2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649733摘要：緊急醫療系統(EMSS)銜接醫療，衛生與公共安全三大領域，攸關公眾健康與醫療事故緊急應變的樞紐，提升其品質是不容忽視的議題。到院前心跳停止病患(OHCA)的存活率，最能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格式來研究OHCA流行病學，評估緊急醫療系統成效。Utstein格式包括病患因素，事件因素，現場急救因素，以及預後，可比較不同EMSS急救復甦成效。透過網頁介面與網路的速捷，可同時多後端(橫跨衛生及消防系統)資料上傳、查詢、監測、與長期追蹤個案預後，建立EMS資料的整合架構。網路化OHCA登錄追蹤系統，可減少原本含消防、醫院、及管理人員重複抄寫或輸入資料與往返寄送紙本檔案之困擾。本團隊自2008年起，已成功建置Utstein格式「網路化OHCA登錄系統」並自2010年6月於台北市正式使用。國際經驗顯示，政府或公共衛生健康照護單位應建立EMS品質管理與評估架構，藉由指標數據監控、分析、追蹤，達到品質管理與提昇目標。而因OHCA復甦存活可作為評估緊急醫療系統的重要依據，因此，建置OHCA復甦品管評估架構，開發新指標偵測，優化復甦資源配置，可作為「緊急醫療品質管理」的最重要依據與主體。本研究計畫欲建置OHCA急救執行成效e化評估、監測、警示、與品質管理系統，研發復甦品質新的數位偵測技術，與規劃最即時救治的公眾去顫，對公眾健康緊急醫療的發展與提昇，至為樞鑰。本計畫為參年度之連續計畫，以本研究團隊已建立的「網路化心跳停止病患(OHCA)登錄系統」為基礎，(1)研發與擴充e 化品質監測及效能管理之實務應用(Cardiac ArrestRegistry e-Quality System - CAREQ)：重點在設計EMS 緊急醫療系統OHCA 病人急救復甦執行成效之e 化評量系統，研發並建置EMS 系統OHCA 病人復甦執行成效圖型化監測與警示系統，與EMS 救護隊的效率評估系統。除持續前瞻式長期登錄追蹤病案，並應用前述研發之各項評量、監測、警示、與效率評估等品質管理核心技術，整合性建置於「網路化OHCA 登錄系統」，提昇此登錄系統更即時有效的e 化監測與策略管理。(2)研發電腦影像感測技術，創新應用於評估到院前心肺復甦品質：目前尚缺乏方便有效的技術評現場或救護車內的急救復甦品質，運用Kinect 等技術研發心肺復甦影像偵測品質技術，結合OHCA 登錄系統的實證預後資料，創新分析救護車中復甦品質與患者預後的影響。(3)優化公眾去顫系統：結合OHCA 登錄系統資料，分析本地可電擊去顫患者猝死的好發場所與位置，應用地理資訊系統空間分析與相關統計工具，以優化本地公眾早期去顫系統(PAD)場所之設計與規劃。<br> Abstract: Emergency Medical Service System (EMSS) is critical to public health system acrossthree major dimensions including medical care, health, and public safety. The continuousquality assurance of EMSS should not be overlooked. The survival of out-of-hospital cardiacarrest (OHCA) could mostly reflect the level of EMSS in a community. Currently the UtsteinStyle format composed of patient, event, prehospital emergency care characteristics, andoutcome is widely utilized for international OHCA researches, EMSS evaluations andcomparisons among various EMSS.Web-based model for registry may facilitate timely recordings and improve dataaccuracy. It may save time that individual EMS healthcare providing unit could input optimaldata directly from end-user domain through web-links, without frequent or multilateralcommunications between each unit, and could retrieve the results easily. Our team hassuccessfully established an Utstein Style “Web-based OHCA Registry” system well runningonline since June 2010.The experiences from U.S indicated that government or health authority shouldimplement and maintain a quality evaluation system of EMSS, to achieve continuous healthquality promotion through monitoring, analyzing, and exploring the Key PerformanceIndicators (KPI). Resuscitation of OHCA is crucial to EMSS performance. An excellentquality evaluation system of OHCA resuscitation performance is the key to success for betterEMSS. Our proposal will be able to establish an e-quality system on OHCA web registry.This multi-functional e-quality web system will include performance evaluation, effectivenessmonitoring, early warning for deterioration, and prehospital care efficiency. ConstructingOHCA resuscitation quality framework, exploring EMS resuscitation KPIs, and optimizingthe resources are the cores for EMS quality management. In this project we intend to expandthe cardiac arrest registry to an e-quality system (CAREQ), to develop new frontiertechniques for CPR (cardiopulmonary resuscitation) computerized quality evaluation andperformance indicators, and to simulate PAD reallocations, the promising themes inenhancing public emergency healthcare.The proposing 3-year project is (1) to establish a web e-system of EMS quality andperformance integrated with Taipei OHCA Web Registry, and to expand its multi-functions toan e-quality system (CAREQ). The major tasks are designing an e-scoring system forresuscitation performance, establishing an e-SPC (statistical process control) system forperformance vigilance and early warning, and evaluating prehospital care efficiency for EMSmore instantaneous management and strategic enhancement; (2) to innovate motion detectiontechnology with video-based and depth camera-based analysis (Kinect) applying onprehospital CPR quality evaluation, that would be combined with CAREQ data to predictpatient survival; (3) to apply GIS (Geographic Information System) techniques and statisticsto optimize the scheme for Public Access Defibrillation (PAD) sites implementation.到院前心跳停止網頁登錄系統緊急醫療系統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) PerformanceMotion Detection AnalysisCardiopulmonary Resuscitation (CPR) QualityPublic Access Defibrillation (PAD)Geographic Information System (GIS)