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研究生:張維剛
研究生(外文):Wei-Kang Chang
論文名稱:國軍現行空中傷患後送作業效能之研究
論文名稱(外文):Audit of Aeromedical Evacuation System in ROC Armed Forces
指導教授:吳怡昌吳怡昌引用關係
指導教授(外文):Yi-Chang Wu
學位類別:碩士
校院名稱:國防醫學院
系所名稱:航太醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:81
中文關鍵詞:空中傷患後送國際疾病分類標準
外文關鍵詞:aeromedical evacuationInternational Classfication of Disease(ICD-9)
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中文摘要
前言:根據美軍多年來的軍事行動經驗得知,利用空中傷患後送機制將前線傷員迅速後送至後方醫院,以獲得確切的醫療救護,不但可以降低傷兵的因傷致死率,亦可使前線部隊免於耗費過多的兵力於傷兵之照顧而得以將兵力完全集中於戰鬥事務。我國軍現存之空中傷患後送機制自民國48年9月實施至今,雖已建構完整的作業體系,然尚未曾進行作業模式與效能的系統性評估。研究目的:分析我國軍空中傷患後送機制之現況,以探討其優勢及可能潛存的問題,並提供精進該作業效能之建議。材料與方法:蒐集民國87年7月至90年10月期間,接受空中醫療後送的1977位傷患之各項資料,包括患者之身份(軍、民)、軍種、疾病種類、傷患病情、後送時限等級及後送接收醫院等等。依據傷患之航空護理記錄確認後送病情之臨床診斷,並給予適當之國際疾病分類標準編碼(ICD-9)。研究資料分別採用描述性統計分析,t檢定和卡方檢定等統計方法進行分析。結果:(1)接受空中後送之傷患,以軍人身份者居多,共計1506人,佔全部研究樣本數的76.2%;(2)軍人與民眾傷患之平均年齡分別為22.2±2.8歲和59.9±19.1歲,兩組間差異之t檢定已達統計上顯著水準(p<0.001);(3)若依國際疾病分類標準針對後送疾病診斷加以分類,則軍人組別之傷患是以「傷害及中毒類」之疾病為最多,佔該組總人數的15.8%;而民眾組別之傷患則是以「循環系統」疾病居首位,佔該組總人數的23.6%;(4)針對後送作業時限類別之分析結果顯示,最常實施之作業為例行性後送,佔總架次的91.4%(329架次),遠高於緊急性(7.8%)和優先性(0.8%)後送作業;(5)後送傷患之接收醫院則是以三軍總醫院為主(77.4%),其次為國軍松山醫院(12.8%)。結論:(1)高達97.5%的傷患是採例行性作業模式後送;(2)軍人與民眾兩組間的平均年齡和最常見的後送疾病種類均有差異;(3)未來後送傷患之疾病登錄應採國際疾病分類標準編碼而非現行之臨床科別分類,以利長期作業效能之評估;(4)傷患資料登錄作業應儘速資訊化,以確立後送傷患資料之完整性及線上傳輸和分析之便利性。
Abstract
Introduction: The mission of aeromedical evacuation (AE) system is to move casualties by air from the combat zone to medical treatment facilities for extended and special care. The AE system during wartime can significantly reduce the mortality rate of wounded soldiers and effectively relieve the logistical burdens of front line troops. Although our Air Force AE system has been operated since 1959, no extensive study on its performance and efficiency has been ever made. Purpose: To study the advantages and potential problems of our Air Force AE system by reviewing and analyzing the records of aeromedical patient movement between Kinmen island and the main island of Taiwan. Materials and Methods: The medical records of 1,977 patients transported by air through the Air Force AE system from July 1998 through October 2001 were reviewed. For the purposes of this study, patients were categorized into two major groups including military or civilian groups. All patients were classified into various categories according to clinical diagnosis, clinical divisions of originating hospitals, AE patient classification and AE movement prioritization category. The diagnostic categories were made in accordance with International Classification of Disease (ICD-9) categories. The data collected were analyzed using descriptive statistics, t-test and chi-square test. Results: During this study period, 76.2% of all AE patients were military personnel. The military patients were significantly younger than the civilian patients (mean age of military group = 22.2 yr, SD = 2.8; mean age of civilian group = 59.9 yr, SD = 19.1, P<0.001). For the military group, the most common diagnostic category was “Injury and Poisoning”, comprising of 15.8% of all military patients. Contrarily, the most prevalent disease category for civilian group was the “Disease of Circulatory System”, which occupied 23.8% of all civilian patients. The analysis of AE movement prioritization classification indicated that 91.4% of all AE missions were placed into the “Routine” category. Conclusion: (1) The role of current AE system in providing patients quick aeromedical transportation from Kinmen to Taiwan and offering them a better chance of receiving definitive medical cares has been well established. (2) 76.2% of the AE patients were military personnel and 97.5% of the patients were transported under the “Routine AE” condition. (3) The difference between military and civilian groups in terms of average age and distribution of specific diagnosis was statistically significant. (4) The ICD-9 categorization instead of clinical division classification should be used in each AE patient’s medical record to indicate the real medical causes for requesting AE movement. (5) The management of AE patient movement and patient medical information should be computerized to facilitate rapid information sharing and enhance Command and Control capabilities unifying the parts of the overall AE mission.
目 錄
頁次
正文目錄 …... …...Ⅰ
表目錄 ………………….Ⅲ
圖目錄 …………………Ⅳ
中文摘要 ………………………………………Ⅴ
第一章 前言………………..……................................................................. 1
第一節 研究背景……………………………… …………………………1
第二節 美軍軍陣醫療支援新思維…………………………… …………5
第三節 研究動機……………………………………… …………………7
第四節 研究目的………………………………………………………… 8
第二章 文獻回顧 …………………………………………………………9
第一節 空中傷患後送的發展史… …………….………………………9
第二節 我國空中傷患後送之發展…. ………………………………….14
第三節 空中傷患後送作業之組織架構…………… …………….…....17
第四節 空中傷患後送之功能與其整體效能發揮實例……… …….....23
第三章 研究材料與方法…. ……………………………………...................26
第一節 研究材料….. …………………………………………………...26
第二節 基本資料之類別及項目定義…… ……………………..............28
第三節 資料分析…… ………………………………..............................30
第四章 結果…… …………………………………………………………….31
第一節 後送傷患基本資料分析………………………….. …………...31
第二節 軍人與民眾傷患基本資料之描述與比較…………….. ……...35
第三節 飛行架次與後送接收醫院之描述…………………… ……….41
第五章 討論…….. …………………………………………………………..42
第一節 後送傷患之年齡層分佈………….. …………………………...42
第二節 傷患臨床科別分類與ICD-9疾病診斷分類………….. ……...44
第三節 後送作業架次、時限等級與接收醫院……… ………………..50
第四節 研究限制………. ……………………………………………….56
第六章 結論與建議………………… ………………………………………57
第七章 參考文獻………. ……………………………………………………76
表 目 錄
頁次
表一 國際疾病分類標準編碼…………………………………………59
表二 全體後送傷患之身分、性別與平均年齡之統計表……………60
表三 軍人傷患之軍種分佈……………………………………………61
表四 全體後送傷患年齡層分佈………………………………………62
表五 軍人傷患之軍階類別統計………………………………………63
表六 全體後送傷患之疾病科別分佈…………………………………64
表七 後送傷患之國際疾病分類標準編碼(ICD-9)分佈………….65
表八 後送傷患之病情分類……………………………………………66
表九 後送作業時限等級分佈…………………………………………67
表十 軍人與民眾傷患之年齡分佈……………………………………68
表十一 軍人與民眾傷患之疾病科別分類………………………………69
表十二 軍人與民眾傷患之病情分類比較………………………………70
表十三 軍人與民眾傷患ICD-9號碼分類比較…………………………71
表十四 後送任務之飛行架次統計……………………………………....72
表十五 後送接收醫院統計………………………………………………73
表十六 美空軍現行空運傷患病情之分類及其定義……………………74
圖 目 錄
頁次
圖一 美空軍之傷患後送記錄卡(AF FORM 3899)..………………75
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