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研究生: 彭秀英
論文名稱: 台灣地區國民小學校園緊急傷病處理現況與相關因素探討
指導教授: 陳政友
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2002
畢業學年度: 89
語文別: 中文
論文頁數: 189
中文關鍵詞: 國民小學校園緊急傷病緊急照護校園緊急傷病處理校園緊急照護系統事前規劃事發後處置
論文種類: 學術論文
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  • 摘 要本研究旨在瞭解台灣地區國民小學校園緊急傷病處理現況及其相關影響因素。研究工具為自擬之結構式問卷,研究對象是八十九學年度台灣地區公私立國民小學。總計發出問卷360份,收回有效問卷309份,回收率為86.6﹪。研究結果主要發現如下:目前台灣地區校園緊急傷病事前規劃措施的實施缺乏整體性和協調性;大部分學校在學生發生緊急傷病時,有聯絡不到家長的現象;只有三成學校完成緊急傷病處理組織運作及程序擬訂;學校健康中心處理緊急傷病的人力支援、通訊廣播及緊急照護設備不足;雖有七成學校進行傷病處理紀錄卻只有不到兩成學校能善加應用;各校辦理一般急救訓練課程內容不一、時數及次數不足,參加人員不能普及,經費支援不足,預期成效有限;有八成學校以校護為緊急傷病處理工作主要執行人員,其接受專業急救訓練的時數不足,亟待加強;學校對學生參加保險情形疏於關注;校護差假期間只有二成學校能指定特定職務代理人實質代理其職務。校園急症以發燒、腹痛最多;受傷以裂傷、骨折最多。傷病處理人員以校護和級任老師為主。只有一成的學校在事前規劃整體周延性上屬於良級,而有四成學校在緊急傷病處理表現較佳。校園緊急傷病處理事前規劃措施越週延,事發後處置表現越好,其中「組織運作」、「程序擬訂」、「支援聯絡網建置」、「急救訓練」、「職務代理人安排」等與事發後處置關係密切,而這五項措施又受到「學校所在地」、「工作主要執行人員職稱」及「其最近一次接受急救訓練時間間隔」的影響。因此建議,教育單位應加強建立校內緊急救護系統,制定相關法令,落實事前規劃措施,加強評鑑考核;建議提高急救訓練的質與量,尤其是校護的緊急救護知能訓練;建立長期監測指標,整合學校附近醫療資源,發展符合各校特色之緊急傷病救護系統。 ABSTRACT The purpose of this study was to find out the current practice of the management of the school injuries and sickness in the campus of primary schools around the Taiwan area as well as its relevant influences and factors. In order to do this, a structural questionnaire was created as a tool for the study. Targets for the study were the public and private primary schools of the 2000th academic year around the Taiwan area. Three hundred and sixty copies were issued in total; 309 effective ones were retrieved, with a successful retrieving rate of 86.6%. The main findings of the study are the following: The implementing of the measures for emergency preparedness in the campus around Taiwan lacked coordination and consistency. Most schools had trouble of contacting the parents at the critical moment of an emergency when a student is injured or sick. Only thirty percent of the schools had set up school emergency care committee and written emergency care procedures. The health centers of the schools were insufficient in man power, communication and broadcasting systems, as well as emergency care equipment. Although seventy-percent schools kept injuries and sickness records., less than twenty percent of them have really made good use of them. These schools set up emergency training programs with different designings. They had no enough training hours and the needed attendance frequency. Chances of taking part in these programs were not available to all, and financial supports were inadequate. Consequently, one can hardly expect any good results from them. About eighty percent schools appointed their school nurses as the main agent for taking care of these unintentional injuries and sickness. As these nurses had no enough training hours for handling these, much needs to be done to them yet. And schools paid little attention to students’ insurance for their attendance hours. When school nurses ask for leave, only twenty percent of them have appointed proxies to take care of their duties for them. Fever and abdomen pains occurred the most among all the emergent sickness in campus, while laceration and fractures were the main causes of injuries. Most sicknesses and injuries were taken care of by teachers and school nurses. Only one tenth of the schools could be evaluated as good in their emergency care plans, and forty percent of them treated these emergencies acceptably. Schools with better planning and measures for emergency cares performed the better at the occurrence of emergencies. Among them, emergency care committee, written emergency care procedures, the establishment of supporting and connecting network, first aid training, and duty proxy system were all very consequential to the efficient management of the emergencies at the first time. However, these five measures were also highly influenced by the location of the school, the title of the job’s main performers, and the time span lagging for receiving the latest first-aid training. Therefore, it is suggested that the authorities give more stress on the setting up of the campus emergency care systems, compile the concerning laws and regulations, execute down-to-earth plans and procedures that should have set up beforehand, and give more critical evaluations and appraisals for each schools’ concerning performance. It is also recommended to improve the quality and quantity of first-aid training, especially school nurses’ cognitive and competence training for emergencies. Moreover, setting up long-term surveillance indicators, coordinating the medical care resources nearby, and developing emergency care system fit for the characteristics of each school would all be very helpful.

    The purpose of this study was to find out the current practice of the
    management of the school injuries and sickness in the campus of primary
    schools around the Taiwan area as well as its relevant influences and
    factors. In order to do this, a structural questionnaire was created as a
    tool for the study. Targets for the study were the public and private primary
    schools of the 2000th academic year around the Taiwan area. Three hundred and
    sixty copies were issued in total; 309 effective ones were retrieved, with a
    successful retrieving rate of 86.6%.
    The main findings of the study are the following:
    The implementing of the measures for emergency preparedness in the campus
    around Taiwan lacked coordination and consistency. Most schools had trouble of
    contacting the parents at the critical moment of an emergency when a student
    is injured or sick. Only thirty percent of the schools had set up school
    emergency care committee and written emergency care procedures. The health
    centers of the schools were insufficient in man power, communication and
    broadcasting systems, as well as emergency care equipment. Although seventy-
    percent schools kept injuries and sickness records., less than twenty percent
    of them have really made good use of them.
    These schools set up emergency training programs with different designings. 
    They had no enough training hours and the needed attendance frequency. 
    Chances of taking part in these programs were not available to all, and
    financial supports were inadequate. Consequently, one can hardly expect any
    good results from them.
    About eighty percent schools appointed their school nurses as the main agent
    for taking care of these unintentional injuries and sickness. As these nurses
    had no enough training hours for handling these, much needs to be done to them
    yet. And schools paid little attention to students’ insurance for their
    attendance hours. When school nurses ask for leave, only twenty percent of
    them have appointed proxies to take care of their duties for them.
    Fever and abdomen pains occurred the most among all the emergent sickness in
    campus, while laceration and fractures were the main causes of injuries. Most
    sicknesses and injuries were taken care of by teachers and school nurses. 
    Only one tenth of the schools could be evaluated as good in their emergency
    care plans, and forty percent of them treated these emergencies acceptably. 
    Schools with better planning and measures for emergency cares performed the
    better at the occurrence of emergencies. Among them, emergency care
    committee, written emergency care procedures, the establishment of supporting
    and connecting network, first aid training, and duty proxy system were all
    very consequential to the efficient management of the emergencies at the first
    time. However, these five measures were also highly influenced by the
    location of the school, the title of the job’s main performers, and the time
    span lagging for receiving the latest first-aid training.
    Therefore, it is suggested that the authorities give more stress on the
    setting up of the campus emergency care systems, compile the concerning laws
    and regulations, execute down-to-earth plans and procedures that should have
    set up beforehand, and give more critical evaluations and appraisals for each
    schools’ concerning performance. It is also recommended to improve the
    quality and quantity of first-aid training, especially school nurses’
    cognitive and competence training for emergencies. Moreover, setting up long-
    term surveillance indicators, coordinating the medical care resources nearby,
    and developing emergency care system fit for the characteristics of each
    school would all be very helpful.

    第一章 緒論………………………………………………….1 第一節 研究動機……..…………..……………..……………….1 第二節 研究重要性……..…………..……………..……….…..3 第三節 研究問題與研究目的………………………………….…..5 第四節 研究假設……………………………………………….…..6 第五節 名詞界定…………………………………………………….6 第六節 研究限制…………………………………………………...9 第二章 文獻探討……………………………………………..11 第一節 校園緊急傷病處理的意義………………………………..11 第二節 校園緊急傷病流行病學研究…………………………..…16 第三節 校園緊急傷病處理理念…………………………..……..23 第四節 校園緊急傷病處理措施…………………………………..27 第三章 研究方法與實施步驟………………………………..49 第一節  研究架構…………………………………………………….49 第二節  研究對象…………………………………………………….50 第三節  研究工具…………………………………..……………….51 第四節  實施步驟……………………………………………….…..54 第五節  資料處理…………………………………………………….56 第四章 研究結果與討論……………………………………..57 第一節 研究對象背景資料………………………………………….57 第二節 研究對象校園緊急傷病處理規劃與執行現況…………...71 第三節 影響辦理校園緊急傷病處理的相關因素…………………111 第五章 結論與建議…………………………………………161 第一節 結論………………………………..……………………..161 第二節 建議………………………………………..……………..162 參考文獻………………………………………………………166 中文部份…………………………………………………………..166 英文部份……………………………………………………………172 附  錄…………..…………………………….…………..175 附錄一 正式調查問卷…………………………………………..175 附錄二 問卷內容效度專家名單…………………….………….185 附錄三 致問卷內容效度專家信函及評分說明…………….….186 附錄四 致校長的一封信…………………………………….….187 附錄五 影響校園緊急傷病處理事前規劃的相關因素一覽表…188 圖  目 次 圖2-1學校內緊急傷病處理作業流程圖…………………………………………….………….40 圖2-2 衛生署緊急醫療救護系統圖…………………………………………………………….41 圖3-1 研究架構圖……………………………………………………………………………….49 表  目  次 表2-1最近四年全國各級學校校園意外事件傷亡人數比較表………………………….…….22 表2-2最近四年全國國民小學校園意外事件發生傷亡人數比較表…………………….…….22 表2-3傷病緊急程度五分類法……………………………………………………………….….37 表2-4校園緊急傷病處理三階段措施內容對照表……………………………………………..48 表3-1 校園緊急傷病處理事前規劃週延程度評分標準……………………………………….55 表4-1-1 問卷回收狀況及研究對象分佈一覽表……………………………………………….. 60 表4-1-2 學校所在地與學校規模分佈情形…………………………………………………….. 61 表4-1-3 各地區學校護理人員分佈情形……………………………….……………………. …61 表4-1-4學校規模與學校護理人員分佈情形…………………………….……………….…. …61 表4-1-5  醫療資源可近性分佈情形……………………………………………….…… ……. 61 表4-1-6 學校與鄰近之醫療資源可近性情形答題次數分配表………………………………63 表4-1-7 工作主要執行人員個人基本資料次數分配表…………………………….……. …. 68 表4-1-8 工作主要執行人員教育程度分佈情形…………………………………….…….….. 69 表4-1-9  工作主要執行人員急救訓練證明「發給單位」與「發給時間」分佈情形…… …..69 表4-1-10 工作主要執行人員最近一次接受急救訓練情形……………………………….. …70 表4-1-11 工作主要執行人員最近二年內所接受的急救訓練型態……………………….….. 70 表4-2-1 校園緊急傷病處理相關組織運作情形答題次數分配表……………………...……. 74 表4-2-2 校園緊急傷病處理相關程序擬訂情形答題次數分配表……………………...……. 78 表4-2-3 學校建置緊急傷病處理支援聯絡網情形答題次數分配表…………………...……. 81 表4-2-4 學校設置急救器材與CPR教學設備情形答題次數分配表………………….….….86 表4-2-5 辦理急救訓練情形答題次數分配表…………..……………………….………... …..88 表4-2-6 工作主要執行人員差假職務代理人安排情形答題次數分配表………………...…. 94 表4-2-7 實施學生緊急傷病處理紀錄情形答題次數分配表…………………………………96 表4-2-8 學生參加保險的情形答題次數分配表………………………………..……………. 99 表4-2-9 學校因應學生緊急傷病照護的實際運作狀況答題分配次數表…………..…… …105 表4-2-10 學校發生緊急傷病事後處置表現自我評值情形得分分佈表…………………..…. 106 表4-2-11 處理學生緊急傷病工作所遭遇的困難及建議答題次數分配表……………..… …109 表4-3-1 學校背景變項與成立緊急傷病處理組織運作之關聯檢定……………….………. 114 表4-3-2 學校背景變項與組織運作事前規劃之週延程度的變異數分析………….….. …....115 表4-3-3 學校背景變項與緊急傷病處理程序擬訂之關聯檢定……………………..…...…. 118 表4-3-4 學校背景變項與緊急傷病處理程序擬訂事前規劃之週延程度的變異數分析.…. 120 表4-3-5 學校背景變項與緊急傷病處理支援聯絡網之關聯檢定……………………….…. 126 表4-3-6 學校背景變項與緊急傷病處理支援聯絡網事前規劃週延程度的變異數分析….. 130 表4-3-7 學校背景變項與緊急傷病處理急救設備之關聯檢定…………………………….. 131 表4-3-8 學校背景變項與緊急傷病處理急救設備事前規劃之週延程度的變異數分析….. 134 表4-3-9 學校背景變項與緊急傷病處理急救訓練各項執行內容之關聯檢定…………….. 139 表4-3-10 學校背景變項與緊急傷病處理急救訓練事前規劃之週延程度的變異數分析…... 140 表4-3-11 學校背景變項與緊急傷病處理工作主要執行人員職務代理人之關聯檢定…... …141 表4-3-12 學校背景變項與傷病處理工作主要執行人員職務代理人週延程度變異數分析... 142 表4-3-13 學校背景變項與緊急傷病處理紀錄與應用之各項執行內容的關聯檢定……... …143 表4-3-14 學校背景變項與緊急傷病處理紀錄與應用事前規劃週延程度變異數分析表.….. 144   表4-3-15 學校背景變項與辦理學生保險之各項執行內容之關聯檢定…………… …..….…149 表4-3-16 學校背景變項與辦理學生保險事前規劃之週延程度的變異數分析………….….. 150 表4-3-17 學校背景變項與緊急傷病處理執行人員人力設置各項執行內容之關聯檢定…... 151 表4-3-18 學校背景變項與主要執行人員人力配置事前規劃之週延程度的變異數分析…... 152 表4-3-19 校園緊急傷病處理事前規劃週延程度得分分佈表………………….……………. 153 表4-3-20 學校背景變項與事前整體規劃之週延程度的變異數分析…………….…………. 154 表4-3-21 學校背景變項與緊急傷病事發後處置表現自評的變異數分析………..…………. 155 表4-3-22 校園緊急傷病處理事前規劃與事發後處置表現間之關係……………..…….…... 157.

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