醫院緊急應變指揮系統探討-以北市收治SARS病患醫院為例

A Study on Emergency Incident Command System : In-depth Study on the SARS management in Taipei City

黃紀諺(Chi-Yen Huang)

指導教授 ： 蘇喜

共同指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.02285

摘要

醫院是提供病患治療的場所，災難發生時必須屹立不搖，才能提供病患必要與穩定的醫療服務。有鑑於此，台北市政府於2002年要求緊急應變責任醫院發展「醫院緊急應變指揮系統」，希望加強醫院應對災難的能力。雖然有學者對於「醫院緊急應變指揮系統」實施之缺失處加以研究、建議，但是卻少有研究涉及目前各家醫院建置系統的現況、醫院內部推行困難的因素。本研究目的係藉由2003年嚴重急性呼吸道症候群之應變過程，呈現北市收治SARS病患醫院其緊急應變指揮系統之建構及推行現況，及其實際運作困難之處，並描繪適於台灣本土「醫院緊急應變指揮系統」之架構。
運用質性方法進行研究之後，共收案12家醫院，再運用「應變計畫查核表」與SARS大事記交叉比對，所得研究結果如下：
1.醫院緊急應變指揮系統建置情況：醫院緊急應變指揮系統經由衛生局要求下才加以建置，其任務組織架構與美國醫院緊急應變指揮系統相似，經由演習發現的問題有：指揮官權限不明（100％）、社工人員功能不彰（100％）、醫事人力不足（67％）、紙上談兵的謬誤（58％）、後勤部門參與意願不高（50％）。
2. SARS流行期間醫院實際應變措施：成立緊急應變中心，並發現緊急應變指揮系統中，運作上有問題的小組有：財務組（100％）、後勤組（58％）計畫組（58％）、資訊官（25％），而應變中心運作是否成功，與管理方式以及應對災難之技巧有關。
3.後SARS時期之反省：國家政策、醫院內部、以及社區民眾之間的互相配合，才能使醫院緊急應變指揮系統發揮作用。

關鍵字

嚴重急性呼吸道症候群 ； 醫院緊急應變指揮系統 ； 台北市緊急應變責任醫院

並列摘要

Treatments and medical interventions are provided in the hospital. When disasters occurred, hospitals need to remain operational in order to provide first line medical aids and interventions. In order to strengthen the ability responding to disaster, Taipei City Government has requested those emergency response hospitals implementing “Hospital Emergency Incident Command System (HEICS)”. There are some researchers pointing out the shortages of HEICS, however, there are few studies concerning about current situation of these HEICS hospitals and the difficulties to set up HEICS.
The purpose of this study is to utilize the responding process of SARS in the year of 2003, to demonstrate how the HEICS functions in Taipei city： the settings, the current situations and the difficulties when HEICS operates. This study is also trying to establish a framework of HEICS, which will better suitable in the circumstances of Taiwan.
Qualitative research method was implied and 12 sample hospitals were investigated in this study. “Response plan check list” and “ SARS record” are taken for triangulation, conclusions are as follows:
1. Setting situation of HEICS: The order from Taipei City Government is needed to set up HEICS. The functional structure of Taipei HEICS is similar to American HEICS. Through drill exercise, problems were found as following: the authority of commander is not clear (100%)，social workers are malfunctioning(100%)、medical manpower is insufficient (67%)、plan is misuse(58%)、logistics department did not fully support(50%).
2. Hospital measurements during SARS endemics：To establish the emergency incident centers. There are problems in the following functional teams：finance (100%)、logistics(58%)、planning(58%)、information(25%).The management skill is the key to operate a successful emergency incident center.
3. Self-examination in the post SARS period：well cooperation among national policies, hospital administrations and the public can make HEICS most effective !!

並列關鍵字

emergency response hospitals in Taipei ； Hospital Emergency Incident Command System ； severe acute respiratory syndrome

參考文獻

王立敏（2002）

參考文獻

中文部分