1999合歡山雪季高山疾病及緊急醫療救護探討

High Altitude Illness and Emergency Medical Services at Remote Mountain Ho-Huan Resort Area During the 1999 Snow Season

高偉峰(Wei-Fong Kao) ； 郭英調(Ing-Tiau Kuo) ； 郭健中(Chien-Chun Kuo) ； 顏鴻章(David Ht Yen) ； 支伯生(Po-Sheng Chih) ； 張新(Hsing Chang) ； 張元穎(Yuan-Ying Chang) ； 張介明(Chieh-Ming Chang) ； 郭孝齡(Hsiao-Ling Kuo) ； 邱媚珍(May-Jean Chiou) ； 游登良 ； 胡勝川

《中華民國急診醫學會醫誌》 2卷1期 (2000/01) Pp. 34-45

摘要

目的：探討國內合歡山風景區雪季中病患的特質及高山症發生情況，以助於未來緊急醫療規劃。
方法：由1999年一月一日至二月二十八日間的假日，由事前受過高山急症訓練的急診醫師及護理人員，至合歡山區的醫療站為病患服務，以預先設計的病患處置表格（包括高山症診斷及冷急症的診斷及處置特別記錄單），記錄搜集病患基本資料、高山症狀、血氧飽和度及處置情形等。高山症狀使用哈氏急性高山病指數(Hackett's Acute Mountain Sickness Score, HAMSS)計分，以指數總分≧3分，診斷為急性高山病(Acute Mountain Sickness, AMS)；診斷高山腦水腫(High Altitude Cerebral Edema,HACE)，需符合高山病指數≧3，且有走路步態不穩、無法走路或意識不清等神經徵候；診斷高山肺水腫High Altitude Pulmonary Edema,HAPE)，則需高山病指數≧3，且有咳嗽、呼吸加快＞25次／分鐘、肺部聽到囉音、或發紺等徵候。藉由資料蒐集，初步瞭解國內合歡山風景區雪季中病患的病況及緊急醫療救護需求，並同時予以積極治療，以保障遊客及居民的安全。
結果：從醫療人員第一天進駐到最後一天離開，共有病患290人次，有9位病患重複就診，年齡由11個月到76歲，平均為27.2±12.4歲，男性有119人次，佔41%；女性有171人次，佔59%。估計每千名遊客每日約有3.07人次（包括外傷0.30位及非外傷2.77位）。病患中遊客有229人次，佔79.0%；工作人員或家屬34人次，佔11.7%；當地居民24人次，佔8.3%；有3人未記錄身份。病患的診斷以急性高山症或高山相關症狀佔最多，有169人次，佔58.3%；其次是上呼吸道感染有55人次，佔19.0%；暈車有28位佔9.7%；外傷性的擦、裂及挫傷有22位(7.6%)；扭傷或拉傷有6位；腸胃炎有9位，牙痛有6位。高山症中，高山腦水腫有11位，高山肺水腫有16位，急性高山病有59位，高山相關症狀有87位。大多數病患都可在現場，經急診醫師處理而獲得改善，只有一位病患懷疑為高山肺水腫，因無法立即改善，使用救護中轉送，但其在轉送到醫院時，症狀就已改善了。
結論：從這次的初步評估可以發現，國內像合歡山這樣的偏遠風景區，確實有緊急醫療救護的需求，依初步估計傷病發生率與國外的報告相近。在合歡山這樣的高山地區確實有不少高山症病患，甚至也有不少病患已嚴重至高山肺水腫或高山腦水腫。對於有三分之二的土地是山地，超過3,000公尺的高山超過二百座的台灣，應加強高山旅遊時高山症的預防與治療。隨著週休二日的實施，風景區的安全及緊急醫療救護的規劃，將愈加重要，國人在推廣觀光旅遊的同時，應積極發展全方位安全無漏的緊急醫療救護系統，以保障遊客的安全，並提昇我們的國際形象。

關鍵字

高山症 ； 緊急醫療救護 ； 高山風景區

並列摘要

Object: To asses the characteristics of patients in remote mountain resort area and help establish an organized emergency medical services(EMS)
Method: Between January 1 and Feb 28, 1999, we staffed one emergency physician and two nurses in each holiday for the medical care of people seeking help at mountain Ho-Huan resort area. Before the medical services, all the doctors and nurses had been trained including the management of high altitude illness, cold injury, and the emergency medical services available at mountain Ho-Huan resort area. We use a standardized medical abstraction form and another on high altitude illness to extract information including demographic data. Patient identification, time and place of the events, time and problems of patient visiting, high altitude symptoms, vital signs, positive physical findings, diagnoses, treatments, and dispositions. We used the Hackett’s acute mountain sickness score(HAMSS) system to define the diagnosis of acute mountain sickness(AMS) as the HAMSS ≧3. Each chart was recorded by either staffed physician or nurse.
Result: During these services, there were two hundred ninety cases seeking for medical assistance at medical stations or field. Of the two hundred ninety cases, there were one hundred nineteen males and one hundred seventy-one females. Age ranged from eleven months to seventy-six with average of 27.2±12.4 years old. Of the two hundred ninety cases, there were two hundred twenty-nine tourists(79%), thirty-four staffs or their relatives(11. 7%), and twenty-four local residents (8.3%). The medical use rate was estimated about 307 cases/100,000 people/day. The most common illness was high altitude illness which accounted for one hundred sixty-nine cases (53.8%), followed by fifty-five cases(19%) of URI, twenty-eight cases(9.7%) of motion sickness, and twenty-two cases (7. 6%) of abrasion and/or laceration and/or contusion. Of the one hundred sixty-nine cases of high altitude illness, there were eighty-two cases diagnosed to be AMS. There were eleven cases diagnosed to be high altitude cerebral edema (HACE) and sixteen cases to be high altitude cerebral edema (HAPE). Most of the cases can be treated at the medical station or field. Only one case was transferred by ambulance due to respiratory distress and cyanotic appearance. However, he recovered when he arrived at the hospital about two hours later.
Conclusion: By this preliminary data, we found that there is the need of the emergency medical care at the remote mountain Ho-Huan resort area. The medical use rate was similar to a previous report of outdoor activity in USA. There were many AMS cases, and even the HAPE and HACE. Therefore, a well-designated EMS system staffed with personnel familiar with the management of the high altitude illness is mandatory in this remote mountain resort area.

並列關鍵字

high altitude illness ； emergency medical services ； mountain resort