| 摘要: | 研究動機：我國國軍自民國48年9月實施空中傷患緊急後送作業迄今已近60年，尚無文獻對國軍執行澎湖地區傷患後送效能執行正式評估，且對金門地區效能評估研究文獻已逾15年，實有再重新研討評估的必要性。
研究目的：藉分析國軍執行空中傷患後送作業現況、金門及澎湖地區對國軍空中傷患作業利用情形差異及比較91年文獻國軍空中傷患後送作業利用情形，瞭解國軍現行空中後送作業之運用成效及其可能潛存的問題，希望能經由本研究，提供國軍在執行空中傷患作業之效能提升參考建議，提供離島在改善專科醫療能量投入之參考依據，作為離島緊急醫療政策發展之參考，盼減少空中後送案件，促進醫療在地化，對離島醫療發展貢獻一份心力。
研究方法：本研究主要是針對本國空軍101-105年所有經由國軍C-130型機執行空中傷患後送個案資料實施回溯性個案研究，期間個案總計3,011人，選取資料建立完整之有效樣本數2,392人執行研究分析探討。
研究結果：發現國軍現行空中傷患後送服務對象，男生多於女生；民眾多於軍人；傷患年齡層以「71~80歲」區間最多；平均年齡61.07±22.17歲；空中後送傷患分類標準以「Class2A」最多；疾病科別內科多於外科，其中軍人多為身心科；疾病ICD9碼分類以「390-459循環系統疾病」類別最多；以航線「金門→台灣」後送人次最多；轉出醫院以「衛生福利部金門醫院」最多；金門年平均後送利用350件，澎湖年平均後送利用127件；金門後送任務平均每架次實施3.62人次，馬公後送任務平均每架次實施1.46人次；15年期間政府在改善離島醫療在地化的推展，確實有減少金門地區的空中傷患轉送數量；金門及澎湖之離島醫院實有需要再強化內科專科科別「心臟內科」、「血液腫瘤科」、「肝膽腸胃科」及外科專科科別「骨科」、「神經外科」醫療在地化作業推展，以減少空中後送頻次，提升空中後送作業效能。
研究建議：可由三方向精進 (1)國軍傷患後送作業精進對策：後送申請審查作業標準建立、網頁系統傷患後送管理平台建立、委由「衛生福利部空中轉診審核中心」負責「民眾」空中轉診之申請及審核相關工作、加強後送週期性改善運用效率；(2)從空中後送角度探討離島醫療強化作為：加強專科醫療改善、公費醫師人力培養；(3)離島空中後送管理機制：跨部會後送系統整合及資源共享、空中後送分級制度建立。
Introduction: The Republic Of China (R.O.C) Armed Forces has a long history of aeromedical evacuation system (AEs) dating back since September, 1959. However, limited to no studies had emphasized on the utilization of these systems upon the Taiwan offshore islands including the Penghu county and the Kinmen county, and the last known study had only focused on Kinmen county AEs, and had already been out dated for more than 15 years. Therefore, it is essential to re-evaluate recent system utilization upon these vital regions to improve R.O.C AE strength and localized medicine development.
Objectives: By analyzing the statistics of Island-wide R.O.C Armed Forces AEs and offshore island AEs and comparing the results against past AE statistical characteristics, this study hopes to fully comprehend the utilization of modern R.O.C Armed Forces AEs and seek out the pros and cons that may elevate or enervate the system, and therefore provide reference to future AE improvements and investment, enhance localized medical care, guide offshore islands emergency medical care (EMC) policies and lessen unnecessary strains to the R.O.C military medicine system.
Methods: Based on 3,011 AE cases carried out by the C-130H Hercules military transport aircraft of the R.O.C Air force from 2012 to 2016, this cohort study analyzes the characteristics of transported patients, frequent clinical cases and types (classification via OPNAVINST 4630.9C and ICD-9-CM), frequent flight routes, frequent AE regions and many other figures, in which 2,392 valid cases were selected as the study population group.
Results: The results indicate that within the study group, male cases surpass female cases, and the majority of cases are civilian rather than military personnel. In age group, most cases are from the “71 to 80 years old” group, the average age ranges at 61.07 ± 22.17 years old. In OPNAVINST AE classification, “Class 2A” (Immobile litter patients) are mostly seen. In ICD-9-CM classification, Diagnosis Code “390-459: Diseases Of The Circulatory System” is the most common disease requested for AE, and clinical cases happen more than surgical cases. In frequent flight routes, the “Kinmen to Taiwan” route is the most frequent, in which the “Kinmen Hospital of the Ministry of Health and Welfare” requests the most transfers. In Offshore Island AE sorties, the Kinmen county conducts an average of 350 sorties per year, the Penghu county conducts an average of 127 sorties per year; Kinmen AEs transfers an average of 3.62 cases per sortie, Penghu AEs transfers an average of 1.46 cases per sortie. During the past 15 years, the R.O.C Government has made effort in improving localized medical care, therefore when comparing to 15 years ago, the Kinmen county has indeed seen a decrease in AE system sorties; However, offshore island hospitals and medical facilities still require specific clinical and surgical divisions to compensate for their lack of advanced treatment, including cardiology, hematology, oncology and gastroenterology for clinical medicine, and orthopedics and neurosurgery for surgical medicine.
Discussion: This study proposes the following suggestions: (1)For improving R.O.C Armed Forces medical evacuation systems: Establish a standard AE application validation procedure, establish an online platform for AE system management, let the Ministry of Health National Aeromedical Approval Center take authority over civilian AE application and validation duty, regulate and strengthen AE periodicity and management. (2) For improving localized medical care for R.O.C offshore island regions: strengthen specific medical division capabilities, raise publicly funded physicians to aid in localized medical care. (3) For refining the management of offshore island AE systems: integrate public and military medical evacuation systems, share medical evacuation resources, and establish AE grading system for prioritization of sorties. |
