2015-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646373摘要：緊急醫療救護，可以減少因為急重症造成傷病患的死亡與失能。救護員可提供傷病患最重要的急救之一，即是到院前呼吸道的處置、可分為下列兩種：基礎呼吸道與進階呼吸道。進階呼吸道的好處在於能提供一個確定的給氧方式、於長時間搬運時減少缺氧的發生。然而建立進階呼吸道也有潛在問題，例如未被察覺的食道插管、管路移位、以及多次插管所造成的急救中斷。針對猝死傷病患，最佳的到院前呼吸道的處置策略目前尚未定論。欲探討進階呼吸道對病患存活的影響，有兩點干擾因子最需釐清。第一是「進階呼吸道技術的純熟度」、第二是「進階呼吸道是否能良好固定」。本研究為期二年，採用「資料庫分析」及「臨床試驗」兩種方式來釐清上述問題。前者經由台北市Utstein‐style 猝死傷病患登錄系統，分析不同到院前呼吸道處置對傷病患存活的影響。後者包括兩項介入性試驗：其一是經由救護員定時插管複訓，探討「首次插管成功率」的變化。其二是經由救護員使用延伸蛇管，檢視「進階呼吸道良好固定率」的變化。之後再度進行分析，比較二項介入前後「不同到院前呼吸道處置」與「病患存活」的關係。研究結果將能尋找出適合我國緊急醫療救護體系的最佳到院前呼吸道處置策略，進而提升社區猝死傷病患的急救成效。<br> Abstract: Emergency medical services (EMS) are developed to prevent the death and disabilityfrom injury and acute illness and to promote patient well-being. The most importantintervention provided by emergency medical technicians (EMTs) is the prehospital airwaymanagement, which can be divided into basic airway management and advanced airwaymanagement. Establishment of prehospital advanced airway provides a confirmed andsecured airway for critical patients; however, the process might threaten patients’ outcome ifunrecognized misplaced device or multiple attempts occurred.The best strategy of prehospital airway management is still under debated. Two majorconfounding factors must be controlled to examine the effect of advanced airway on patients’survival. One is the operating familiarity of advanced airway by EMTs, and the other is thecorrect fixation of established advanced airway during ambulance transport.We aimed to examine the causal relationship between advanced airway and patients’outcome through three steps. Firstly we will analyze Utstein-style registry database ofout-of-hospital cardiac arrest (OHCA) in Taipei to find out which kind of airway managementassociated with the better patients’ outcome. Then we will carry out two interventions toenhance the EMTs’ skills of advanced airway and to avoid the dislodgement of establishedadvanced airway by applying an extended tube. The effects of these two interventions will beevaluated by different endpoints respectively. Finally, after optimization of EMT’s skill andprocess of fixation of advanced airway, we will re-examined the causal relationship betweenadvanced airway and patients’ outcome, comparing the before- and after- period of the twointervention.Expected results from this study can figure out the best strategy of prehospital airwaymanagement in our own and worldwide EMS with similar configuration, therefore find outthe promising chance to improve outcomes of patients with OHCA.緊急醫療救護系統救護技術員呼吸道處置到院前心肺功能停止高級救 命術emergency medical services (EMS)emergency medical technicians (EMTs)out-of-hospital cardiac arrest (OHCA)airway managementadvanced life support (ALS)