高山暨偏遠旅遊地區的緊急醫療救護

Emergency Medical Services in Mountain and Remote Recreational Areas

胡勝川(Sheng-Chuan) ； 高偉峰(Wei-Fong Kao)

《慈濟醫學雜誌》 14卷5期 (2002/10) Pp. 301-309

https://doi.org/10.6440/TZUCMJ.200210.0301

摘要

目的：為瞭解高山暨偏遠旅遊地區的緊急醫療救護現況，做為政府未來建立該地區緊急醫療救護制度的參考依據，俾達成實施緊急醫療救護最大的目的－提高到院前死亡的救活率。材料與方法：於89年11月1日至90年10月31日期間，我們選擇合歡山、玉山、太平山、阿里山、墾丁等五個國內有名的旅遊勝地，做為調查的對象。由參與活動時負責醫療救護的醫護人員記錄必要資訊，再由研究助理輸入電腦，然後分析現況並做合理規劃。結果：各地緊急醫療救護現況如下：(1)合歡山：1人暈厥、1人呼吸困難，因急救得法免去後送。一高山腦水腫病人，經醫護人員在現場給予急救，預後良好。該地沒有緊急醫療網的無線電固定分台，119可於40分鐘到達。距離最近的區域醫院車程為80分鐘。只有1個氧氣筒及1個袋瓣面罩和數個紗布繃帶。(2)玉山：今年5月一47歲男性登玉山，回程中跌落山谷身亡。該地沒有緊急醫療網的無線電固定分台，台中榮總曾派醫護人員於週末駐診，但實施沒多久就宣告停止。119反應時間為1.5小時。距離最近的區域醫院車程為2小時。只有若干三角巾繃帶及紗布繃帶。(3)太平山：有宜蘭緊急醫療網的無線電固定分台，功能完好，有一男性護佐於公務員上班時段駐守於醫務室。每個週末都應該有支援醫師做緊急醫療救護，然而經常開天窗，且來此的醫師均不是受過急救訓練的急診醫師。救護技術員(emergency medical technicians, EMT)可於60分鐘內趕到。距離最近的區域醫院車程為2小時。有救護車1輛，其內只有氧氣、毛毯及短背板，另有1個氧氣筒及1個袋瓣面罩和數個紗布繃帶。(4)墾丁：該地有緊急醫療網的無線電固定分台，但功能不好，EMT可於10分鐘至20分鐘內到達。距離最近的區域醫院車程為110分鐘。有1個氧氣筒、固定夾板、彈性繃帶和三角巾繃帶。(5)阿里山：有緊急醫療網的無線電固定分台，且功能良好，園區內有119，可於5分鐘至10分鐘內反應到現場，但並無EMT駐守，距離最近的區域醫院車程為90分鐘。急救設備方面尚稱健全。結論：一、我國高山及偏遠遊樂區的緊急醫療救護能力非常不理想，包括：(1)通訊不理想；(2)急救設備不理想；(3)119反應時間太長(阿里山除外)；(4)遊樂區內沒有醫護人員駐守(阿里山除外)，更遑論受過專業訓練的急救醫護人員；(5)沒有規劃完善的直升機救護場地及制度。二、高山及偏遠遊樂地區均無法提供能救回病人的生命之鏈的四個環－早期進入119系統、早期心肺復甦術、早期電擊、早期高級心臟救命術。三、由太平山及玉山之曾有志願醫護人員支援，但實施沒多久就無以為繼的事實來看，徵求志願工作者上山支援並渡假的方式，無法持久，不是一個最好的方法。

關鍵字

緊急醫療救護 ； 高山症 ； 偏遠旅遊地區

並列摘要

Objective: To explore the current status of emergency medical services (EMS) in high mountain and remote recreatoional areas, and to help the government establish a well organized EMS in these areas, as well as the main goallowering the resuscitative rate of prehospital cardiac deaths. Materials and Methods: this study was conducted from November 1,2000 through October 31, 2001. Five travel sport (Ho-Hwan mountain, Yu mountain, Tai-Ping mountain, Y-Li mountain and Keng-Ting National Park) were selected as study sites. The current EMS status, including EMS needs, function and equipment, was investigated. Results: During the one-year study, the current status of EMS at each study site was as follows: (1) Ho-Hwan mountain: One patient with syncopy and one patient with respiratory difficulties completely recovered after treatment. One patient with cerebral edema had a good prognosis after admission to hospital. No communication network existed. EMS response time averaged 40 minutes. Transportation time to the nearest community hospital averaged 80 minutes. Equipment consisted of only one oxygen tank, one bag-valve-mask and several roller bandages. (2) Yu mountain: No communication network existed. Doctors and nurses from TaiChung Veterans General Hospital had previously served here as volunteers every weekend but were not doing so at the time of this study. The EMS response time averaged 90 minutes. Transportation time to the nearest community hospital averaged 120 minutes. Supplies included only some triangle bandages and roller bandages. (3) Tai-Ping mountain: There was a communication network whick functioned well. A nurse’s aid worked here during office hours. Doctors weresupposed to serve here every weekend, but were often absent. EMS response time averaged 60 minutes. Transportation time to the nearest community hospital averaged 120 minutes. Equipment consisted of only one ambulance with oxygen, a blanket and a short back board, with one oxygen tank, one bag-valve-mask and several roller bandages in the office. (4) Keng-Ding: There was an EMS communication network but it functioned poorly. EMS response time was 10 to 20 minutes. Transportation time to the nearest community hospital averaged 110 minutes. Supplies included only one oxygen tank, splints, elastic bandages and triangle bandages. (5) Y-Li mountain: There was a well functioning communication network. EMS response time was 5 to 10 minutes. Transportation time to the nearest community hospital averaged 90 minutes. Emergency equipment was acceptable. Conclusions: EMS capabilities in mountaion and remote recreational areas in this country are far inferior to that of standard. There is no communication network, and only a few places have emergency 119 phone service. Equipment for rescue and emergency use is not adequate for critically ill or injured patients. Respones time is too slow. No well-organized helicopter rescue planexsists. It is the norm for remote recreational areas to have no qualified health care provider. The “chain of survival”-early access, early cardiopulmonary resuscitation, early defibrillation, and early advanced cardiac life support is not being provided in remote recreational areas. Volunteer doctors and nurses serving in remote recreational areas often quit after a short period of time, so using this method to organize an EMS system in this areas is not satisfactory.

並列關鍵字

Emergency medical services ； high altitude syndrome ； remote recreational area