臺灣博碩士論文加值系統

臺灣於1995年公布實施「緊急醫療救護法」，涵蓋到院前的緊急救護及到院後的緊急醫療照護，需消防、衛生及醫療單位三者間緊密的合作。到院前的消防緊急救護隸屬內政部消防署；而醫療與衛生單位則由衛生福利部管轄負責到院後的緊急醫療照護，兩機構互不隸屬，無法發揮到院前與到院後緊密合作的功能，因此，2005年修訂「緊急醫療救護法」，於全台建置6個區域緊急醫療應變中心（EOC），由EOC扮演緊急醫療救護體系跨消防、衛生及醫療單位三者間的整合協調與通報角色，及辦理該法第9條明定八項業務。
2009年8月8日莫拉克颱風肆虐台灣南部，造成高雄甲仙、寶來山區眾多民眾受困，於8月11日搶救之大量傷患未能分流送醫，導致高雄旗山醫院癱瘓。本研究發現上述事件EOC無法發揮即時掌握醫療單位緊急醫療照護資訊功能分流送醫問題，提出改善建議，並針對EOC法定業務及跨單位間的整合協調與通報機制可能需改進的問題，提出建議。
本研究分為兩個部分。第一部分是臺灣區域緊急應變中心三年的性能研究。這是採用整合性評價去分析評估6個區域緊急應變中心過去三年的執行性能外，並針對區域緊急應變中心與地方衛生、消防及醫療機構間的橫向整合，建構一套適當的協調運作與通報模式框架。第二部分是以災害管理角度看臺灣醫療應變中心在大量傷患事件的運作。使用不同災害管理的階段建立問題項目去設計一份調查問卷，並從調查結果以統計方法分析緊急應變中心在處理大量傷患運作過程中遇到的問題。這兩個部分的簡要說明如下:
第一部分評估6個區域緊急應變中心從2005到2007年的性能，及綜合評估與探討目前緊急應變中心與地方衛生、消防及醫療機構間的協調運作與通報模式。研究發現緊急應變中心與上述三個機構建立一個緊密的協調運作與通報模式關係，關鍵因素在提供即時的資訊傳遞和查詢服務。未來應該建立一個共同的災害資訊和醫療資源交換平台，此外，緊急應變中心必須賦予法規權力和責任來執行他們的服務。
在第二部分中，問卷準備是根據臺灣緊急醫療救護法賦予緊急應變中心法定任務來設計，問卷每個問題是依據不同災害管理階段來分類，以瞭解緊急應變中心在法定任務內處理大量傷患運作時，與衛生、消防及醫療機構協調運作所遇到的問題。首先是由緊急應變中心人員進行自我評估調查，其次再由外部專家評估。調查結果用統計方法（獨立兩樣本t檢定）進行分析。結果發現緊急應變中心缺乏權力干預或協調上述三個機構。同時，應該把重點放在復原階段以改善未來的預防和應變機制。為改善大量傷患事件的應變，修訂緊急醫療救護法讓緊急應變中心成為執行機關和發揮復原階段回饋功能去改善未來的運作。

Taiwan’s Emergency Medical Care Law (EMCL) was promulgated and implemented in 1995, covering both pre-hospital and post-hospital emergency care, needing close cooperation with fire, health and medical agencies. Close cooperation could not be executed then because pre-hospital and post-hospital emergency care belonged to different administrations, the former being National Fire Agency under the Ministry of the Interior and the latter being Ministry of Health and Welfare. In 2005, six regional Emergency Operating Centers (EOC) were set up to address the above issue, playing the role of integration, coordination and notification between the above three agencies and executing the eight mandates entrusted by the EMCL Article 9 in the Emergency Medical Service System (EMSS).
On August 8, 2009, Typhoon Morakot wreaked havoc to southern Taiwan which left numerous civilians stranded in the mountain areas of Chiahsien and Bora district. During a rescue attempt on August 11, Cishan Hospital was paralyzed because of failure to diverge mass casualties. This research discovered that EOC could not effectively secure real-time regional emergency medical information and resource status, which was the reason why EOC inefficiently diverged mass casualties. Besides understanding and providing recommendations for improvement on why EOC could not effectively secure real-time regional emergency medical information and resource status, this research also addressed the problems EOC encountered when executing the mandates and during cross-agency integration, coordination and notification.
This research was divided into two parts. The first part was “A research on the three-year performance of the regional EOCs in Taiwan”, which was a comprehensive evaluation adopted to analyze the performance evaluation of six regional EOCs over a three-year basis and propose an appropriate coordinated operation and notification model framework between regional EOCs and local health, fire, and medical agencies. The second part was “Operation of EOCs during MCIs: a disaster management perspective”. A survey questionnaire was designed and created with problem items using the different disaster management phases. Results from the survey then used statistical methods to analyze the issues EOCs encountered during MCIs. Brief illustrations of these two parts were as followed:
The first part assessed the performance of six regional EOCs from 2005 to 2007 and the current coordinated operation and notification mode between EOCs and local health, fire, and medical agencies by comprehensive evaluation and exploration. The research discovered that establishing a framework for closer coordinated operation and notification modes for the EOCs with above three agencies was a key factor to provide real-time information delivery and query services; hence a common disaster information and medical resource exchange platform should be established in the future. In addition, EOCs must be given a regulatory power and responsibility to execute their services, which would allow them to play an active role rather than a passive role during MCIs.
In the second part, the questionnaire was prepared according to the legislative mandates of the EOCs entrusted by Taiwan’s EMCL. Each question in the questionnaire was categorized according to different disaster management phases to understand the problems EOCs encountered during integration between local health, fire, and medical agencies in MCIs. First was the self-assessment survey conducted by EOC personnel, and secondly were the assessments by external experts. The results from the survey were analyzed with statistics methods (independent two-sample t-test). Findings showed that EOCs lacked authority to intervene or coordinate with above three agencies. Emphasis should be placed on the recovery phase to improve future prevention and response mechanisms. Completion of the EMCL amendment is also needed to allow EOCs to act as the official execution agency and use feedback from the recovery phase to improve future operation during MCIs.

Chinese Abstract ------------------------------------------------i
English Abstract ------------------------------------------------ii
Acknowledgements ------------------------------------------------iv
Contents --------------------------------------------------------v
List of Tables --------------------------------------------------------vii
List of Figures --------------------------------------------------------viii
Chapter 1 Introduction--------------------------------------------1
1.1 Literature review and research background-----------------------1
1.2 Research motivation---------------------------------------------3
1.3 Research purpose -----------------------------------------------3
Chapter 2 Methodology---------------------------------------------4
2.1 Step1: identify problems. Interviews on the regional EOCs, health, fire and medical agencies in the EMSS -4
2.2 Step 2: questionnaire design. Statistical method（t test）on questionnaire survey of the operation of EOCs during MCIs-8
Chapter 3 A Research on The Three-Year Performance of The Regional EOCs in Taiwan -11
3.1 Introduction ---------------------------------------------------11
3.2 Methods---------------------------------------------------------14
3.2.1 Performance evaluation of the regional EOCs from 2005 to 2007-14
3.2.2 Review and exploration of the current coordinated operation and notification mode between regional EOCs with the health, fire and medical agencies -19
3.3 Results and discussion-----------------------------------------26
3.3.1 Performance of the regional EOCs from 2005 to 2007---- 26
3.3.2 Proposed of the coordinated operation and notification mode framework between regional EOCs with the health, fire and medical agencies ---39
3.4 Conclusions ----------------------------------------------------45
Chapter 4 Operation of EOCs during MCIs in Taiwan: A Disaster Management Perspective ---46
4.1 Introduction ---------------------------------------------------46
4.2 Methods---------------------------------------------------------48
4.2.1 Benchmark index survey of legislative mandates----------- 48
4.2.2 Survey of disaster management phases----------------------- 52
4.3 Results and discussion------------------------------------------ 53
4.3.1 Exploration of benchmark index survey of legislative mandates---53
4.3.2 Level of competence in disaster management phases------ 58
4.4 Conclusions ----------------------------------------------------60
Chapter 5 Conclusions and Recommendations-------------------------62
5.1 Conclusions-----------------------------------------------------62
5.2 Recommendations----------------------------------------------- 63
References --------------------------------------------------------65

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