消防人員創傷後壓力症候群之危險因子-以到院前心肺功能停止案件為例

Abstract

研究背景與目的 台灣自民國88年921大地震開始至今經歷了復興航空空難、普悠瑪翻車事件及維冠大樓倒塌等大型災害造成各式到院前心肺功能停止(OHCA)案件，使事後救護員內心裡產生極大的痛苦與壓力，因此希望能透過實證醫學發現創傷後壓力症候群之危險因子，促使各縣市消防機關能重視員工心理衛生健康，進而改善職場環境。 研究方法 本研究採橫斷式研究，研究以問卷調查設計，經參與對象均同意受測後開始使用Google電子表單問卷填寫。問卷採不記名方式填寫，且回收問卷的個人身分辨別資料以號碼取代，以保障受訪者權利及隱私，並透過中文版戴氏創傷量表評估，該量表超過44分效標分數，為診斷罹患PTSD，研究對象需為年滿20歲以上且於台灣各縣市消防局實際執行OHCA救護勤務之現職消防人員。 研究結果 共回收328份問卷，扣除義消25份，無效問卷3份，有效問卷達300份，經單變項統計分析後，自變項與PTSD有顯著性相關達14類項目，透過向前選取法(Forward Selection)之多變項分析得知教育程度、恐懼程度、救護班時數、身體狀況及飲酒次數等6個自變項，為罹患PTSD之危險因子，又以飲酒次數為主要暴露因子，以每週飲酒1含以下為參考值，當每週飲酒4次以上有高達8.4倍勝算比罹患PTSD(P<0.001)，或許可以推論過去消防人員習慣透過同事間飲酒方式排解工作期間的疲勞或是心理壓力，但是當長期的飲酒所造成身體狀況下降，因此當面對重大創傷OHCA案件而與PTSD有顯著性相關。 結論 消防人員心理健康已成為全球化所關心的議題，透過研究已經證實消防機關24小時的工作型態已造成同仁睡眠品質不良，身體自我評估較差，皆會影響工作品質，在單位內救護班時數181小時以上、執行救護案件達45件以上或面對OHCA案件的恐懼程度，都會影響工作表現，另最重要的個人化健康管理，促成PTSD的主要暴露因子為每週4次以上的飲酒習慣，更是要改善，因此上至消防機關，下至個人健康問題，都要共同努力，才能使消防單位為建康優良的職場。

Research background and purpose Taiwan has experienced various disasters such as cardiopulmonary dysfunction (OHCA) before the hospital since the 921 earthquake in 88 in the Republic of China and has experienced major disasters such as the air crash of Fuxing, the rollover incident of Puyuma and the collapse of the Victoria Crown building, which caused the ambulancemen extremely painful and stressful in the aftermath. Therefore, I hope that through empirical medication, the risk factors of post-traumatic stress syndrome can be discovered, so that county and city fire agencies can pay attention to the mental health of employees and improve the workplace environment. Research methods In this case, a cross-sectional study was adopted. The study was designed with a questionnaire survey. After the participants all agreed to be tested, they began to fill out the electronic form questionnaire. The questionnaire was filled out anonymously, and the personal identification data of the recovered questionnaire was replaced with a number to protect the rights and privacy of the interviewees. It was evaluated by the Chinese version of Davidson Trauma Scale. The scale exceeded 44 points. To diagnose PTSD, the research subjects must be current firefighters who are over 20 years of age and who are actually performing OHCA ambulance duties in the fire bureaus of counties and cities in Taiwan.

Research result After descriptive statistical analysis, the independent variables were significantly related to PTSD in 14 categories. Through the multivariate analysis of the Forward Selection method, we learned that 6 independent variables such as education level, degree of fear, ambulance hours, physical condition and drinking frequency are risk factors for PTSD, and the number of drinking is the main exposure factor. Taking the weekly drinking as a reference value, when drinking more than 4 times a week, the odds of being up to 8.4 times higher than that of suffering from PTSD (P<0.001), it may be inferred that firefighters used to use alcohol among colleagues to resolve fatigue during work or psychological pressure. However, when long-term drinking causes a decline in physical condition, it is possible to induce PTSD in the face of major trauma OHCA cases. Conclusion The mental health of firefighters has become a topic of globalization concern. Research has confirmed that the 24-hour work pattern of firefighters has caused poor sleep quality and poor physical self-assessment of colleagues, which will affect the quality of work. The number of ambulance hours in the unit of more than 181 hours, the execution of ambulance cases of more than 45 cases, or the degree of fear of facing OHCA cases will affect work performance. Another most important personal health management, contributed to PTSD main exposure factor of more than 4 times weekly drinking habits, but also to improve. This on to fire authorities, down to personal health problems, we must work together in order to make excellent fire units to our health in the workplace.