臺灣博碩士論文加值系統

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

參考文獻
1. Ainscough, M.J. Aeromedical evacuation mission and organization. Presented in AAMIMO course, March 06, 1998.
2. Barbash GI, et al. Management Control of Aeromedical Evacuation Systems. Aviat. Space Environ. Med. 1998; 59: 172-175.
3. Brig Gen Bruce G, USAF. Challenge of aeromedical evacuation in the Post-Cold-War Era. Aerospace Power J. 2001; 14(4):14-26.
4. Carroll R. Aeromedical evacuation Operations and Management. Air Force Instruction 41-302, 28 July 1994.
5. DE Lorenzo RA. Military and civilian emergency aeromedical services: common goals and different approaches. Aviat Space Environ Med. 1997; 68:56-60.
6. Dice, W.H. The role of military emergency physicians in an assault operation in Panama. Ann Emerg Med 1991;20:1336~1340.
7. Dorland PG, Nanney JS: Dust off: Army aeromedical evacuation in Vietnam. Washington, DC, US Army Center of Military History, 1982, pp 4-8, 14-16, 23, 117, 121.
8. Driscoll, R.S. U.S. Army medical helicopters in the Korean War. Mil Med 2001; 166(4):290-6.
9. Eddi Cohen. Airmedicine: Intensive Care up High! Merginet. News for August, 1996.
www.merginet.com/tgp/1996/9608/aeromed.shtml
10. Frazer EP. Past, present and future perspectives of air medical safety. Emerg Care Q. 1991; 6:16-26.
11. Gibson, T.M. Samuel Franklin Cody: Aviation and aeromedical evacuation Pioneer. Aviat Space Environ Med. 1999; 70:612-617.
12. Guilford, F.R. and B.J. Soboroff. Air Evacuation: an historical review. Aviat Med 1947;601-616.
13. Hansen P.J. Safe Practice for Our Aeromedical Evacuation Patient. Military Medicine. 1987; 152(6): 281-283.
http://www.doh.gov.tw/todaynews/900608/Welcome.htm
14. Johnson, A., JR. Two years of routine patient movement in the U.S.A. ( Jan. 1974-Dec. 1975). Avit. Space Environ. Med. 1977; 48(5): 451-453.
15. Jones, D.R. The Macy reports: combat fatigue in World War II fliers. Aviat Space Environ Med 1987; 58:807-811.
16. Kirby DJ. A brief overview of the development of aerospace medicine in the United States. Aviat Space Environ Med. 2001; 72(10):940-7.
17. Lam, D.M. To pop a balloon: Aeromedical evacuation in the 1870 siege of Paris. Aviat Space Environ Med. 1988; 59:988-991.
18. Link, M.M. and H.A. Coleman. Air Evacuation Mission. In: Medical Support of The Army Air Forces In World War II. Washington, DC: Office of the Surgeon General, USAF, 1955;pp.352-418.
19. Lyons, T.J and S.B. Connor. Increased flight surgeon role in military aeromedical evacuation. Aviat Space Environ Med 1995; 66(10):927-929.
20. Mabry, E.W., R.A. Munson and L.A. Richardson. The wartime need for aeromedical evacuation physicians: The U.S. Air Force experience during Operation Desert Storm. Aviat Space Environ Med 1993; 64:941-6.
21. Manning, Treg. The Helicopter in Air Medical Service. Bell Helicopter. http://www.bellhelicopter.textron.com/content/encyclopedia/applications/ems/airMedBook/index.html
22. Meier DR, Samper ER. Evolution of civil aeromedical helicopter aviation. South Med J. 1989; 82:885-891.
23. Neel, S. Army aeromedical evacuation procedures in Vietnam. JAMA 1968; 204(4):99-103.
24. Olsen CJC. Patient Movement in the Pacific Theater: Changing the Strategic Focus From Airplane to Patient. Military Medicine. 2001; 166(5): 389-393.
25. Phillips, R.T., C. Conaway, D. Mullarkey and J.L. Owen. One year’s trauma mortality experience at Brooke Army Medical Center: Is aeromedical transportation of trauma patients necessary? Mil Med. 1999; 164(5):361-5.
26. Sanger, A. and P. Stoner. Global Aeromedical Evacuation. In: Flight Suregon’s Guide. Ed. by D.M. O’Brien. Pp. 19-1~19-32. USAF School of Aerospace Medicine, Brooks AFB, TX. 1995..
27. Sheehy, S.B. The evolution of air medical transport. J Emerg Nurs. 1995; 21(2):146-8.
28. Ternus M. Bosnia and Kosovo: aeromedical evacuation in the initial stages of deployment. Aviat Space Environ Med. 2001; 72: 357-360.
www.merginet.com/tgp/1996/9608/aeromed.shtml
29. 兵役法。民國八十九年二月二日修頒。總統 (89) 華總一義字第 8900028450 號令。
30. 吳怡昌。美空軍航太醫學校1998年國際航醫高級班完訓報告。國防部軍醫局，民國87年07月。
31. 徐南麗：航空護理學。大學圖書出版社發行。
32. 空軍總司令部。空中傷患後送航空護士手冊。80年5月31日頒行。
33. 衛生署：八十九年主要死因之統計結果。
www.doh.gov.tw/todaynews/900608/welcome.htm
34. 金門縣現住人口數性別及年齡分類。金門縣政府八十九年底縣政統計資料。
www.kinmen.gov.tw/stat/stat.aspx