臺灣博碩士論文加值系統

緊急救護已成為台灣消防隊重要服務項目，其中到院前心肌梗塞復甦率是重要效能指標之一。執行OHCA急救服務為不同機關或部門之間的連結，藉由優化或簡化過程可爭取保命急救時間。嘉義市有其獨特人文及環境資源，本研究著重於該市到院前心肌梗塞傷患，藉以確認及評估不同影響因子並了解有那些地方仍需改善。從2018年310件OHCA病患中，篩檢出291件樣本並與17件成功康復出院樣本研進行究結分析，從結果得知需要改進的領域為公眾危機意識(包含使用公眾AED〔p分別為0.011-ROSC及0.005-康復出院〕、目擊OHCA﹝p分別為0.04-ROSC及0.01-康復出院﹞)及現場處置時間(p分別為0.022-ROSC及0.039-康復出院)，另現階段執行線上指導或由高級救護技術員實施派遣對於結果無明顯影響。嘉義市緊急救護服務的表現與其他先進國家相當甚至更好，但仍有許多關鍵領域可以升級改進。

The ambulance has become an important service for fire departments in Taiwan with the OHCA resuscitation rate as an important indicator of EMS performance. Chiayi City has its own unique humanities and environmental resources, this study focuses on the recorded 310 OHCA patients in 2018, through screening a sample of 291 patients were selected for this study, a total of 17 successful ROSC and discharge patients were identified and compared with the rest of the database for analysis. Different factors were identified and evaluated to see which areas the EMS system in Chiayi City could be further improved. The main area which needs to be improved is public awareness, as use of public AEDs (p=0.011 and 0.005 for successful ROSC and discharge respectively) and cardiac arrest witness (p=0.04 and 0.01 for successful ROSC and discharge respectively) which play a significant role in successful resuscitation. The need to shorten overall time is also essential, especially onsite treatment time (p=0.022 and 0.039 for successful ROSC and discharge respectively). Currently, there are also no adverse improvements in having an EMT-P dispatcher and DA-CPR implementation. It is shown that the performance of Chiayi City emergency dispatch model is on par or even better than other advanced countries, nonetheless, there are still many key areas which can be upgraded and improved.

ABSTRACT
中文摘要
ACKNOWLEDGEMENTS
CONTENTS
LIST OF FIGURES
LIST OF TABLES
LIST OF ABBREVIATIONS
Chapter I. INTRODUCTION
1.1. Background and Motivation
1.2. Importance of Study
1.3. Study subjects and objectives
1.4. Limitations
1.5. Methods and Process
Chapter 2. LITERATURE REVIEW
2.1. Golden Hour
2.2. EMS strive for shorter response
2.3. EMS in Taiwan
2.4. EMS in Chiayi City
2.5. EMS and hospital characteristics
2.6. Successful ROSC
2.7. Bystander CPR
2.8. DA-CPR (Dispatcher Assisted CPR)
2.9. Public AED
2.10. EMT Classes
2.11. EMS dispatch
2.12. OHCA medical SOP
2.13. Types of Ambulance
2.14. Patient Gender
2.15. Time of Occurrence
2.16. Mechanical chest compression
2.17. Survival rates comparison 19
2.18. Big Data / Emergency Medical Management database
2.19. Key variables of interest
2.20. Methods
Chapter 3. RESEARCH CONTENT
3.1. Research subjects
3.2. Data collection
3.3. Data analysis
3.4. SPSS
Chapter 4. FINDINGS AND DISCUSSION
4.1. Analysis by seasons
4.2. Analysis by time of happening
4.3. Analysis by patient sex
4.4. Time interval analysis
4.5. Witness analysis
4.6. Bystander CPR
4.7. Public AED
4.8. DA-CPR
4.9. EMT-P Dispatcher
4.10. CPR quality
4.11. AED Shock
4.12. Number of EMT dispatched
4.13. Analysis report
Chapter 5. CONCLUSION
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APPENDIX

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