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醫院對核生化恐怖攻擊傷患處置準備度調查

Hospital Preparedness for Nuclear, Biological, and Chemical Casualties from Terrorism Attacks

摘要


縱使恐怖主義從未自歷史上消失,並非每一個人都能正視這種真實的威脅,並且做好率備。當遭遇恐怖份子使用核生化武器攻擊時,您將會發現我們是多麼地脆弱。如果救命的醫院未事先準備妥當,下場將是悲慘不堪。我們於是研究本國醫院,看看是否對於核生化恐怖攻擊傷患的處置已然率備妥當。 針對醫院準備的三個象限,我們製造出問卷:(1)硬體:醫院的建築、相關的儀器設備與耗材;(2)韌體:災難應變計畫及人員訓練;(3)軟體:醫師的認知與知識。全臺共挑選了19家醫院,有關硬體與韌體部分的問卷先寄出請該院的行政主管填寫,再由受過訓的訪問員依約前往協助完成。有關軟體部分的問卷,直接由該院的醫師回答。資料收集齊全後,再加以分析討論。 受訪的19家醫院,12家的急診有獨立的出、入口,14家有特定的除污區,13家在急診有負壓隔離室。當急診擠爆或是遭受污染不得不關閉時,這些醫院都有備用地區可以繼續急診服務。這些醫院都很忙碌,因此不論是急診或是住院的擴充能量都十分有限,唯有暫停門診服務才能獲得改善。在個人保護裝備上,除了基本的全方位防衛所需的器材,14家可達到美國職安局(Occupational Safety & Health Administration, OSHA)B級防護、一家甚至有A級防護衣。這些醫院大多有足夠的藥品庫存,以治療細菌或神經戰劑所造成的第一波傷病患,然而一但呼吸衰竭的患者湧入,僅有7家能在一小時內增調到超過12台呼吸器。這些醫院均提供了相關的教育訓練,然而接受訓練的人員還是以急診與加護病房為主。對於核生化恐怖攻擊造成傷病患的診斷與治療,大部分醫師的知識與經驗都相當有限。 雖然我們的安全感已在2001年9月11日起美國遭遇一連串的恐怖攻擊後支離破碎,對於核生化傷患的處置,我們的醫院仍未準備妥當。除了繼續加強所需的設備與器材,補充相關知識與技能的訓練課程與演習絕不可忽略,而且必須是涵蓋全院所有的人員。

並列摘要


Introduction: Although terrorism never dies in history, not every one thinks it as a real threatening and has been well prepared. We are fragile to terrorist attacks with nuclear, biological and chemical (NBC) agents. Miserable outcomes will be resulted if hospitals are not well prepared. We investigated the hospital preparedness for casualties from NBC terrorism in this study. Material & Method: Questionnaires were made to assess the preparedness in three dimensions of (1) hardware: hospital architectural structure, related devices and consuming parts; (2) firmware: response plans and training, and (3) software: awareness and knowledge of physicians. Nineteen major hospitals in Taiwan were chosen. Questions about the hardware and the firmware were responded by the administrative representatives and were confirmed by the pre-trained investigator. Questions about the software were responded by physicians. Collected results were analyzed and discussed. Result: 12/19 Emergency Department (ED) had separated entry and exit, 14/19 had specified decontamination area, 13/19 had negative-pressure rooms in ED. All hospitals had alternative sites for emergency services once the ED is contaminated or overwhelming. All hospitals were quite busy with limited surge capacities for emergency services and hospital admission. It could be improved when the outpatient service is shut down. In personal protective equipments beyond the universal precautions, 14 were equipped to Occupational Safety & Health Administration (OSHA) level B and one to level A. Most of these hospitals had enough medications for the first-wave casualties from bacterial agents and nerve agents; however, only 7/19 hospitals could get 12 more ventilators within 1 hour. Related education programs were provided in all hospitals; however, ED and ICU staffs remained the majority of trainee. Most of the physicians had limited knowledge and experience in diagnosis and treatment of NBC related casualties. Discussion: Although the sense of security has been shattered by multiple terrorist attacks since September 11, 2001 in the United States, our hospitals have not well prepared for NBC casualties. Besides the necessary equipments and supplies, continuing learning educational programs and exercises providing knowledge and skills for NBC incidents are critical and should be reinforced without delay to every staff of the hospital.

被引用紀錄


蔡文煥(2014)。論生化恐怖攻擊之研究〔碩士論文,國立中正大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0033-2110201613585600

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