公共場所自動體外去顫器佈建與使用情形之相關性研究

Abstract

前言： 根據衛生福利部近年國人十大死因統計，心臟疾病皆高居十大死因的前三名，心臟疾病所造成的死亡，許多是以突發性心跳停止的形式發生，而電擊正是可以使心臟恢復正常心跳的方式。自動體外心臟電擊去顫器(Automated External Defibrillator，簡稱AED)設置於人潮眾多的公共場所，供民眾搶救時使用，可降低該類傷病患到院前心肺功能停止(Out-of-hospital cardiac arrest，簡稱OHCA)之死亡率。政府推動公共場所自動體外心臟電擊去顫器的政策近七年，國內公共場所AED佈建的數量近萬台，但依公共場所使用自動體外心臟電擊去顫器(Public Access Defibrillation，簡稱PAD)回報件數甚低，深究探討，國內並未對PAD佈建合宜性與地點適切性有相關研究分析。 研究目的： 本研究旨在探討以下三項：1、了解臺灣PAD設置對非創傷公共場所OHCA事件的覆蓋狀況；2、探討非創傷公共場所OHCA事件地點至PAD距離與使用的關係；3、探討OHCA個案個人特質及地理特性與使用PAD之關係。 研究方法： 本研究運用回溯性次級資料進行分析，以2018年全國消防機關救護紀錄表到院前心肺功能停止事件之個案為研究對象，排除創傷和非公共場所，以可辨識發生地址之1,021筆救護紀錄個案為研究樣本，進行事故發生地點與PAD設置地點之距離描述分析，並探討事故發生地點至PAD直線距離與PAD使用率之差異，以及事故樣本之性別、年齡；事故發生地之區域行政層級、醫療區域分區、鄉鎮(市、區)發展程度與PAD使用分析，方法包括平均數、標準差、百分比、雙母體比例差檢定、卡方檢定等分析。 研究結果： 1.22.5% 的 OHCA個案發生在AED佈建的方圓100公尺之內，49.6% 的個案發生在200公尺範圍內、65.7%的個案發生在300公尺範圍內、74.3%的個案發生在400公尺以及79.3%的個案發生在AED佈建的500公尺範圍內。 2.在OHCA發生個案，有使用PAD占6.8%。在有使用PAD的個案中，有37.7%在AED佈建的方圓100公尺之內；63.8%的個案是發生在200公尺範圍內；75.4%的個案在300公尺範圍內，87%的個案在400公尺內；88.4%在500公尺範圍內。 3.在OHCA發生未使用PAD的個案，有21.4%在AED佈建的方圓100公尺之內；48.5%的個案是發生在200公尺範圍內；65%的個案在300公尺範圍內，73.4%的個案在400公尺內；78.7%在500公尺範圍內。 4.以PAD的使用率與AED佈建距離分析，發生於AED佈建的方圓100公尺之內的OHCA案件使用率為11.3%，發生於AED佈建的100-200公尺之內的OHCA案件使用率為6.3%；發生在200-300公尺內的OHCA案件使用率為4.8%；發生在AED佈建的300-400公尺內的OHCA案件使用率為9.0%；發生在AED佈建的400-500公尺內的OHCA案件使用率為1.9%。 5.各縣市OHCA案件發生在PAD的佈建200公尺範圍內，比全國平均值高的縣市為臺北市、新竹市、南投市、嘉義市；OHCA案件發生在PAD的佈建400公尺範圍內，比全國平均值高的縣市為臺北市、南投市、嘉義市及高雄市。 6.個人基本資料因素與PAD使用情形之統計分析結果顯示，其變項皆無顯著差異，亦即非創傷公共場所OHCA之PAD使用情形不會因性別跟年齡的差異而有不同。 7.都市階層發展因素與PAD使用情形之統計分析結果顯示，其變項的醫療區域分區方面有統計上的顯著差異，到院前心肺功能停止事件發生在不同醫療區域分區，會因為發生區域(臺北區、北區、中區、南區、高屏區及東區)不同，而影響到院前心肺功能停止事件是否進行PAD使用情形。 8.PAD佈建情形與使用情形進行交叉分析顯示，PAD使用情形與100公尺佈建情形(χ2=9.738*，p =.002)、200公尺佈建情形(χ2=5.977*，p =.015)、400公尺佈建情形(χ2=6.176*，p =.013)，PAD使用與佈建情形，達正相關顯著差異，表示使用情形與佈建情形之間有正相關顯著關係。 研究結論： 1.目前國內PAD的佈建對於公共場所OHCA事件之覆蓋已達相當水準，目前設置的PAD已幾乎將8成的事件涵蓋在500公尺範圍內。 2.各縣市PAD的佈建對於公共場所OHCA事故之覆蓋有相當之差異，此結果可提供各縣市做為未來政策推動之參考。 3.公共場所OHCA發生地點與PAD設置點之距離對OHCA事故使用PAD的程度有關，距離愈近，使用PAD的比率越高。 4.救護紀錄表之內容與格式需調整、登錄方式需智慧化、登錄需更確實，以強化登錄資訊的正確性與完整性。

Introduction: According to the statistic of top ten causes of death published by Taiwan’s Ministry of Health and Welfare in recent years, heart disease remained the top three causes of death among Taiwanese. Many of the deaths caused by heart diseases occurred in the form of sudden cardiac arrest, and defibrillation can restore heartbeat. Automated External Defibrillators (AED) are installed in public places for emergency rescue by the public, which can greatly reduce pre-hospital mortality rate. For the past seven years, the government had advocated deploying AEDs in public places, with about ten-thousand devices deployed. However, the rate of Public Access Defibrillation (PAD) remained low and there is no study on the relevance and suitability of deployment of AEDs in Taiwan. Purpose: This study aimed to explore the following three items: 1) understand AED deployment in coverage of non-traumatic OHCA events in public places; 2) explore the relationship between distance and the use of AED in non-traumatic OHCA events in public places; 3) explore the relationship between use of AED and personal and geographical characteristics of OHCA cases. Method: This study utilized retrospective secondary data analysis to study 2018 Fire Agency Ambulance Records. Traumatic and non-publics places records were excluded. A total of 1021 cases with identifiable OHCA locations were included in this study. Then analysis between OHCAs and AEDs’ locations and distances were carried out. Results: 1.22.5% of OHCA cases occurred within 100 meters of AED; 49.6% of cases occurred within 200m; 65.7% of cases occurred within 300m 74.3% of cases occurred in 400m; and 79.3% of cases occurred within 500m of AED deployment. 2.Within OHCA cases, 6.8% had underwent public access defibrillation. Among cases with PAD, 37.7% were within 100m of the AED; 63.8% of the cases occurred within 200m; 75.4% of the cases were within 300m; 87% cases were within 400m; and 88.4% were within 500m. 3.In OHCA cases without PAD, 21.4% of cases were within 100m of AED; 48.5% of cases were within 200m; 65% of cases were within 300m 73.4% of cases were within 400m; and 78.7% were within 500m. 4.Analyzing relation between rate of PAD and distance to AED, it was found that the rate of PAD for OHCA within 100m of AED was 11.3%; 6.3% for OHCA in range of 100-200m to AED; 4.8% for OHCA in range of 200-300m to AED; 9.0% for OHCA in range of 300-400m to AED; and 1.9% for OHCA in range of 400-500m to AED. 5.Analyzing OHCA occurrences in various counties and cities within 200m of AED, Taipei, Hsinchu, Nantou, and Chiayi City had higher occurrences than national average. Within 400m of AED, Taipei, Nantou, Chiayi, and Kaohsiung City had higher OHCA occurrences than the national average. 6.According to the statistical analysis of basic personal information factors and uses of AEDs in public areas, the result shows there is no significant difference between variables. In other words, the situation of uses of AEDs in public areas is not different because of the difference of gender or age. 7.According to the statistical analysis of urban class development factors and uses of AEDs in public areas, the result shows that there is a significant difference in terms of the factor of medical area divisions. Due to different medical area divisions where out-of-hospital cardiac arrest (OHCA) events happen, the condition of use of AEDs for OHCA is different in different areas (Taipei district, North district, Central district, South district, Gaoping district and East district). 8.According to the cross-analysis between deployment condition of AEDs in public areas and usage condition, there is a significant difference of positive correlation, with deployment condition being 100 meters (χ2=9.738*, p=.002), 200 meters (χ2=5.977*, p=.015) and 400 meters (χ2=6.176*, p=.013). It shows that there is a significant positive correlation between usage condition and deployment condition of AEDs. Conclusion: 1.At the time of study, Taiwan implementation of PAD had reached a fairly high level of coverage for OHCA events in public places. Nearly 80% of the OHCA events were within 500m of AED. 2.The deployment of AED in each county and city has quite different coverage of OHCA events in public places. This study can serve as reference for future policy planning in each county and city. 3.The distance of OHCA location in public places to AED is related to the rate of AED use in OHCA events. The closer the distance, the higher the rate of AED use. 4.In order to strengthen the accuracy and integrity of the ambulance record, the content and format of the record form need to be modified, the recording method needs to be digitized, and the data entry needs to be more accurate.