緊急救護技術員自評急救處置能力及相關因素
A Study of Emergency Medical Technician’s Self-Assessed Emergency Management Competencies and

Factors Affecting the Competencies

背景:緊急醫療救護在臺灣至今發展約20年，主要由24小時全年無休的消防人員進行到院前緊急救護工作，近年來救護件數逐年攀升，民眾對於醫療的認知水準提高，進而連帶要求到院前緊急救護品質也能被提升。然而目前國內仍無制定出緊急救護技術員相關的核心能力指標及對應課程內容，導致訓練課程內容如何設計，往往由授課單位自行決定，缺凡一致性的訓練內容，加上消防機關內緊急救護技術員的訓練多為師徒制的傳授，造成訓練品質不一，取得相同層級證照的救護技術員不見得具備相同處置傷病患的能力。

目的：本研究以自我評估的方式探討緊急救護技術員的急救處置能力，以及不同個人背景的緊急技術救護員在自評急救處置能力上有何差異，最後分析緊急救護技術員自評急救處置能力的預測因子。

方法：本研究採橫斷式調查(cross-section survey)的研究設計，採立意取樣針對東部某消防局的緊急救護技術員進行全面普查，研究工具為自擬「緊急救護技術員自評緊急處置能力量表」問卷，於2017年4月11日至4月28日共發放295份問卷，回收272份問卷，回收率92.2%，資料分析採描述性設計、推論性設計方式包括One-way ANOVA、Kruskal Wallis test、雙變項線性迴歸及多變項線性迴歸。

結果：本研究結果發現，緊急救護技術員自我評估執行緊急能力，共計47題，整題平均得分為3.58分。平均得分最高的項目為「正確操作自動體外去顫器(AED)」(4.48±0.76)；平均得分最低項目為「明白產後出血的處理方式」(2.57±1.17)。另利用探索式因素分析建構出六個因素：危急個案判斷與處置能力、初步急症評估與緊急救護技能能力、與急救責任醫院溝通協調能力，六個因素合計解釋63.7%的變異量。在個人基本資料與自評緊急處置能力之差異分析中，年齡、教育程度、緊急救護技術員資格、是否緊急救護教官或助教資格、、擔任緊急救護技術員年資、目前服務單位每月救護救勤量、個人月平均救護勤務量及最近一年內是否曾額外參與緊急救護課程等變相均有顯著差異存在。緊急救護技術課程等三個變項可解釋緊急救護技術員整體急救處置能力31.3%變異量，調整後變異量為24.3%。

結論：期望藉此研究分析緊急救護技術員自我評估的緊急處置能力，除找出緊急救護技術員較家與待加強的能力之外，另也可供承辦緊急救護業務者參考未來有哪些能力是應該被加強的，並針對此設計訓練課程。本研究結果發現之六大能力，亦可當作緊急救護技術員必備之急救能力指標參考。

Background: Emergency medical service has been developing for about twenty years in Taiwan. It is performed mainly by firefighters who work around the clock. In recent years, the numbers of emergency medical cases have increased year by year.
People nowadays are more educated as far as medical services is concerned and, therefore, they have a higher standard for pre-hospital emergency medical services. However, there is currently no relevant core competence indices and corresponding
fundamental curriculums in place for Emergency Medical Technicians (EMT), the training programs set by individual instructors or units usually demonstrate, lack of consistency. In addition, EMTs in Taiwan are trained through apprenticeship, meaning EMTs trained in different units perform differently in terms of their capabilities, abilities, and performances.

Objective: Self-assessment is used to evaluate EMTs competence and to explore the differences due to EMTs’ personal backgrounds. Finally, the predictors of emergency management competence of EMTs are analyzed.

Methods: Cross-section survey is applied to the samples and the census on the EMTs in a fire department in eastern Taiwan. We created an EMT self-assessment emergency management competence scale as the research tool. 295 questionnaires were collected from April 11 to April 28, 2017 with a recovery rate of 92.2%. The data were than analyzed using descriptive and inferential statistical methods including One-way ANOVA, Kruskal Wallis test, bi-variate linear regression, and variable linear regression.

Results: Our finding indicate that the overall average score for the self-assessment management competence of EMTs is 3.58. The item with the highest average score is “the correct operation of the auto external defibrillator.” (4.48 ± 0.76), and the item
with the lowest average score is “the awareness of the treatment of postpartum hemorrhage” (2.57 ± 1.17). Additionally, six factors were constructed via exploratory factor analysis including the ability to deal with server medical cases, the capacity to do the primary survey and emergency medical techniques, the ability to coordinate and to communicate with first aid responsibility hospital, the ability of self-protection, the ability to maintain patients’ airway, and finally, the ability to deal with mass casualty incidents and to solve problems. These six factors 63.37% of the total variance. In the analysis of basic personal information and self-assessment emergency management competence, statistically significant differences were found for the following items: age, education, qualification as an EMT, qualification as an EMT instructor/ assistant, tenure as an EMT, the number of emergency medical tasks per month of the unit, the average personal work load per month, and the attendance of additional emergency medical courses in a year. Among these factors, tenure the average monthly tasks of emergency medical service and one’s the attendance in additional emergency medical courses explain 31.3% of the variance in the item of the ability to deal with emergency medical incidents, and the adjusted variance was 24.3%.

Conclusion: The current study is an attempt to provide EMTs and emergency medical industry with more opportunities to enhance their performance and techniques. A more adequate and well-designed curriculum for EMTs is strongly advised; moreover,
the six factors devised in this study, can be adopted as a critical tool to evaluate EMTs would be an important reference for EMTs techniques and performances.