臺灣消防緊急救護制度之政經分析

臺灣緊急救護制度發展，自1968年起概略可分成五個階段：系統前期、先驅期、示範期、成熟期及穩定期。在系統前期，緊急醫療救護服務量極有限，政府部門並未大幅介入；在先驅期，政府頒布救護車管理辦法，並把加強緊急醫療救護納入籌建醫療網計畫；進入示範期，政府制定緊急醫療救護法並全面推行區域醫療網計畫；最後進入成熟期及穩定期，政府對緊急醫療救護經費支出持續增加，其服務的質與量均受社會要求而大幅提昇。緊急醫療救護法之制定與推動，促成1995年8月11日修正公布消防法增訂緊急救護為現代消防三大任務之一，消防工作從原有火災預防、災害搶救，正式跨足緊急救護領域。而消防人員執行緊急救護工作，除依消防法第二十四條規定：「直轄市、縣（市）消防機關應依實際需要普遍設置救護隊；救護隊應配置救護車輛及救護人員，負責緊急救護業務…」外，另有關緊急救護勤務執行方式、救護技術員教育訓練及救護業務等主要規範，皆規定於緊急醫療救護法。消防單位因承接緊急救護工作而從警察機關分立升格為消防署，但其位階仍在中央衛生主管機關之下，且消防隊執行緊急救護工作主要依循之緊急醫療救護法也由衛生主管機關頒定、修法或函釋。長期以來執行面與法規面存在諸多爭議，但就相關專家學者研究及民眾對消防人員之期待，到院前緊急救護工作仍由消防人員執行最佳。因時代政經環境變遷影響，消防隊從被動接受緊急救護工作為法定職掌，再從技術外行變成專業人員，更因此獲得民眾高度滿意與高度期待。本文建議另外制定消防機關到院前緊急救護專法，由消防隊全權處理、全面負責，以達政府服務民眾、救護品質全面提升之理想目標。

關鍵字

緊急救護制度；區域醫療網計畫；救護隊；救護車輛；救護技術員

並列摘要

The development of the emergency medical system in Taiwan has been roughly divided into five phases since 1968: the early phase of the system, the forerunner phase, the demonstration phase, the maturity phase and the stabilization phase. In the early phase of the system, the amount of emergency medical services was extremely limited, and government agencies did not substantially intervene; in the forerunner phase, the government issued the ambulance management measures and included the strengthening of emergency medical services into the medical network plan; entering the demonstration phase, the government formulated the Emergency Medical Care Law and comprehensively implemented the regional medical network plan; Lastly entering the maturity and stabilization stage, the expenditure of government on emergency medical service continues to increase, and the quality and quantity of its services are significantly improved due to public demand. The formulation and promotion of the Emergency Medical Care Law expedited the amendment and promulgation of the Fire Protection Law on August 11, 1995, emergency medical service was added to one of the three major duties of the modern fire protection. The fire protection work has officially entered the field of emergency medical services added on the initial fire prevention and disaster rescue. Yet firefighters carry out emergency medical services, according to the Fire Protection Law, article 24 : "Fire departments shall broadly set up emergency response teams base on actual needs in the municipality, county (city) ; the emergency response teams shall be equipped with ambulance vehicles and emergency medical technicians to be responsible for the assignments of emergency medical service..." In addition, the main regulations concerning the administration of emergency medical services, education and training of emergency medical technicians, as well as medical services assignments are all stipulated in the Emergency Medical Care Law. The fire departments were upgraded and divided from the national police agency to its own national fire agency due to the emergency medical services assignments, but its rank is still under the central health authority, thus the Emergency Medical Care Law that the fire brigade mainly follows in carrying out emergency medical services is also issued by the health authority, together with the amendment or interpretations. In spite of many controversies from the viewpoint of administrations and regulations for a long time, pre-hospital emergency care is still best carried out by firefighters in the opinion of the relevant research from experts along with the expectations from the public. Due to the changes in the political and economic circumstances over the times, the fire brigade has changed from passively accepting the assignments of emergency medical service to its official duties, and subsequently from a technical amateur to a professional; As a result, it has gained high satisfaction and high expectations from the public. This thesis proposes an additional formulation of a special law as regards pre-hospital emergency care under the fire agency, enabling the fire brigade to possess full authority and responsibility, ultimately to achieve the ideal goal of improving the overall quality of the emergency medical services provided by the government to the public.