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研究生:林昱銘
研究生(外文):Yu-Ming Lin
論文名稱:國人國際空中轉診之流行病學研究
論文名稱(外文):Epidemiology of Taiwanese internationally aeromedical transported
指導教授:蔡行瀚蔡行瀚引用關係
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:傷害防治學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:104
中文關鍵詞:空中轉診流行病學傷害防治
外文關鍵詞:epidemiologyaeromedicalinjury prevention and control
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背景: 近年我國出國人數日漸增多,1980年約48萬人次,1990年約294萬人次,2000年為732萬人次,2007年已達896萬人次,超過我國總人口數的三分之一。國人出國在海外一定會發生醫療狀況,但其流行病學迄今無專業之研究,殊為遺憾,本研究係首次探討國人自海外空中轉診回國之流行病學研究。

方法: 本研究資料,取自國際SOS台北警報中心的熱線及電腦登錄資料,從2005年10月至2007年9月兩年間。使用EXCEL軟體以及SPSS軟體,做敘述性統計分析。

結果: 兩年中空中轉診的資料,共計390航次(416人次)。扣除外國人轉出台灣以及兩階段轉診的病患,國人實際使用空中轉診共計有376航次(379人)。男性病患271人(72%),女性108人(18%);季節分析以秋季最多共105人(28%);返國的地理區域以亞洲區356人(94%)最多,其中大陸空中轉診返國的人數有295人(78%),位居第一;年齡層分析,以46~60歲人數佔最多,有159人(43%),以0~15歲人數最少,有5人(1%);疾病分類顯示非外傷的病患人數為215人(57%),外傷的病患人數為164人(43%);其中內科211人(56%),外科164人(43%),婦產科0人(0%),兒科4人(1%),與國內急診之疾病分類比例有顯著之差異,而神經內科病患總共有113人(30%),為所有科別中最多的一科;使用兩岸直航醫療包機共有51人(13%);使用呼吸器的病患有33人(9%);以病患登機方式分析,使用擔架有233人(61%),使用輪椅有146人(39%);所有病患中,參加民間保險之海外急難救助或旅遊平安險佔大多數,共321人(85%),自費個案則有58人(15%)。

結論: 本研究是第一篇關於國人海外國際空中轉診的流行病學研究,由於國人每年出國的人數日益增多,相關研究更值得重視。國際空中轉診因為牽涉到國外之醫療品質、民間醫療保險以及其他相關的法規,我國之醫療品質平均高於其他國家,又因實施全民健康保險,可說是物美價廉,故國人在海外罹患疾病或發生意外時,均希望能盡速空中轉診回國。本研究結果顯示,國人出國約八成前往中國大陸,大陸之醫療品質落後我國甚多,早期兩岸因政治問題,空中轉診相當困難,相關資料亦付之闕如,近年來已逐漸開放,國人國際空中轉診流行病學的資料亦較為確實。未來如何導入傷害防治學觀念,例如全天候24小時提供遠距醫療諮詢的服務機制,協助解決國人海外緊急醫療問題,為本研究主要的建議。
Background: There are more and more people going abroad in recent years in Taiwan. The number was approximately 480,000 people in 1980, 2,940,000 in 1990, 7,320,000 in 2000, and in 2007 the number has reached 8,960,000, has been over one third of our total population. Medical problems in the people who travel abroad are inevitable. There is no related study of the epidemiology. This is the first report to discuss the epidemiology of Taiwanese internationally aeromedical transported.

Method: All materials are taken from the document of International SOS in Taipei alarm center. The period of study is from October 2005 to September 2007. The data are analyzed by EXCEL software and SPSS software.

Results: In two years, the epidemiology of Taiwanese internationally aeromedical transported had 390 voyage
numbers (416 people). Excluding the foreigners transported from Taiwan and two-stage transporters, the people using the international aeromedical transported were 376 voyage numbers (379 people). There were 271 male patients (72%) and 108 female patients are 108 (18%). Most of the patients (295, 78%) were transported from China to Taiwan. There were 105 patients transported in autumn, which is the peak of four seasons. The age of patients revealed that the age between 46-60 y/o (159, 43%) was the largest population. Patients suffered from trauma were 164 people (43%) and non-trauma were 215 people (57%). Disease classification showed that neurology accounted 113 people (30%) is in first place. There were 33(9%) patients using ventilators. The model of transportation revealed 233 (61%) with stretchers and 146 (39%) with wheel-chairs. There were 51 patients (13%) transported with chartered air ambulance. Among all of these patients, 321 (85%) were covered with commercial insurance and 58 (15%) were private cases.

Conclusion: This is the first study about the epidemiology of Taiwanese internationally aeromedical transported. Relevant researches are more and more important due to the increasing numbers of people going abroad in Taiwan. Information collection was very difficult in previous time due to the quality of medical service in foreign countries, the policy of medical insurance, and related laws and regulations. The quality of medical service in Taiwan is higher than other countries. However the price is relatively lower due to proceeding National Health Insurance Taiwan. Therefore, Taiwanese suffering from either disease or accident in foreign countries were willing to come back to Taiwan as soon as possible. Our study demonstrated that 80% of the Taiwanese travelers went to mainland China. The medical quality in most regions of China is lower than it is in Taiwan. In addition, the political issues cause the aeromedical transports more difficultly. For the purpose of injury prevention and control, we suggested that providing 24-hours telemedicine consultation may help the Taiwanese patients going abroad.
第一章 研究的動機與背景...........................1
1-1 國人出國趨勢概況 ..................................1
1-2 國人出國位置之地理分佈.............................1
1-3 各國醫療費用探討...................................2
1-4 傷病患後送的起源...................................6
1-5空中傷病患後送發展史...............................7
1-6 我國空中傷病患後送系統發展史......................11
1-6-1 空中救護隊..................................11
1-6-2空軍第六聯隊第六醫務中隊....................12
1-6-3 交通部民航局航空隊..........................13
1-6-4 內政部警政署空中警察隊......................14
1-6-5 民營直昇機專業航空公司......................14
1-6-6 國際醫療救援組織............................15
1-6-7 內政部消防署空中消防隊......................15
1-6-8 內政部空中勤務總隊..........................16
1-7 我國空中緊急醫療救護人才之培育....................17
1-7-1 空勤醫務士官訓練班..........................17
1-7-2 航空護士訓練班..............................17
1-7-3 航空醫官訓練班..............................18
1-7-4 直昇機救護訓練課程..........................18
1-7-5 航空醫師與航空護士訓練課程..................19
1-7-6 高級救護員訓練課程..........................19
1-7-7 國際SOS空中轉診訓練課程....................19
1-7-8 急診醫學會空中轉診訓練課程..................20
1-7-9 航空醫學會航空醫學專科醫師制度..............20
1-8 空中傷病患後送制度................................21
1-9 我國空中傷病患後送制度............................21
1-10 行政院衛生署空中轉診審核中心之建制與成效.........22
1-11 國際SOS緊急醫療救援組織簡介.....................23
1-12 國際SOS緊急醫療救援組織在台灣的發展.............26
1-13 國際SOS緊急醫療救援組織提供之服務...............26
1-13-1 海外人身安全服務...........................27
1-13-2 第二醫療專家意見...........................27
1-13-3 病患照護計畫...............................28
1-14 研究動機.........................................28
第二章 文獻回顧..................................30
2-1 研究空中緊急醫療救護制度之文獻…..................30
2-2 研究轉入醫療機構之文獻............................30
2-3 研究轉出醫療機構之文獻............................31
2-4 研究特定地理環境區域之文獻........................32
2-5 研究提供飛行載具的機構(單位)之文獻................32
2-6 研究國際轉送之文獻................................34
2-7 研究離島地區空中醫療轉送之文獻....................35
2-8 研究建立國家空中緊急醫療諮詢制度之文獻…..........36
2-9 其他參考文獻......................................36
第三章 材料與方法................................40
3-1 研究材料..........................................40
3-2 研究資料蒐集期間..................................40
3-3 研究對象..........................................40
3-4 國際空中轉診方式..................................40
3-5 國際空中轉診作業流程..............................41
3-6 國際空中轉診轉送方式..............................41
3-7 國際空中轉診所使用的工具..........................42
3-8 研究方式..........................................42
第四章 研究結果......................................43
4-1 人數統計分析......................................43
4-2 性別統計分析......................................44
4-3 季節統計分析......................................44
4-4 地理區域統計分析..................................45
4-5 年齡層統計分析....................................45
4-6 病患疾病分類統計分析..............................45
4-7 由大陸空中轉診回國之資料分析......................46
4-8 醫療包機返國資料分析..............................46
4-9 病患使用呼吸器資料分析............................46
4-10 病患登機方式統計分析.............................47
4-11 自費個案統計分析.................................47
第五章 討論...........................................48
5-1 性別之分析討論....................................48
5-2 季節之分析討論....................................49
5-3 地理環境之分析討論................................50
5-4 年齡之分析討論....................................52
5-5 外傷及非外傷病患之分析討論........................53
5-6 疾病分類之分析討論................................54
5-7 神經科疾病之分析討論..............................55
5-8 大陸空中轉診返國之分析討論........................56
5-9 兩岸醫療包機直航之分析討論........................56
5-10 使用呼吸器之分析討論.............................58
5-11 病患登機方式之分析討論...........................58
5-12 自費包機空中轉診資料之分析討論...................59
5-13 轉送方式之分析討論...............................59
第六章 結論.........................................61
第七章 參考文獻.....................................62
附表...............................................69
表一..................................................69
表二..................................................70
表三..................................................71
表四..................................................72
表五..................................................73
表六..................................................73
表七..................................................73
表八..................................................74
表九..................................................74
表十..................................................75
表十一................................................77
表十二................................................77
附圖...............................................78
圖一..................................................78
圖二..................................................79
圖三..................................................79
圖四..................................................80
圖五..................................................81
圖六..................................................82
圖七..................................................83
圖八..................................................84
圖九..................................................85
圖十..................................................85
圖十一................................................86
圖十二................................................86
圖十三................................................87
圖十四................................................87
圖十五................................................88
圖十六................................................88
圖十七................................................89
圖十八................................................89
圖十九................................................90
圖二十................................................90
圖二十一..............................................91
圖二十二..............................................91
圖二十三..............................................92
圖二十四..............................................93
圖二十五..............................................94
圖二十六..............................................95
附錄...............................................96
附錄表一..............................................96
附錄表二..............................................99
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