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題名 | Analysis of Prehospital ALS Cases in a Rural Community=鄉村到醫院前需高級救命術病例之分析 |
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作者 | 胡勝川; 高偉峰; 蔡哲宏; 陳啟華; 顏鴻章; 羅鴻彰; 李建賢; Hu, Sheng-chuan; Kao, Wei-fong; Tsai, Jeffrey; Chern, Chii-hwa; Yen, David; Lo, Hong-chang; Lee, Chen-hsen; |
期刊 | 中華醫學雜誌 |
出版日期 | 19960900 |
卷期 | 58:3 1996.09[民85.09] |
頁次 | 頁171-176 |
分類號 | 419.53 |
語文 | eng |
關鍵詞 | 高級救命術; 緊急醫療救護; 到醫院前救護; Advanced life support; ALS; Emergency medical services; EMS; Prehospital care; |
中文摘要 | 背景 儘管在現場從事高級救命術(ALS)是否對病人的預後有影響尚 無定論,很多國家仍然在發展包含可以從事ALS服務之醫佐員在內的緊急醫療 救護系統(EMS)。先前的研究顯示我國都會地區之需ALS服務的病例並不多。 鄉村的情形就不得而知。本研究的目的是在探討鄉下地區ALS的需求以及它的 早期預後,期於我國建立一全方位且符經濟效益的EMS。 方法 宜蘭的EMS係以消防人員出勤從事基本救命術的單層反應系統。一些 必要的資料都會輸入電腦。我們抽取1993年至1994年間ALS病例的資料做回 顧性研究,分析其到院時的感覺及出院時的預後。同時,年齡、性別、反應時 間、現場停留時間、運送時間以及究屬創傷或疾病引起者也一併分析。 結果 於二年研究期間共收集到11352例送醫的緊急醫療救護案件,其中594 (5.2%)例需ALS服務,包括211例到院前死亡(DOA)。DOA中103 (48%)例係創 傷引起。ALS和DOA病人之反應時間、現場停留時間、運送時間分別是5.5分、 4.7分、13.6分和5.6分、5.6分、15.7分。於211例創傷病例(佔ALS病例的55%), 交通意外事件佔96%。意識不清、胸痛或胸悶則佔疾病引起之ALS的90%。到 達急診室時,只有5%覺得病情變壞,然而出院時則有三分之一的病人之預後不 良。 結論 基於鄉村地區之特徵:ALS需求量極低、交通意外事件特多,反應時間 尚可、運送時間不長、極低的非創傷引起的DOA病例、不少的病人有不好的預 後,一個有別於美國、甚至不同於都市的獨特之EMS系統是必須的。一個大規 模的比較型的研究更有其必要。 |
英文摘要 | Background. An Emergency Medical Services (EMS) system containing the advanced life support (ALS) and manned with paramedics, is developing in many countries in view of the importance of prehospital ALS skills on ALS eligible patients, although previous studies have only revealed that a meager need for ALS in urban community. The purpose of this study is to understand the real demand of ALS in a rural community, so that a well organized and cost-effective EMS system can be developed in this country. Methods. An EMS system with a single tiered response configuration, using firefighters to give basic prehospital care, stored in computer with some necessary informations was established in Ilan County. Cases with ALS from January 1993 through December 1994 were retrieved from the computer. The ones truely eligible for ALS were reconfirmed and analyzed in terms of neurological outcome while discharging from hospital, sex, age, response time, time spent on scene, transportation time, as well as whether the cases were trauma or medically induced. Results. Of 11352 cases collected during 731 study days, 594 (5.28%) ALS eligible cases (including 211 DOA and 383 non-DOA) were studied. Of 211 DOA, 103 (48%) were caused by trauma. The response time, time spent on scene and transportation time in ALS and DOA cases were 5.5 min., 4.7 min., 13.6 min., and 5.6 min., 5.6 min., and 15.7 min., respectively. Of 211 cases of trauma (55% of total ALS cases), traffic accident accounted for 46%. Altered mental status and chest pain or tightness made of 90% of medical induced ALS cases. Five percent of patients felt worsening of condition during transit. One third of patients seemed to experience a bad outcome. Conclusions. Based on the characteristics of low demand for ALS services, more than half trauma-induced ALS cases, acceptable response time, short transportation time, extremely few medically induced DOA cases, and quite a poor outcome in the setting of limited prehospital care, a unique EMS system different from that in the United States or in the urban area is needed in the rural area. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。