影響空軍救護人員到院前救護知識 ; 、技術之相關因素

1. 影響空軍救護人員到院前救護知識;、技術之相關因素影響空軍救護人員到院前救護知識;、技術之相關因素 • 國軍醫療體系平時維護官兵健康，儲備戰力維繫士氣，戰時則扮演戰傷救護之重要角色，但現行衛生部隊擔任救護重要角色之醫官，均剛自醫學院畢業，臨床經驗不足，且面臨現行人力嚴重短缺，訓練不足情況下，更遑論處理大量傷患支援國軍作戰，加上近年組織調整朝「募兵制」規劃，在無法招募足夠醫師情況下，救護技術員替代醫師擔負部隊緊急救護工作，必成為國軍醫療體系須積極因應的問題，故本研究目的在瞭解空軍救護人員到院前救護知織與技術現況、比較現行救護技術員與醫官救護知織與技術之差異以及影響救護人員救護知識與技術之相關因素。本研究為橫斷式量性研究，以空軍衛生部隊尉級(含)以下為研究對象，研究工具採自填式結構問卷及學科、術科測驗，問卷以Likert量表五點尺度衡量，經信度及效度檢定後，自民國97年11月2日至98年2月2日收案，共收集267份有效樣本，回收率78.5%，所得研究以spss12.0版統計套裝軟體進行平均值、標準差、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關及複迴歸等統計進行資料分析。結果發現，中級技術員及醫官在知識表現(學科成績)優於初級技術員；中級技術員在總技能(術科成績)亦表現最佳，初級技術員次之，醫官再次之，另救護人員對到院前救護之需求，在體制部份以「訓練經費投入」排名第一，其次為「訓練器材投入」，而在訓練部份以「訓練技術」排名第一，其餘依序為「訓練器材操作」及「學理知識教授」；對到院前救護之認知上，體制部份以「救護評比」排名第一，其次為「訓練經費投入」，而在訓練部份以「訓練器材操作」排名第一，其餘依序為「訓練技術」及「學理知識教授」。受測人員之技術(術科成績)與知識(學科成績)成相關(β=0.10，t=2.91， p<0.01)，而影響知識(學III科成績)之顯著變項，在教育程度為研究所(β=13.60，t=4.42， p<0.001)，在救護組別為264小時授課時數(β=14.84，t=5.44， p<0.001)；另外影響術科測驗成績之顯著變項為有臨床經驗(β=-9.69，t=11.2, p<0.001)，在救護組別為264小時授課時數(β=0.10，t=2.91， p<0.01)。整體而言，教育程度越高、接受救護課程訓練時數越多者，學科表現較佳。接受救護課程訓練時數越多者，技能(術科成績)亦表現較優，但具臨床、急診實習經驗及各類急救證書(ETTC、APLS、ACLS)人員，在到院前術科成績反而相對表現不佳。故建議服役之醫學系畢業學生，於衛生勤務學校施訓時，宜增加到院前救護課程時數與實作，以滿足衛生部隊之需求，另因應未來體制變革，部隊仍應投入訓練經費及器材，透過持續教育以補強救護知識與技術之不足。

2. The Factors Affecting Air Force Emergency Medical Service Members’ Pre-hospital Care Knowledge & Skills • Armed forced medical service system maintenances soldiers’ health in peacetime, but it could play an important role of rescuing the wounded in wartime. However, those young military medical doctors who always take the important role of first aid just graduated from medical school and had inadequate clinical experience Actually, under the shortage of human resources and without appropriate training, the contribution of young military medical doctors would be quite limited in the war. Moreover, the structure of military organization will be adjusted toward mercenary system recently, so the volume of medical doctors will not be enough to serve as emergency care. At that time, Emergency Medical Technician (EMT) will replace medical doctor’s roles . Thus, objectives of this study were 1) to investigate pre-hospital emergency care knowledge and skills in Air force emergency medical service members, 2) to compare the pre-hospital emergency knowledge and skillsbetween EMT and medical doctor, and 3) to probe related factors of affecting pre-hospital emergency knowledge and skills .This was a cross-sectional study. The study population is members of military rank under lieutenant in medical division of the air force. The study tools assessed by reliability and validity were including self-conducted structured questionnaire, knowledge, and skill tests. 267 effective samples were collected during Nov. 2 in 2008 and Feb. 2 in 2009. The response rate was highly reached 78.5%. The data were analyzed by means, standard deviation, independent sample t test, one-ANOVA, Pearson correlation and multiple linear regression through SPSS software.In results, EMT-Ⅱs and medical doctors had better knowledge scores than EMT-Ⅰs. EMT-Ⅱs had a better skill performances than EMT-Ⅰs and medical doctors. At the system aspect of pre-hospitalVemergency care training needs, the first was training costs investing and the second was training equipments adding. At the training aspect of it, the first was skill training, and the others were training equipment using and knowledge teaching. At the system aspect of pre-hospital emergency care recognition, the first was emergency care examining, and the second was training costs investing. At the training aspect of it, the first was training equipment using, and the others were skill training and knowledge teaching. Skill performance was positively correlated with knowledge score(β=0.10，t=2.91， p<0.01). Knowledge score was significantly correlated with the variables, graduate degree(β=13.60，t=4.42， p<0.001) and 264 hours training course(β=0.10，t=2.91， p<0.01). Skill performance was significantly correlated with the variables, clinical experience(β=-9.69，t=11.2, p<0.001) and 264 hours training course(β=0.10，t=2.91， p<0.01).。In conclusion, knowledge score was better in samples having higher education degree and more hours of emergency training course. Skill scores were also better in samples having more hours of emergency training course. However, people experienced in clinical and emergency practical training and owned licenses (ETTC, APLC, ACLS) would have worst performance in skill tests. Thus, we suggested that adding the hours and practical exercises of pre-hospital emergency care training courses for medical doctor in the sanitation duty branch in Army Logistics School. In order to satisfy the demand of medicine division of the Air Force. Because the system will be improved in the future, the Armed forced medical service system must invest training costs and equipments and strengthen emergency care knowledge and skills through the continuing education.