2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649381摘要：緊急醫療救護 (Emergency Medical Services Systems, EMSS) 的目的，在於減少因為急重症造成的死亡與失能。不但是民眾遭遇緊急傷病的第一道防線，也是進步國家的象徵。許多緊急醫療重要傷病的確切治療 (definite care)， 都有所謂的「黃金時間(golden period」。一旦病患在超過「黃金時間」後才抵達醫院，其所能接受確切治療治療的方式會受到限制，預後也會截然不同。在這些非常具有救護時效性的急症當中，又以「急性腦中風」、「急性心肌梗塞」、「重大創傷」三者，在實證醫學上的治療黃金時間，以及確切治療的內容都相當明確。現代以「以病人為中心」的緊急醫療救護系統，應該實行區域化(regionalization)的運作策略，包括「醫院分級(hospital categorization」與「到院檢傷(prehospital triage)」，根據病患的病情，決定送醫的對象與時效，才可以縮短治療時間，使病患在「黃金時間」內接受確切的治療，增進其預後。腦中風，心肌梗塞以及重大創傷等三大急症，對於國人健康的重要性與日俱增。緊急醫療體系必須對這些急症，結合到院前救護與到院後醫療，進行區域化運作的趨勢，活化資源，提供即時的確切醫療。本研究將針對台北緊急醫療網中，三大急重症的的EMS 區域化運作與到院前檢傷，進行為期三年，多面向的整體評估研究，以期對我國EMS 在相關三大重症的區域化運作，能夠提出完整藍圖與前瞻性的規劃。本研究的目的如下:1. 結合到院前救護與到院後醫療資訊，建立網路化緊急醫療網三大急重症(腦中風、重大外傷、心肌梗塞)之區域化運作病患資料庫。2. 評估相關區域化措施，包括醫院分級與到院前檢傷，對於三大重症的救護時效性，治療過程與預後的影響。3. 評估三大重症到院前檢傷工具的正確性。4. 發展適當的本土化院前檢傷與後送模式。5. 評估民眾對於相關重症啟動緊急醫療體系與繞道政策的觀點。<br> Abstract: The purposes of emergency medical services systems (EMSS) are to reduce thedeath and disability from acute illness and trauma. Such strong communitysafetynets only exist in modern and progressive societies. For certain life-threateningconditions and time-critical conditions, the definitive therapies must be deliveredwithin certain ‘golden period’. If the patients arrive at the hospital longer than suchperiod, the possibility of receiving desired definitive therapies will be limited, and theoutcomes would be impaired.Cerebral vascular accident (CVA), acute myocardial infarction (AMI), and majortrauma are the three acute conditions among EMS service with evidence-based andwell-defined definitive therapy that have to be rendered with the ‘golden treatmentperiod’. Recognizing this, modern EMSS must implement regionalization measures,including hospital categorization, and prehospital triage, to match communityresources to patient needs, and to shorten the time between sympom onset anddefinitive treatment.In recent decade, CVA, AMI and major trauma have become the leading causes ofmortality and morbidity in Taiwan. EMSS alike are required to become‘regionalized’ to provide more timely, definitive care to these acute conditions in thecommunityWe therefore propose a three-year study to provide a comprehensive,multi-disciplinary assessment of the regionalized EMS on Cerebral VascularAccidents, Acute Coronary Syndrome, and Major Trauma in Taipei with the followingobjectives:1) to build a web-based information system that combines both prehospital andhospital information on the performance of regionalized care of CVA, AMI andmajor trauma in Taipei;2) to assess the impact of regionalization on the timeliness, processes, and outcomesof care for CVA, AMI and major trauma in the community;3) to evaluate the predictive value of current prehopsital triage tools deployed forCVA, AMI and major trauma;4) to develop triage rules and transport mechanisms based on demographics andsystem characteristics of the community; and5) to assess the awareness and knowledge of EMSS utilization, triage, and bypasspolicy for acute conditions in the community緊急醫療救護系統區域化運作到院前檢傷腦中風心肌梗塞重大創 傷到院前十二導程心電圖Emergency Medical ServicesRegionalizationPrehospital TriageCerebral vascular accident (CVA)acute myocardial infarctionmajor traumaprehospital 12-lead electrocardiography