2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649462摘要：腦視覺分析，與公眾去顫系統可近性探討- 到院前心跳停止登錄系統的持續應用緊急醫療系統(EMSS)聯結包括醫療，衛生與公共安全三大領域，為銜接公眾健康與傷病緊急應變的樞紐，而到院前心跳停止病患(OHCA)的存活率，則反應一個社會緊急醫療照護的整體水準，目前國際間均以標準Utstein格式來分析OHCA流行病學以評估緊急醫療系統成效。本團隊自2008年起建置Utstein格式「網路化OHCA登錄系統」，運用網頁與網路速捷，銜跨多端資料上傳、查詢、監測、長期追蹤個案預後，建立EMSS資料整合架構與模式，減少原本含消防、醫院、及管理人員重複抄寫或輸入資料及往返寄送紙本之困擾。此登錄系統自2010年6月於台北市正式使用，至今也提供給其他四大都會使用，成功達成智慧平台資源共享，也促進其他地區EMS的發展。公共衛生健康照護體系應建立EMS品質管理與評估架構，而OHCA復甦成效可作為評估EMSS的依據，因此，建置OHCA復甦品管架構，開發新偵測指標，優化復甦資源配置，研創儘早急救的機制，可作為「EMS品質管理」的重要依據與主體。據此，本研究計畫設計涵蓋以下面向：優化緊急救護調度，創新視訊輔助報案，評估OHCA復甦新治療的效益，研發自動化復甦品質評估技術，與探討公眾去顫系統的策略部署，對於公眾健康緊急醫療的提昇，應屬樞鑰。本計畫申請規劃為參年度之連續計畫，以研究團隊已建立的「網路化心跳停止病患(OHCA)登錄系統」流行病學資料為基礎，延伸研發以下四項主軸：(1) 優化緊急救護調度：重點為設計派遣調度員指示旁觀者對OHCA 儘早進行復甦之流程系統，建置社區與社群網絡志願群以協助調度員指示CPR，提升旁觀者儘早復甦率；創新研發並建置視訊實境輔助救護報案系統- 對OHCA 與急重症患者儘早辨識與復甦。(2)評估復甦新治療的效益：重點為對體外心肺復甦(ECPR)與治療性低溫療法(TH)兩項治療技術，研究其對於OHCA 存活的影響與效益。(3)創新研發自動化復甦品質評估技術，應用於到院前心肺復甦品質評估：運用電腦視覺偵測技術開發可對影像資料進行復甦品質自動化評估的軟件，據以評估傳統CPR 與自動CPR 機復甦品質與差異，進而結合OHCA 登錄實證資料，創新分析救護車中復甦品質對患者預後的影響。(4)探討公眾去顫系統(PAD)的可近性：應用地理資訊系統空間與時間分析工具，結合OHCA 登錄之實證資料，研究垂直向度空間與PAD 可近性的關係，與對OHCA 存活的影響。<br> Abstract: Emergency Medical Service System (EMSS) is crucial to public health system across threemajor dimensions- medical care, health, and public safety. The survival of out-of-hospitalcardiac arrest (OHCA) could mostly reflect the level of EMSS in a community. Currently theUtstein format is widely utilized for international OHCA outcome evaluations. Our teams hasestablished an Utstein format “Web-based OHCA Registry” for Taipei in 2008, successfullyrunning online since 2010, that may timely record and improve data accuracy. IndividualEMS unit could input data directly from end-user domain through web-links, without frequentor multilateral time-consuming communications between units, and retrieve the results easily.Until today four other major cities (Tao-Yuan, Tai-Chung, Tai-Nan, Kao-Hsiung) has joinedthe registry and run well. We have achieved a platform sharing with EMS innovations andresources, which may enhance regional EMS development.The government health authority should maintain a continuous quality improvement of EMS,and explore the Key Performance Indicators (KPI). An excellent quality evaluation system ofOHCA CPR resuscitation (Resus) performance is the key for better EMS. ConstructingOHCA Resus quality framework, exploring EMS Resus KPIs, optimizing the resources, andinnovating early CPR technics are the cores for future EMS quality management. Therefore inthis project our researches will be focused on optimizing Emergency Medical Dispatch (EMD)and innovating an immersive videotelephony call system (iDispatch), assessing new CPRskill’s impact, automating CPR quality motion analysis, and analyzing spatial and temporalaccessibility of Public AED (automated external defibrillator) in vertical dimension toenhance early Resus performance.In conjunction with the community database from OHCA registry, this designated 3-yearproject is (1) to optimize EMD process, to initiate community and social network system fordispatch-assisted volunteer CPR team, and to innovate an immersive videotelephony dispatchsystem, which may early recognize cardiac arrest and critically ill or injured patients toimprove call-to-chest compression time for OHCA and rapid response for certain criticalsituations; (2) to assess the impact and effectiveness of advanced health technology includingECPR and therapeutic hypothermia on OHCA survival, and the cost-effective analyses; (3) todevelop an automated computerized CPR quality motion analysis system, to compare CPRquality for both manual and mechanical device CPR during ambulance transport, and toevaluate its impact on patient survival; and (4) to analyze Public AEDs for their spatial andtemporal accessibility especially in vertical dimension consideration, by utilizing dynamicGIS technology, in order to enhance early resuscitation performance and rapid publicresponse for emergency healthcare.到院前心跳停止網頁登錄系統緊急醫療系統緊急救護調度視訊報案影像感測心肺復甦品質公眾去顫地理資訊系統Out-of-hospital Cardiac Arrest (OHCA)Web RegistryEmergency Medical Service (EMS) PerformanceEmergency Medical DispatchVideotelephonyMotion Detection