臺灣博碩士論文加值系統

我國近年發生多起重大災害傷亡事故，從2014年高雄丙烯氣爆、2015年新北市八仙樂園粉塵爆燃、2016年台南維冠金龍大樓倒塌以及2017年台北市南港遊覽車翻覆、2018年宜蘭普悠瑪列車出軌事件，這些大量傷病患事故(Mass Casualty Incident,以下稱為 MCI)案例，讓消防體系對於災害現場的應變機制與救援方式進行進一步檢討，而對於後送至醫療機構的急診分流調度亦是現今所面臨的難題。
我國現行大量傷病患事故，依緊急救護法之規定為單一事故、災害發生之傷病患人數達十五人以上，或預判可能達十五人以上者。現場初期指揮官為第一梯次到場轄區消防分隊主管，並同時通知適當層級指揮官到場指揮，初期指揮官視情況將指揮權移轉；初期衛生主管機關未到場前，應先執行初期傷勢評估與傷患後送，待衛生主管機關到場後協助成立臨時救護站(急救站)，進行緊急救護處理。然而，災害現場處於混亂且具有不定的危險性， 初期救災人員如何有效且正確地進行災害判別、應變救援、傷患檢傷分類、指揮系統建立等積極作為，為目前消防人員重要探討的課題。
本研究透過AnyLogic模擬宜蘭普悠瑪列車出軌事故，探討不同傷患人數需要救護車數量，才能達到高品質緊急救護。模擬結果顯示傷患為100人情況下需要25輛救護車，紅標傷患能在設定目標時間離開現場，在傷患300人以下，救護車需求數量與傷患人數呈倍數成長。

In recent year, there were several tremendous disasters, from the propylene gas explosion at Kaohsiung in 2014, the crash of Trans Asia Airways aircraft at Nan Kang in 2015, the dust explosion at Formosa Fun-Coast in 2015, the collapse of Weigrum building at Tainan City in 2016, the turnover accident of tour bus at Taipei City in 2017, and the Puyuma express train derailed in Yilan County. These destructive disasters cause many injuries. Thus it triggers the firefighting system to review the emergency response mechanism and the rescue modes of the Mass Casualty Incident (MCI). Besides, it is also a difficult problem to dispatch the injuries to medical institution.
According to Emergency Medical Care Law, MCI represent the number of patient with a single accident or disaster is more than 15, or those with a pre-judgment of more than 15 persons. The initial commander on the scene is the supervisor of fire brigade, and notifies the appropriate level commander to manage the disaster scene.
The fire department also carries out the injury assessment and evacuation before the health authority arrives, then helps them to establish the first aid station for emergency treatment. However, the disaster site is chaotic and highly dangerous. It is an important topic for firefighters to identify the disaster correctly and effectively, the operation of rescue, patient triage, and the command system organization.
In this study, we simulate the Puyuma express train derailed accident using AnyLogic to explore the impact of different ambulance dispatch number on disaster site, and achieve high quality emergency medical service.

第一章 緒論 1
第一節 研究動機與目的 1
第二節 研究範圍與限制 3
第二章 文獻回顧 5
壹、作業研究模型 5
貳、模擬應用於醫療與災害管理 8
參、緊急醫療救護 9
肆、大量傷病患檢傷分類 12
伍、大量傷患事故救護派遣 18
陸、國內外火車事故災例 19
第三章 宜蘭普悠瑪列車出軌事件 23
壹、災情概述 23
貳、應變處置作為 25
參、災害現場搶救 29
肆、宜蘭衛生局醫療應變 32
第四章 研究方法 33
第一節 AnyLogic軟體模擬 33
第二節 個別深度訪談 39
第三節 個案空間實地調查 40
第五章 訪談與綜整分析 50
壹、訪談目的與對象 50
貳、訪談內容與過程 50
參、訪談結果與分析 52
第六章 電腦模擬分析 63
壹、模型驗證 63
貳、數據結果關鍵績效指標 64
參、傷患人數147人不同救護車數量模擬 65
肆、不同傷患人數救護車數量模擬 68
第七章 結論與建議 76
第一節 結論 76
第二節 建議 78
參考文獻 81

[1]張易鴻(2016)公路長隧道煙控模式與避難策略之分析及大量傷患緊急醫療救護對策之研究–以雪山隧道為例，國立雲林科技大學，博士論文。
[2]蕭力愷(2008)長公路隧道大客車火災大量傷患緊急醫療救護對策之研究–以雪山隧道為例，中央警察大學，碩士論文。
[3]陳政彥(2016)大量傷病患事故應變搶救之研究-以新北市八仙樂園粉塵爆燃為
例，中央警察大學，碩士論文。
[4]戴誌毅(2016)八仙樂園粉塵爆炸大量傷病患機制之精進研究，中華科技大學，碩士論文。
[5]吳青翰(2010)最小化整體死亡人數之大量傷病患事故救護車派遣模式，成功大學，碩士論文。
[6]王忠漢(2001)災區緊急醫療資源之激動配送管理研究，國立雲林科技大學，碩士論文。
[7]內政部統計處(2018)，107年第36週內政統計通報–消防緊急救護。
[8]內政部消防署，緊急救護統計，更新日期108/04/03：https://www.nfa.gov.tw/cht/index.php?code=list&flag=detail&ids=379&article_id=1851&site_id=2
[9]馮丁樹(2010)基本模擬原理，真理大學工業管理與經營資訊學系。
[10] Sullivan, Kendra.(2008), Simulating rural emergency medical services during mass casualty disasters, Department of Industrial and Manufacturing Systems Engineering, College of Engineering.
[11]Rauner, Marion S.,Schaffhauser-Linzatti, Michaela M and Niessner Helmut(2012), Resource planning for ambulance services in mass casualty incidents: a DES-based policy model, Health Care Management Science,15(3),pp. 254-269.
[12]Jia, Hongzhong, Ordóñez Fernando and Dessouky Maged(2007), A modeling framework for facility location of medical services for large-scale emergencies, Institute of Industrial Engineers, 39(1), pp. 41-55.
[13]Wu Ching Han, Hwang, Kevin P.(2009), Using a Discrete-event Simulation to Balance Ambulance Availability and Demand in Static Deployment Systems, Academic Emergency Medicine,16(12), pp.1359-1366.
[14] Dr. János Sztrik, Basic Queueing Theory, p12, 2012.
[15]William Fawcett, Carlos Sousa Oliveira(2000), Casualty Treatment after Earthquake Disasters: Development of a Regional Simulation Model, Disasters, 24(3), pp. 271-287.
[16] MaWen(2015), Research on Methods for Judging the Quantity of City Firefighting Vehicle Marshalling Based on Queueing Theory, 7th International Conference on Intelligent Human-Machine Systems and Cybernetics, pp.162-166.
[17] Petrovic N, Alderson D, Carlson J(2012), Dynamic resource allocation in disaster response: Tradeoffs in wildfire suppression, PLoS ONE, 7(4), e33285.
[18] Li, Jianguo, Li, Cong(2011), Simulation and Analysis of Time-consumption of Emergency Supplies Loading Services based on Queue Theory, pp.135-142.
[19] Yisha Xiang, Jun Zhuang(2014), A medical resource allocation model for serving emergency victims with deteriorating health conditions, Annals of Operations Research, 236(1), pp. 177–196.
[20] Davide Bosco, Ruggiero Lovreglio, Alessio Frassoldati, Marco Derudi, Fabio Borghetti(2018), Queue Formation and Evacuation Modelling in Road Tunnels During Fires, CHEMICAL ENGINEERING TRANSACTIONS, 67, pp. 805-810.
[21] P. Trucco, N. Minato, N. Careri(2013), Resilience of Transport Systems Under Disaster : Simulation-based Analysis of 2011 Tsunami in Japan, 2013 IEEE International Conference on Industrial Engineering and Engineering Management, Thailand.
[22] L. Aboueljinane, E. Sahin, and Z. Jemai.(2013), A review on simulation models applied to emergency medical service operations. Computers & Industrial Engineering, 66(4):734–750.
[23] Gunes, E., & Szechtman, R. (2005). A simulation model of a helicopter ambulance service. In M. E. Kuhl, N. M. Steiger, F. B. Armstrong, & J. A. Joines (Eds.), Proceedings of the 2005 winter simulation conference, pp. 951–957.
[24] Inakawa, K., Furuta, T., & Suzuki, A.(2010), Effect of ambulance station locations and number of ambulances to the quality of the emergency service. In The 9th international symposium on operations research and its applications (ISORA’10) (pp. 340–347). Chengdu-Jiuzhaigou, China
[25] Alexander Komashie and Ali Mousavi(2005), Modeling emergency departments using discrete event simulation techniques, Proceedings of the 2005 Winter Simulation Conference.
[26] Levi, Lion, Bregman, David, Geva, Hana and Revach, Moshe (2017), Hospital disaster management simulation system, pp. 1-6.
[27] Galindo, G., Batta, R.(2013), Review of Recent Developments in OR/MS Research in Disaster Operations Management, European Journal of Operational Research, 230(2), pp. 201-211.
[28] N. Wagner, V. Agrawal(2014), An agent-based simulation system for concert venue crowd evacuation modeling in the presence of a fire disaster, Expert Systems with Applications, 41(6), pp. 2807-2815.
[29] K. Uno, K. Kashiyama(2008), Development of Simulation System for the Disaster Evacuation Based on Multi-Agent Model Using GIS, Tsinghua Science and Technology, 13(1), pp. 348-353.
[30] C. Fikar, M. Gronalt, P. Hirsch(2016), A decision support system for coordinated disaster relief distribution, Expert Systems with Applications, pp. 104-116.
[31] C. Fikar, P. Hirsch, P. Nolz(2018), Agent-based simulation optimization for dynamic disaster relief distribution, Central European Journal of Operations Research, 26(1), pp. 423-442.
[32] Tseng, Wei Wen, Shen, Tzu Sheng, Hsieh, Pin Ping(2018), Theory Establishment and Data Preparedness for Modeling Emergency Medical Service in case of a Mass Casualty Incidents in Road Tunnels, Procedia Engineering, vol.211, pp 36-45.
[33]行政院衛生署(2010)區域緊急醫療應變中心標準作業流程。
[34]石富元(2003)大量傷患及災難事件—緊急醫療現場控制，台北縣消防局。
[35]林志豪(2008)災難醫學與緊急救護，出國考察報告。
[36] Sacco, William J., Navin, D. Michael, Fiedler, Katherine E., Waddell, Robert K., Long, William B., Buckman, Robert F.,(2005), Academic Emergency Medicine, 12(8), pp. 759-770.
[37]Q. Gong, R. Batta(2007), Allocation and reallocation of ambulances to casualty clusters in a disaster relief operation, Institute of Industrial Engineers, 39(1), pp.27-39.
[38]皮托科技股份有限公司網頁：http://www.pitotech.com.tw/contents/zh-tw/p13518_%E7%82%BA%E4%BB%80%E9%BA%BC%E9%81%B8%E6%93%87%E5%A4%9A%E6%96%B9%E5%BB%BA%E6%A8%A1.html
[39]內政部消防署全球資訊網，更新日期108/02/22：https://www.nfa.gov.tw/cht/index.php?code=list&flag=detail&ids=815&article_id=4037
[40]宜蘭縣政府衛生局網頁，宜蘭縣救護車分布統計表，發布日期2019/03/25：https://www.nfa.gov.tw/cht/index.php?code=list&flag=detail&ids=815&article_id=4037
[41]Z. Xu, J. Yang, C. Peng, Y. Wu, X. Jiang, R. Li(2014), Development of an UAS for post-earthquake disaster surveying and its application in Ms7 . 0 Lushan Earthquake , Sichuan , China, Computers and Geosciences, 68, pp.22-30.
[42]M. Erdelj, M. Kr, E. Natalizio(2017), Wireless Sensor Networks and Multi-UAV Systems for Natural Disaster Management, Computer Networks.
[43]王天佑、蕭振洋(2013)，應用無人載具航拍及非常規攝影量測進行土石流三維地形重構，財團法人中興工程顧問社，第120期，pp.3-12。