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Abstract

The educational value of radiation for emergent medical staff under radiation accident management center (RAMC): experience of KMUH.

victoria-randolph
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Abstract

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  1. The educational value of radiation for emergent medical staff under radiation accident management center (RAMC): experience of KMUH Yu-Wen Chen1,2, Yin-Feng Huang1,2 , Yung-Chan Lai1,2, Po-Shue Chang1,3, Shan-Bin Jong1,2, Tzeng-Chih Lin1,4, Han-Wen Chen1,4. Radiation accident management center (RAMC) 1, department of nuclear medicine2, radiation oncology3, emergency4, Kaohsiung medical university, Chun-Ho memory hospital (KMUH), Kaohsiung, Taiwan

  2. Abstract • Radiation accident management center (RAMC) of KMUH was established under support of Tai-Power Company since 1996. There are two major setup steps of center: (1) hardware setup, including architecture, instruments etc. (2) software setup, such as membership training and education. As we know, department of emergent medicine is an entrance of hospital. When the accidence occurred, emergent medical staff is the first-line member who will face and manage the issue. Consecutive education is definitely important! In this article, we will review the past educational programs and evaluate the value. Methods: At beginning of program, there were about twenty members including different specialist of medical doctors and nurses, such as emergency, nuclear medicine, radiation oncology, hematology, orthopedic and radiation safety official who had received short-course of training in Oak ridge, USA. All of them become training trainer in future. During past years, we arranged several training courses, twice per year, in our hospital and even extended to the hospitals in Ping-Tong County from the third year of project. Education programs were focus in basic introduction of radiation, radiation biology, radiation prevention, emergent management of acute radiation syndrome (ARS), and decontamination of patients. Small- scale rehearsals were held independently. Results: (1) setup of well-established teaching materials (2) Standard operative procedure for practice (3) several rehearsal records in website (www.ramc.org.tw) (4) above four hundred medical staff joining programs, after twenty time training courses. Conclusions: Medicine has the widest application in radiation, such as medical images and radiation oncology. There is a great value of consecutive radiation education for emergent medical staff with high turnover rate under support of RAMC in medical center.

  3. Instruments • Ge(LT)偵檢器多頻道脈器 • 蓋氏偵檢器

  4. 張進富醫師(急診) 黃英傑醫師 (急診) 黃英峰醫師(核醫) 李碧芳醫師(核醫) 陳毓雯醫師(核醫) 張肇松醫師(血液內科) 連熙隆醫師(放射治療) 林高田醫師(骨科) 張寶樹副教授 鍾相彬副教授 張桂蘭放射技術師 護理師及督導 List for Oak-Ridge training(1996)

  5. . • （三）輻射意外事件處置訓練課程1999 Course 3 • Elementary Course for Managements of Radiation Accidents • 時間：1999年10月20~21日地點：墾丁福華大飯店M104會議室 • 10月20日 • 09:40-10:00 報到福華飯店大廳 • 10:00-12:00 參觀核三廠核三廠涂舉賢股長 • 13:15-13:30 開訓致詞全委會陳伯綸副主任 • Lesson 1 核子事故緊急應變計畫簡介原子能委員會 • 13:30-14:20 Introduction of the Radiation Accident & Our 吳慶陸科長 • Management System • Lesson 2 輻射安全法規原子能委員會 • 14:30-15:20 Radiation Safety Regulation 關展南科長 • Lesson 3 輻射偵測與防護鍾相彬教授 • 15:30-16:20 Introduction of Radiation Physics with Focus • in Radiation Detection & Protection • Lesson 4 輻射對生物體的影響及輻射意外事件所造成蔡米山主任 • 16:30-17:20 的急性傷害 • Biological Influences of Radiation & Acute Injuries • Caused by Radiation Accident • Lesson 5 輻射意外事件院前緊急處置陳毓雯醫師 • 17:30-18:20 Prehospital Management of Radiation Accident • 10月21日 • 08:30-08:40 報到 • Lesson 6 創傷處置與實習郭美娟醫師 • 8:40-09:30 Management of Trauma Patient & Work Shop • Lesson 7 輻射意外事件院內緊急處置黃英峰主任 • 09:40-10:30 In-Hospital Management of Radiation Accident • Lesson 8 傷患處置示範、服裝穿卸與輻射偵檢實習張桂蘭放射師 • 10:40-11:40 Demonstration of Patient Management & 曾志偉醫檢師 • Practice in Use of Protection Devices • Lesson 9 • 11:50-12:10 學習成果測驗黃英峰主任 • 12:10-12:30 檢討座談會陳伯綸副主任、黃英峰主任

  6. Lectures & Practices (RAMC website) • .

  7. 成效評量 • 一、目的： 為了明瞭學員對於教授課程的學習及瞭解程度，以作為日後課程改進的參考依據，故施行此學習成效評量。 二、材料與方法：（一）量表介紹： 本學習成效評量表是由輻射傷害防護教育課程之授課教師共同出，共計二十八題。其中包括基本資料三題，原子能相關法規及我國核子事故緊急應變系統簡介六題，輻射物理、偵測及防護三題，輻射生物效應與急性輻射症候群四題，輻射意外事件院前、院內處置六題，體內輻射劑量兩題，骨髓移植及病患照護四題。（二）樣本說明： 本年度受訓對象為高屏地區核災二、三級救護醫院之醫護人員，採事先傳真報名方式

  8. 2002 Course Examplemembers identification

  9. 2002 Course ExampleEducation Background

  10. 2002 Course Examplegender difference

  11. 評量方法 • 同一份學習成效評量表分別於上課前後各施測一次，收集施測後的評量表，經閱卷後統計各學員在各部分試題答錯之題數，採用SPSS for Windows 8.01中文版進行配對t檢定（paired t-test），取α=0.05，檢驗學員們於上課前後的平均答錯題數是否有差異，若有差異是否達顯著水準。

  12. Results • 體內輻射劑量：授課時間為一小時，課程內容主要介紹體內輻射劑量和對生物體的影響。所有學員在評量測驗前測之平均答錯題數為0.88題，標準差為0.65，後測之平均答錯題數為0.56題，標準差為0.66，前後測的平均答錯題數差異為0.32題，標準差為0.78，t值=3.783 > t.975(83)=1.992，p=0.000 < 0.05，表示學員於課前及課後測驗中答錯題數有差異，此差異達統計學上的顯著標準。 • 骨髓移植及病患照護：授課時間為一小時，課程內容主要介紹遭受高劑量輻射傷害時，如何進行骨髓移植和骨髓移植病患照護的概況。所有學員在評量測驗前測之平均答錯題數為2.00題，標準差為1.21，後測之平均答錯題數為0.60題，標準差為0.68，前後測的平均答錯題數差異為1.40題，標準差為1.27，t值=10.124 > t.975(83) =1.992，p=0.000 < 0.05，表示學員於課前及課後測驗題數有差異，此差異達統計學上的顯著標準。 • 輻射物理、偵測與防護：授課時間為一小時，課程內容主要介紹輻射基本特性及防護措施。所有學員在評量測驗前測之平均答錯題數為0.20題，標準差為0.40，後測之平均答錯題數為0.12題，標準差為0.33，前後測的平均答錯題數差異為0.083題，標準差為0.42，t值=1.833＜t.975(83)=1.992，p=0.070 > 0.05，表示學員於課前及課後測驗中答錯題數的差異並無統計學上的顯著水準。 • 原子能相關法規及我國核子事故緊急應變系統簡介：授課時間為一小時，課程內容主要介紹核能相關法規及輻射意外事件的緊急應變體系。所有學員在評量測驗前測之平均答錯題數為2.29題，標準差為1.21，後測之平均答錯題數為1.10題，標準差為0.94，前後測的平均答錯題數差異為1.19題，標準差為1.42，t值=7.693 > t.975(83) =1.992，p=0.000 < 0.05，表示學員於課前及課後測驗中答錯題數有差異，此差異達統計學上的顯著標準

  13. Results • 輻射意外事件院前、院內處置：授課時間為一小時，課程內容主要介紹受輻射污染的病患在送達醫院前的緊急處置方法和送達醫院後的後續醫療過程。所有學員在評量測驗前測之平均答錯題數為2.00題，標準差為0.94，後測之平均答錯題數為0.95題，標準差為0.73，前後測的平均答錯題數差異為1.05題，標準差為1.05，t值=9.129 > t.975(83) =1.992，p=0.000 < 0.05，表示學員於課前及課後測驗中答錯題數有差異，此差異達統計學上的顯著標準。 • 輻射生物效應與急性輻射症候群：授課時間為一小時，課程內容主要介紹輻射對生物體造成的危害。所有學員在評量測驗前測之平均答錯題數為2.18題，標準差為0.96，後測之平均答錯題數為0.90題，標準差為0.94，前後測的平均答錯題數差異為1.27題，標準差為1.17，t值=10.019 > t.975(83) =1.992，p=0.000 < 0.05，表示學員於課前及課後測驗中答錯題數有差異，此差異達統計學上的顯著標準。

  14. Standard Operative Procedure(SOP) in KMUH. • 目錄 • 前言 • 核子事故緊急應變體系 • 輻射意外特質 • 急性輻射症候群 • 第一章總則 • 第二章 人員 • 第三章 儀器設備 • 第四章 人員防護裝備示範 • 第五章 緊急救護聯絡系統 • 第六章 院內病患輸送動線 • 第七章 病患處理標準作業流程 • 第八章 輻射廢棄物處理 • SOP

  15. RAMC rehearsal in 2004 • 93核災演習

  16. Conclusions • Medicine has the widest application in radiation, such as medical images, nuclear medicine and radiation oncology. • There is a great value of consecutive radiation education for emergent medical staff with high turnover rate under support of RAMC in medical center.

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