緊急醫療跨區救護派遣原因分析

Abstract

緊急醫療系統的建置成本高昂，如何分配有限的院前救護資源並且有效率的運作系統是此領域中不斷被討論的主題。當社區緊急醫療需求遠高於該區域的緊急救護資源時，便容易發生救護車「跨區」出勤至距離較遠的案件，此即為「跨區派遣」。「跨區派遣」的案件數量越多，可能會導致緊急救護系統運作效率降低。本研究目的在找出在什麼時段、什麼區域、什麼條件下，救護資源相對不足而容易發生「跨區派遣」。若能辨認出這些情境的特定條件，那便能以此調整派遣優先順序，兼顧系統效率和病人自主權。 本研究使用2018年臺北市消防局救護派遣資料進行分析，共有548,934趟去個資化之救護車出勤紀錄，內容包括出勤分隊、案件位址、報案原因、出勤各項時間點紀錄、病患生命徵象等。首先，依照救護紀錄表的案件位址計算案件與關鍵分隊的距離，並訂定「跨區派遣』的定義。接著，採用描述統計以及羅吉斯迴歸分析探討影響「跨區派遣」之變因。 本研究發現跨區派遣佔總案件約十分之一。迴歸分析的結果發現跨區派遣較容易發生在分隊勤務繁重時、一般派遣案件、案件附近醫院壅塞情況較嚴重時、上班尖峰時段、火災一小時內等。 在未來人力配置無法彈性配合救護需求的波動以及救護人力無法同步成長的狀況下，如何辨認出系統超載並且在這些時段將有限的救護資源分配給真正需要的民眾乃是緊急救護係統的下一階段挑戰。

Establishing the emergency medical system is costly, and how to allocate limited pre-hospital resources and use the system most efficiently in various scenarios is a continuously discussed topic in this field. When the demand for emergency medical services far exceeds the available resources in an area, it can lead to the dispatch of ambulances to more distant cases, referred to as "cross-district dispatch." A high frequency of "cross-distric dispatch" can potentially reduce the efficiency of the emergency medical system. This study aims to identify when, where, and under what conditions there is a relative shortage of ambulance resources, leading to a higher likelihood of "cross-district ambulance" dispatch. By pinpointing specific conditions or even predicting the occurrence of such scenarios, ambulance dispatchers and paramedics can adjust their dispatch and rescue principles based on these factors, balancing system efficiency with patient autonomy. This study analyzed 548,934 de-identified ambulance dispatch records from Taipei City Fire Department dispatch between 2015 and 2018. The data included the responding units, case locations, reasons for the call, timestamps for various dispatch stages, and patient vital signs. The distance between the case location and the key subunits was calculated based on the information provided in the dispatch records. If the responding subunit was not among the nearest three, it was marked as a "cross-distric dispatch." After organizing the variables in the database, factors representing case timing, case location, case density, and other relevant variables were selected as explanatory variables. A logistic regression analysis was then employed to identify the factors influencing "cross-distric dispatch." The ultimate findings of this research revealed that "cross-distric dispatch" accounted for 10% of all cases. The regression analysis results indicated that "cross-distric dispatch" was more likely to occur during periods of heavy caseloads and in areas where ambulance resources were already in short supply. Specifically, "cross-distric dispatch" tended to occur more frequently when cases happened on typical weekdays during daytime hours, within one hour of a reported fire incident, in more densely populated subunits, when nearby subunits had a higher volume of severe cases, and in situations where nearby hospitals were experiencing congestion. With the advancement of the emergency medical system, the content of pre-hospital emergency care has become more complex, and the requirements for paramedics'' skills are increasing. In recent years, the demand for emergency medical services has increased. However, increasing the manpower for these services simultaneously in the future is not feasible. In the situation of limited emergency resources, utilizing the findings of this research to identify system overload and allocating the limited emergency resources to those who genuinely need them during these periods will be the next-stage challenge for the emergency medical system.