消防機關執行OHCA患者到院前緊急救護之調查研究

A Study on Resuscitative Outcome of Out-of-Hospital Cardiac Arrest Patients－The Implementation Experience of the Fire Bureau of Taipei County

　　台北縣政府消防局自2008年起陸續成立專責救護隊，並配合試辦由17名取得高級救護技術員證照的高級救護技術員，希望對到院前心肺停止病患實施高級救命術，在取得預立醫囑情況下，於到院前的黃金時間，對病患進行電擊、給藥等侵入性治療，藉此增加到院前心肺停止患者的存活率。本研究根據台北縣政府消防局的救護資料庫和緊急救護紀錄表，分析在專責救護隊配置緊急救護技術員的境況下，消防機關執行到院前心肺停止患者的救護成效。
　　從實施一年多以來發現，台北縣政府消防局就到院前心肺停止病患的救活率與存活率，專責救護隊分別較一般消防分隊提昇了44％（30.89%對21.52%）與294％（3.74%對1.27%）；配置高級救護技術員對到院前心肺停止病患施行高級心臟救命術，病患的循環恢復率（34.4%對23.5%）、存活至住院率（18%對15.1%）與存活率（4.9%對1.8%），也明顯優於只施行基本救命術，成效斐然。專責救護隊對到院前心肺停止患者，提供了最適當的緊急救護人員搭配方式，提供經濟、有效的救護服務，提高患者到院前的自發性循環，創造患者存活到院的機會，是值得各縣市政府參考設置。

關鍵字：到院前心肺停止、緊急醫療救護系統、緊急救護技術員。

ABSTRACT

The Fire Bureau of Taipei County has piloted the idea of the designated ambulance crews coordinating with EMT-P to implement ACLS upon OHCA patients. This idea is implemented in order to increase survival rate of OHCA patients by executing electric shock or by offering medication therapy on them. The purpose of this study is to analyze the rescue effects and efficiency of OHCA patient rescued by the designated ambulance crews with EMT-P according to the rescuing database banks and emergency rescue record charts provided by the Fire Bureau of Taipei County. After more than one year’s practice, the designated ambulance crews of the Fire Bureau of Taipei County has upgrade 44% of their performance in comparison with the ordinary ambulance crews regarding the save rate and survival rate of the patients. It’s obvious that it’s more effective for EMT-P to implement ACLS to OHCA patients in comparison with the implementation of only basic life-saving actions in terms of ROSC, save rate and survival rate. Thus, it is highly recommended that this kind of rescue pattern executed by the designated ambulance crews in order to elevate the save rate and survival rate of OHCA patients should be adopted and followed by the other townships and city governments in Taiwan.