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Hastane Öncesinde Çalişan Paramediklerin Telefonla Danişman Hekimden Ilaç Onayi Almalarinin Değerlendirilmesi

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Hastane Öncesinde Çalişan Paramediklerin Telefonla Danişman Hekimden Ilaç Onayi Almalarinin Değerlendirilmesi T.C. SELÇUK ÜNİVERSİTESİ SAĞLIK BİLİMLERİ ENSTİTÜSÜ HASTANE ÖNCESİNDE ÇALIŞAN PARAMEDİKLERİN TELEFONLA DANIŞMAN HEKİMDEN İLAÇ ONAYI ALMALARININ DEĞERLENDİRİLMESİ SONGÜL DEMİR YÜKSEK LİSANS TEZİ İLK VE ACİL YARDIM ANABİLİM DALI DANIŞMAN PROF DR AYŞEGÜL BAYIR KONYA-2017 i ÖNSÖZ Türkiye’de Hastane Öncesi Acil Sağlık Hizmetleri’nde görev yapan paramedikler 26.03.2009 Tarih 27181 Sayılı Resmi Gazete’de yayınlanan “Ambulans ve Acil Bakım Teknikerleri ile Acil Tıp Teknisyenleri’nin Çalışma Usul ve Esaslarına Dair Tebliğ'' yazısındaki Hastane Öncesi Acil Tıbbi Yardım ve Bakım Yetişkin ve Pediatrik Uygulama Kılavuzu’ndaki akış şemalarına göre ilaç uygulamaktadırlar. Bu akış şemalarının da bilimdeki değişmeler doğrultusunda değiştirilmesi gerekmektedir. Yüksek lisans eğitimim süresince yoğun iş temposu ve dar zamanlarında zamanını ayırıp bana her türlü desteği veren, bilgi ve tecrübeleri ile her daim yanımda olan danışman hocam Prof. Dr. Ayşegül BAYIR’a sonsuz teşekkürlerimi sunarım. Ayrıca yüksek lisans eğitimim boyunca, bilgi ve deneyimleri ile her daim yanımda olan Prof. Dr. Ahmet AK ve Doç. Dr. Hasan KARA’ya sonsuz teşekkürlerimi sunarım. Çalışmanın uygulanmasında desteklerini esirgemeyen Antalya İl Ambulans Servisi Başhekimi Dr. Yusuf GÜNAY’a, 112 Personel Birim Sorumlusu Paramedik Coşkun GÜMÜŞ’e ve anketi doldurarak destek veren Antalya İl Ambulans Servisi’nde çalışan paramediklere teşekkürlerimi sunarım. Her daim yanımda olan ve desteklerini hiçbir zaman esirgemeyen aileme sonsuz teşekkürler. ii İÇİNDEKİLER Sayfa ONAY SAYFASI ................................................. Hata! Yer işareti tanımlanmamış. ÖNSÖZ ........................................................................................................................ ii İÇİNDEKİLER ........................................................................................................... iii ÇİZELGELER LİSTESİ .............................................................................................. v ŞEKİLLER LİSTESİ ................................................................................................. vii SİMGELER VE KISALTMALAR ............................................................................. ix ÖZET............................................................................................................................ x SUMMARY ............................................................................................................... xii 1. GİRİŞ ...................................................................................................................... 1 1.1. Dünyada Hastane Öncesi Acil Sağlık Hizmetleri ............................................. 3 1.1.1. Güney Afrika ........................................................................................... 4 1.1.2. Almanya .................................................................................................... 5 1.1.3. Yunanistan ................................................................................................ 6 1.1.4. Birleşik Krallık .......................................................................................... 7 1.1.5. Kanada ...................................................................................................... 9 1.1.6. ABD ........................................................................................................ 10 1.1.7. Fransa ...................................................................................................... 11 1.2. Türkiye’de Hastane Öncesi Acil Sağlık Hizmetleri ........................................ 12 1.3. Türkiye’de Paramedik Mesleği ........................................................................ 13 1.3.1. Tıbbi Danışma Kuralları ve Sorumluluklar ............................................ 14 1.3.2. Acil İlaç Kullanımı ve Hekim Desteği .................................................... 15 1.3.3. Paramediklerin Onaysız Kullanabileceği İlaçlar..................................... 17 1.3.4. Paramediklerin Onay İsteyeceği İlaçlar .................................................. 17 1.3.5. Paramediklerin Kullanamayacakları İlaçlar ............................................ 18 1.4. Hastane Öncesi Telekominikasyon .................................................................. 18 2. GEREÇ VE YÖNTEM ........................................................................................ 21 2.1. Araştırmanın Modeli ........................................................................................ 21 2.2. Evren ve Örneklem .......................................................................................... 21 2.3. Veri Toplama Aracı ......................................................................................... 21 2.4. Verilerin Analizi .............................................................................................. 21 iii 3. BULGULAR ......................................................................................................... 22 4. TARTIŞMA .......................................................................................................... 52 5. SONUÇ VE ÖNERİLER ..................................................................................... 63 6. KAYNAKLAR ..................................................................................................... 65 7. EKLER .................................................................................................................. 69 EK-A: Etik Kurul Kararı ......................................................................................... 69 EK-B: İl Sağlık Müdürlüğü İzni ............................................................................. 73 EK-C: Veri Toplama Formu ................................................................................... 74 8. ÖZGEÇMİŞ .......................................................................................................... 79 iv ÇİZELGELER LİSTESİ Sayfa Çizelge 1. Franco-German Modeli ile Anglo-Amerikan Modeli karşılaştırması ...................................................................................... 4 Çizelge 3.1. Paramediklerin cinsiyete göre dağılımı ............................................. 22 Çizelge 3.2. Paramediklerin yaş gruplarına göre dağılımı ..................................... 23 Çizelge 3.3. Paramediklerin eğitim durumuna göre dağılımı ................................ 24 Çizelge 3.4. Paramediklerin görev yılına göre dağılımı ........................................ 25 Çizelge 3.5. Paramediklerin aldıkları eğitimlere göre dağılımı (çoklu) ................. 26 Çizelge 3.6. Paramediklerin danışman hekim sayısının yeterliliğine ilişkin görüşlerinin dağılımı .......................................................................... 27 Çizelge 3.7. Paramediklerin danışman hekimden onay alma durumlarının dağılımı .............................................................................................. 28 Çizelge 3.8. Paramediklerin onay aldıkları ilaç türlerinin dağılımı ....................... 29 Çizelge 3.9. Paramediklerin danışman hekime ulaşma sürelerinin dağılımı ......... 30 Çizelge 3.10. Danışman hekime ulaşma süresinin uzun olma ihtimali durumunda paramediklerin onay alma tutumlarının dağılımı ........... 31 Çizelge 3.11. Hemen ilaç uygulanması gereken durumlarda paramediklerin davranışlarının dağılımı ..................................................................... 32 Çizelge 3.12. Bir nöbet boyunca, danışman hekimden ilaç onayı alınması gereken ortalama vaka sayısının dağılımı .......................................... 33 Çizelge 3.13. Paramediklerin danışman hekimden en çok ilaç onayı aldıkları hasta gruplarının dağılımı .................................................................. 34 Çizelge 3.14. Paramediklerin kırsalda danışman hekime ulaşamadıkları durumdaki davranışlarının dağılımı ................................................... 35 Çizelge 3.15. Danışman hekim ilaç onayı vermediğinde paramediklerin davranışlarının dağılımı ..................................................................... 36 Çizelge 3.16. Danışman hekim ilaç onayı vermediğinde paramediklere alternatif çözüm önerme durumlarının dağılımı ................................ 37 Çizelge 3.17. Danışman hekimden ilaç onayı isteyen paramediklerin onay alma durumlarının dağılımı ................................................................ 38 Çizelge 3.18. Paramediklerin onay alırken hastane mesafesini göz ününde bulundurma durumlarının dağılımı .................................................... 39 v Çizelge 3.19. İlaç onayı ile ilgili sıkıntıların çözülmesinde paramediklerin görüşlerinin dağılımı .......................................................................... 40 Çizelge 3.20. Video kamera sisteminin kullanılmasının telefonla danışmadan daha faydalı olabileceğine ilişkin paramediklerin görüşlerinin dağılımı .......................................................................... 41 Çizelge 3.21. Paramediklerin telefonla danışma sisteminin hasta için etkinliğine ilişkin görüşlerinin dağılımı ............................................. 42 Çizelge 3.22. Paramediklere rütbelendirilme getirilmesine ilişkin görüşlerinin dağılımı .......................................................................... 43 Çizelge 3.23. Paramediklerin ilaç onayı almadan ilaç uygulama istekleri konusundaki görüşlerinin dağılımı .................................................... 44 Çizelge 3.24. Paramediklerin aldıkları 2 yıllık eğitimi yeterli bulma durumlarına
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