 72 hours for survival rate and influence variable response time, treatment time, whether CPR on site, whether AED electric shock, use LMA or intubation, whether to give emergency medicine, whether to send out MER, etc. Inter-relatedness.\nIn the empirical results, after deducting some of the factors may have endogenous effects, the response time and treatment time show a highly negative correlation, AED defibrillation also has a highly positive correlation of significance, and MER is negatively correlated. This is due to the fact that in recent years it has only been implemented. Only 106 years of data are not enough for this study parameter case, or the MER ambulance will not be dispatched within 8km of the car. The ambulance was sent to the hospital after emergency treatment, the MER was cancelled midway (not in contact with the patient), or the MER car was on duty in other rescue cases (it was no longer possible to send a MER car).