| Summary: | 博士 === 國立雲林科技大學 === 工程科技研究所 === 103 === 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.
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