緊急救護品管制度對於救護技術員急救表現及到院前心肺功能停止患者存活率之介入成效初探──以新北市政府消防局第五大隊為例

Intervention Effectiveness on First-aid Performance by Emergency Medical Technicians and rate of Pre-hospital Return of Spontaneous Circulation for Out-of-hospital Cardiac Arrest Using an Emergency Rescue Quality Control System : A case of the Fifth Emergency and Rescue Corps of the New Taipei City Government Fire Department

目的：本研究目的在於運用緊急救護品管制度找出救護技術員（EMT）實施CPR常見中斷大於10秒的原因及次數，並探討緊急救護品管制度介入後對於EMT急救表現及院前心肺功能停止（OHCA）患者於到院前存活率（ROSC）之成效。方法：本研究為橫斷性研究，運用緊急救護品管制度介入救護技術員的執勤流程。研究工具包含「新北市政府消防局電子化救護紀錄表」、「第五大隊緊急救護案件影像紀錄」，以及「第五大隊緊急救護案件AED紀錄」等3項數據。本研究採方便抽樣選取新北市政府消防局第五大隊2019年1月至5月及2019年9月至2020年5月到院前OHCA緊急救護案件資料進行分析。結果：EMT實施CPR常見中斷大於10秒的原因，次數最高的項目分別為AED分析、病患搬運，以及機械式CPR架設。緊急救護品管制度對於EMT急救表現在「CPR按壓品質」效果最為顯著，且能顯著提升OHCA患者到院前ROSC情形。結論：緊急救護品管制度可發現EMT實施CPR常見中斷原因及次數，介入救護技術員的執勤流程後，可改善EMT急救表現及提升OHCA患者到院前ROSC情形。本研究僅是短期研究成果，建議未來進行較長期的研究，進一步驗證緊急救護品管制度之介入成效。

Purposes: This study aimed to investigate the reasons and frequency of common interruptions of >10s in cardiopulmonary resuscitation (CPR) implementation by emergency medical technicians (EMTs) using an emergency rescue quality control system and explore its effect on the first-aid performance by EMTs and rate of pre-hospital return of spontaneous circulation (ROSC) for patients with out-of-hospital cardiac arrest (OHCA). Methods: In this cross-sectional study, the emergency rescue quality control system was used for the EMT operation procedures intervention. The research tools included the 'New Taipei City Government Fire Department's electronic emergency rescue records,' 'video records of emergency rescue cases of the fifth corps,' and 'automatic external defibrillator (AED) case records of the fifth corps.' This study used convenience sampling to select the data of pre-hospital OHCA emergency rescue cases from January to May 2019 and September 2019 to May 2020 from the fifth emergency and rescue corps of the New Taipei City Government Fire Department for analysis. Results: The reasons with the highest frequency for the interruption of CPR by EMTs for >10s were AED analysis, patient handling, and mechanical CPR set-up. The emergency rescue quality control system had the most significant effect on the 'CPR compression quality' of EMT first-aid performance and significantly elevated the rate of pre-hospital ROSC in patients with OHCA. Conclusions: The emergency rescue quality control system identified the common reasons and frequency of interruptions of CPR implementation by EMTs. After the operation procedures intervention, the EMT first-aid performance and rate of pre-hospital ROSC in patients with OHCA improved. This was only a short-term study; therefore, a long-term study is recommended to further validate the intervention effectiveness of the emergency rescue quality control system.