基于院前急救心肺复苏执行现况对院前急救人员构架建设及专业培训的探讨  

Discussion on the construction of pre-hospital emergency personnel framework and professional training based on the current situation of pre-hospital emergency cardiopulmonary resuscitation(CPR)

作　　者：许臻晔[1] 蒋婕[1] 韩意[1] 徐艳丽[2] 王佳玉[2] 史霆[2] 毛恩强[1] 黄梁[1] XU Zhenye;JIANG Jie;HAN Yi;XU Yanli;WANG Jiayu;SHI Ting;MAO Enqiang;HUANG Liang(Emergency Department,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Ruijin Clinic College of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院急诊科,上海200025 [2]上海交通大学瑞金临床医学院,上海200025

出　　处：《中华灾害救援医学》2021年第1期728-732,共5页Chinese Journal of Disaster Medicine

基　　金：上海交通大学医学院重点医学教育研究项目(ZD170708)。

摘　　要：目的通过分析当前上海市院前急救人员的组成结构及其实施和培训心肺复苏的现况,探讨院前急救岗位配置及人员培训方案。方法以上海市医疗急救中心所属中心城区院前急救一线人员为调查对象,采用手机端在线调研方式,从岗位背景、院前心肺复苏(CPR)执行现况、相关复苏辅助设施的使用及专业培训等角度获取并分析相关数据。结果目前上海院前急救人员中医生(56.1%)和担架员(62.2%)以工龄<4年的较低年资结构为主,而驾驶员(78.1%)工龄主要集中在8~15年,工龄分布存在统计学差异(χ^2=299.14,P<0.01)。80.2%的受访者常规执行急救任务。各工种薪资满意度没有明显差异(F=2.494,P>0.05)。有56.2%的受访者执行CPR次数<10例/年,去除无效案例后,每位急救人员平均每年实施CPR 5(2,12)例,平均自主循环恢复(ROSC)成功率为20.0%(0.0%,66.7%)。仅24.4%的CPR案例在转运途中使用了机械胸部按压装置(MCCD),“份量重,搬运使用不便”是受访者不使用MCCD的首要原因(54.47%)。受访者末次培训至受访时长为8(1,27)个月,接受过模拟培训和实景演练的比例分别为48.6%和55.6%。各工种人员在CPR培训机构、末次培训至受访时长、模拟培训及实景演练等方面无统计学差异(χ^21=6.167,χ^22=8.543,χ^23=4.103,χ^24=1.042,P>0.05)。结论(1)院前实施CPR更应强调团队复苏原则,驾驶员等高年资组员可对团队复苏及转运决策提出合理建议。(2)仅通过调拨车辆属性或仅通过对非急救任务车辆增加随车医生来执行急救任务,可能存在潜在风险。(3)应进一步提高调度能力并注重院前急救人员在救护车内及突发状况等特定模拟环境下MCCD及高级气道的培训。Objective To discuss the post allocation scheme and personnel training program for pre-hospital emergency medical staff(EMS)in Shanghai based on the analysis of the current EMS composition and the status quo of its CPR training and implementation.Methods The field first-aid providers in downtown area of Shanghai EMS were taken as respondents.The online survey accessed from mobile phone was used to obtain and analyze relevant data from the perspectives of post background,pre-hospital CPR implementation status,use of CPR auxiliary facilities and professional training etc.Results At present,emergency doctors(56.1%)and emergency medical technicians(EMT)(62.2%)of EMS in Shanghai are mainly of lower seniority structure with working age less than 4 years,while the working age of ambulance drivers(78.1%)is mainly 8-15 years,and the working age distribution is statistically significant(χ^2=299.14,P<0.01).80.2%of the respondents performed routine emergency tasks.There was no significant difference in salary satisfaction among different types of work(F=2.494,P>0.05).56.2%of the respondents performed CPR less than 10 cases per year.After removing the invalid cases,each EMT implemented CPR 5(2,12)cases per year,with an average ROSC success rate of 20.0%(0.0%,66.7%).Only 24.4%of the CPR cases used MCCD in transit,“heavy weight,inconvenient handling”was the primary reason why the respondents did not use MCCD(54.47%).The duration from the last training to the interview was 8(1,27)months,with 48.6%and 55.6%of the respondents having received simulation training and hands-on drill respectively.There were no statistical differences in CPR training institutions,the duration from the last training to the interview,simulation training and hands-on drill among all kinds of workers(χ^21=6.167,χ^22=8.543,χ^23=4.103,χ^24=1.042,P>0.05).Conclusions(1)The principle of team recovery should be emphasized in the implementation of pre-hospital CPR,and senior team members should propose reasonable suggestions on team recovery and transfer

关 键 词：院前急救 心肺复苏 岗位构架 急救培训 医学模拟教学 

分 类 号：R459.7[医药卫生—急诊医学]