台灣公眾自動體外去顫器(AED)建置政策之發展現況與評估

Abstract

中文摘要 前言： 台灣公眾AED的發展起源於2008/1/17日，衛生署召開的『急救教育訓練推廣』討論會，會議中決定將AED納入全民CPR教育訓練中，自此開啟了台灣公眾AED發展的序幕。接著在國內外『產、官、學、醫& NGO組織』各領域公眾AED專家們，經過近五年的研討與努力下，促成立法院在2012/12/25日三讀通過緊急醫療救護法14-1 & 14-2增修條文(公眾AED法案及免責法案)，並於2013/1/16日由總統公告實施。台灣公眾AED正式推行至今已五年，有必要整理與分析發展現況，並針對相關政策進行專家訪談與評估，以作為未來修改PAD相關政策之參考。 研究目的： 本研究主要在了解台灣公眾AED發展現況與問題，並就當前建置政策訪談各領域公眾AED專家進行政策評估，以提供未來中央政府衛生主管機關制訂新的公眾AED政策之參考。 研究方法： 本研究將以質性研究(專家訪談)，針對台灣現有公眾AED相關政策，包含：法定應設置AED之公共場所、AED管理辦法、AED推廣活動、CPR+AED教育訓練、AED與EMS之結合與運用、AED登錄系統..等，訪問各領域公眾AED專家，收集各專家意見，彙整與分類，做出研究結果。 研究結果： 對於台灣現行公眾AED法定應設置場所，有92%(23位)的受訪者認為需要重新定義(擴大範圍&降低人數限制)。有80%(20位)受訪者認為需要規範AED設置密度，另16%(4/位)受訪者認為需要建議AED設置密度。有96%(24位)受訪者認為需要增加法定AED設置場所(例如：大型工廠、工業(科學)園區、大型集合式住宅、寺廟、大型宴會場所、大型活動、診所…等)。84%(21位)受訪者認為AED應全面或鼓勵登錄。80%(20位)受訪者認為需要一個基金會(NGO組織)，協助推廣台灣公眾AED以及學術研究與政策評估建議。 研究結論： 依據研究結果顯示，現行台灣公眾AED法定應設置場所應該重新定義(降低人數限制並擴大及增加範圍)。同時考量空間大小以及人流量，應該規範或建議AED設置密度。另外應該緊密結合EMS，同時結合與運用社群媒體新技術(行動APP)，招喚志願救護者，快速取得AED並執行CPR+AED急救，以提升OHCA存活率。 關鍵字：自動體外心臟去顫器、公眾去顫器、心肺復甦術、到院前心肺功能喪失、緊急醫療系統、恢復自主性呼吸與循環、心臟驟停。

Abstract Background: The development of the Taiwan Public access defibrillation (PAD) originated on 2008/1/17 when the Department of Health convened the 'First Aid Education Training Promotion' seminar. The meeting decided to include AED in the National CPR training which opened the PAD development prologue in Taiwan. Later on, after five years of discussion and efforts made by PAD experts from domestic and abroad, and from various fields of 'the manufacturers, the government, science researchers, medical practioners and NGO', the legislature passed the third reading of the 'Emergency Medical Rescue Act 14-1 and 14-2 Amendment pr-ovisions' (PAD Act and Exemption Act) on 2012 /12/25, and the President announced the implementation in 2013/1/ 16th. Taiwan PAD has been officially implemented for five years, it is necessary to collate and analyze the status quo, and interview the experts for their comments and evaluation on the relevant policies, as the reference for future revision of the relevant policies of PAD. Research purposes: This study is mainly to understand the status quo and problems of the development of PAD in Taiwan by conducting interviews with PAD experts in various fieldsrevarding their comments and evaluation of current policy interviews to provide a reference for future government health authorities to formulate new policies. Methods: This study used qualitative research (expert interviews) to enquire the opinions of PAD experts on the issues of Taiwan's existing PAD policy, including: the mandate places to set PAD, AED management regulations, AED promotional activities, CPR+AED Education training, AED and EMS combination and application, AED login system, etc. Interviewed opinions were sorted and classified to draw the research result. Results: For Taiwan's existing PAD mandate provisions places, 92%(23/25) of respondents thought it was necessary to redefine (broaden the scope and reduce the number of people limit); 80% (20/25) of respondents considered it necessary to regulate the density of AED, 16%(4/25) respondents considered that it was necessary to recommend the AED set density. There were 96% of respondents considered that the need for additional legal requirements for AED setting up venues. 84%(21/25) of respondents thought PAD should be fully or encouraged to register. 80% of respondents considered that a foundation (NGO) would be needed to help promote Taiwan PAD, academic research and to generate policy evaluation recommendations. Conclusion: According to the results of the study, the existing Taiwan PAD mandate places should be redefined. At the same time considering the size of space and human flow, it should be stipulated or recommended an AED density. In addition, we should combine EMS closely with the use of social media technology (mobile APP), recruit volunteer ambulance, get AED quickly, and perform CPR+AED first aid to improve OHCA survival rate. Keywords: Automated external defibrillators (AED)、Public access defibrillation (PAD)、Cardiopulmonary resuscitation (CPR)、Out-of-Hospital Cardiac Arrest (OHCA)、Emergency Medical Services (EMS)、Return of spontaneous circulation(ROSC)、Sudden Cardiac Arrest(SCA).