| 摘要註: |
本研究主要探討金門民眾不當使用「到院前緊急救護資源」之原因與對於「到院前緊急救護品質」之服務品質滿意度調查，以了解「到院前緊急救護」服務工程之改善方向，並針對金門離島緊急救護之特性，與其後續救護系統之規畫設計，並結合文獻探討與專家訪談，將統整出五大評估指標與28個要項並轉化為問卷問項：「口碑形象方面」、「緊急救護人員方面」、「救護裝備方面」、「救護流程方面」、「救護結果方面」等五大構面。從訪談中探究金門民眾不當使用「到院前緊急救護資源」之原因？本研究認為應從以下三個面向著手:1.在法令面：法令制度之完備與否，悠關民眾及救護人員所應承擔之權利義務，由於法令設計之不完備常造成民眾走法律漏洞認為有機可乘，並建議在未來修法方向，以保障消防救護人員及民眾權利。2.在教育宣導面：對於到院前緊急救護資源之正確使用宣導不足夠，可藉由社會及學校教育面向宣導，教育民眾正確使用救護車。3.在制度面：基於「使用者付費」原則，對不屬於緊急傷病患者收取一定費用，以抑制不當使用者數量，將到院前緊急救護資源給真正亟需要的人。經由 IPA 分析來辨識品質需求項目最需要改善的方向，並作為現行消防機關緊急救護品質進行資源調整的重要參考。假設服務品質的認知重要度對於滿意度的影響是正向且顯著的，經過統計分析結果證明此假設是成立。而人口統計變項則有部分因素對重要度及滿意度的看法上有差異。至於在救護服務品質滿意度的調查結果顯示：民眾認為較為滿意的項目在口碑形像中為救護車外觀辨識度。緊急救護人員方面為救護人員具有救護技術證照。救護配備方面為救護車耗材之補充情形與救護車輛器材之保養維護情形。救護流程方面為救護處置執行之正確性。救護結果方面為救護評估和技術之正確性。本研究對金門縣消防局之建議如下:有關民眾認為重要度高與消防機關績效度不錯的項目，也是最重要的利基部分，消防機關應盡力維持與持續提升，保持現有資源的投入及品質控制。另民眾認為較不重要的項目，分別為一一九救護免收費之瞭解度與救護人員服裝儀容整潔度，消防機關應減少在這兩項上資源的投入，也可以減少相關的成本支出。績效表現最差的項目，為消防機關後續救護評估回朔及關懷，這也顯示出消防機關在這方面做得不夠完善，應該規劃關懷傷病患本人或家屬的作為，同時回溯追蹤考核，進一步改善社會觀感。 The main purpose of this research is to discuss the causes of misuse of first aid before sending to hospital in Kinmen, and survey the degree of satisfaction concerning first-aid quality, so as to understand the necessary improvement of first-aid services. In addition, five evaluative aspects and twenty-eight factors in questionnaire are extracted through the features of first aid in Kinmen, and subsequent planning of emergency system, in combination of literature review and interview with experts.From the interview, the causes of misuse in first-aid resources for the people in Kinmen? The Study suggests that three dimensions be implemented:1.Law dimension: the maturity of law enactment is related to the rights and obligations the common people and Emergency Medical Technician (EMT) should have. Immaturity of laws brings about loopholes in the law; therefore, revision of laws is suggested to protect the rights of EMT and people.2.Educational guidance: right use of first-aid resources can be proceeded in the society and school, teaching people proper exploitation of an ambulance.3.Emergency system: based on user pays, patients that are not emergent should pay at a reasonable rate, which helps the truly-needed.From the analysis of IPA, the directions that need to improve most within the service needs are identified, and provide fire-control institutions with significant references on adjusting first-aid resources. After the results of statistics, the understanding of service quality has a positive and remarkable influence on the degree of satisfaction. Therefore, hypothesis one is established, and some factors in the population statistics variables show differences between the degree of importance and satisfaction. The survey result of satisfaction degree of emergency service quality shows: people think that preferable factors are the identifiable appearance of an ambulance, and staffs with professional certificates in the aspect of EMT, supplement of ambulance equipments and maintenance of emergency vehicles and materials in the aspect emergency outfits, accurate execution of emergency handling in the aspect of emergency procedure, and first-aid accuracy of evaluation and technique in the aspect of first-aid results.Suggestions to the Kinmen Fire Bureau: As for factors that people think highly important and better achievements of fire control organizations, and also the most significant base, the authority concerned should maintain and continue to elevate the base, and keep the investment in the existing resources and quality control. On the other hand, factors that people think trivial are the understanding of free 119 first -aid and neatness of EMT apparel, the authority concerned should reduce the investment in these two items, which helps cut down on relevant expenses. Besides, the worst achievement turns out the review and care of subsequent first-aid evaluation from the fire control organizations, which indicates that improvement is needed in this part, and consideration for the wounded or dependents should be carried out, and review the results so as to improve people’s reactions. |