不確定行旅的確定守護： 白沙屯媽祖進香ESG智慧醫療隨扈系統之個案研究

Abstract

白沙屯媽祖進香為臺灣最具代表性之大型流動型徒步宗教活動，報名人數逾46萬人次（2026年），全程逾400公里，以路線絕對不確定性為核心儀式特徵。本研究以深度訪談揭露之六大結構性困境為問題意識—缺乏歷史疾病資料、傷患定位困難、指揮體系分散、機車怠速高耗能、生命體徵資訊孤島，以及現場高階急救人力缺口—採質性個案研究法，以ESG（環境、社會、治理）永續治理框架為分析視角，設計並實際執行「五層次動態智慧醫療隨扈系統(5-Tier Smart EMS Architecture)」。 本系統由外而內涵蓋：第0層雲端前進指揮決策中樞（電動行動指揮車、雙螢幕戰情平台）、第1層App一鍵求救GPS定位功能、第2層機車快速反應巡邏隊（EMT搭載IoT生命體徵監護儀）、第3層電動三輪車高階急救團隊（配置NP專科護理師，具備ACLS能力），以及第4層救護車後送與醫院銜接。車隊全面採用電動載具，採用電動三輪車及電動行動指揮車，實現隨扈車隊化石燃料零排放設計。 民國115年（2026年）白沙屯媽祖進香，為本系統首次正式場域驗證。指揮中心共受理162件醫療案件，涵蓋熱傷害(17.3%)、跌倒(13.0%)、交通事故(13.0%)及院外心跳停止(OHCA)2件等多元傷病類型。在定位與派遣成效方面，61件(37.7%)案件成功運用GPS座標完成定位派遣，受理至出動平均僅0.9分鐘、至到達現場平均7.1分鐘，行動指揮車派遣員評估減少無線電詢問效益達4.25分（滿分5分）。在臨床救護成效方面，70件(43.2%)完成實際送醫；NP首度納入機巡編組，94.4%人員評價正面，臨床處置心理安全感達4.83分；電動三輪車完成首次場域驗證。在人員感受方面，系統助益性評分4.48分、整體效率4.56分，77.8%人員表示顯著減輕執勤焦慮感。 在環境維度，全電動化車隊相較傳統燃油五車配置，實現化石燃料直接碳排放歸零，節省510.63公斤CO₂，減碳幅度達100%，並揭示傳統隨扈模式中怠速供電碳排(275.73 kg)高於行駛碳排(234.90 kg)之結構性問題。在社會投資報酬率(SROI)方面，以衛生福利部補助與社會募款合計145.62萬元現金投入（企業贊助另計180.50萬元），總社會效益基準估算達1,325.65萬元，SROI現金投入觀點為9.10、全部資源觀點為4.06，即便在最保守情境下亦維持正向社會效益。 本研究的核心貢獻在於三個層次：概念層次上，首次系統性將ESG框架延伸應用至大型流動型宗教活動醫療治理，填補理論研究缺口；方法層次上，以162件實際執行案件取代慣常「預期成效」論述，建立白沙屯進香史上第一套結構化歷史醫療資料集；實踐層次上，提供整合多元資金動員（政府補助槓桿企業ESG投入）、技術整合與資料治理架構的可複製制度性創新模板。研究亦揭露電動三輪車機動性限制、行動網路覆蓋不穩定、系統整合度尚有提升空間等待改善之處，並提出建立大型宗教活動醫療隨扈制度性標準、推動政府補助機制擴大企業ESG協作、建立跨縣市醫療資料整合機制及推動電動醫療載具採購補助等政策建議，以期此一創新模式能推廣至臺灣其他大型移動型文化宗教活動，形成兼具文化保存、醫療安全與永續治理的整合性解決方案。

The Baishatun Mazu Pilgrimage is Taiwan's most representative large-scale, mobile, and pedestrian religious event, with over 460,000 registered participants in 2026 and a total route exceeding 400 kilometers. Its defining ritual characteristic is the absolute unpredictability of the procession route. Drawing upon six structural challenges identified through in-depth interviews — the absence of historical medical records, difficulty locating injured pilgrims, a fragmented command structure, high fuel consumption from idling motorcycles, isolated vital-sign data, and a shortage of advanced life support personnel on-site — this study applies a qualitative case study methodology and the ESG (Environmental, Social, Governance) sustainability framework to design and field-deploy a 5-Tier Smart Emergency Medical Escort System (5-Tier Smart EMS Architecture). The system comprises five tiers from innermost to outermost: Tier 0, a cloud-based forward command center (electric mobile command vehicle with dual-screen situational display); Tier 1, an in-app one-tap SOS GPS positioning function; Tier 2, a motorcycle rapid response patrol (EMTs equipped with IoT vital-sign monitors); Tier 3, an electric tricycle advanced medical team (staffed by nurse practitioners with ACLS capability); and Tier 4, ambulance evacuation and hospital handover. The entire escort fleet is fully electrified — electric tricycles replace 250cc gasoline motorcycles, and an electric command vehicle (Volkswagen ID.BUZZ) replaces the traditional fuel-powered van — achieving a zero fossil-fuel direct-emission design. The 2026 Baishatun Mazu Pilgrimage served as the system's first official field validation. The command center received 162 medical cases, encompassing heat-related illness (17.3%), falls (13.0%), traffic accidents (13.0%), and two out-of-hospital cardiac arrests (OHCA), among other injury and illness types. In terms of positioning and dispatch performance, 61 cases (37.7%) were successfully located and dispatched using GPS coordinates; average time from call receipt to unit mobilization was 0.9 minutes, and average time to on-scene arrival was 7.1 minutes; dispatch personnel rated the reduction in radio position queries at 4.25 out of 5. In clinical outcomes, 70 cases (43.2%) resulted in actual hospital transport; nurse practitioners were integrated into motorcycle patrol units for the first time, with 94.4% of personnel reporting positive collaboration outcomes and a clinical safety score of 4.83 out of 5; the electric tricycle units completed their first field validation. In personnel experience, system helpfulness was rated 4.48 out of 5 and overall dispatch efficiency 4.56 out of 5, with 77.8% of personnel reporting a significant reduction in on-duty anxiety. On the environmental dimension, the fully electrified fleet eliminated all direct fossil-fuel carbon emissions compared to the traditional five-vehicle gasoline configuration, saving 510.63 kg of CO₂ — a 100% reduction — while revealing a structural finding: idling emissions (275.73 kg) in the traditional escort model exceeded driving emissions (234.90 kg), a source of carbon output typically overlooked in standard audits. On Social Return on Investment (SROI), with NT$1,456,180 in cash inputs (government grants and public fundraising) and NT$1,805,000 in in-kind corporate sponsorship, the baseline total social benefit was estimated at NT$13,256,500, yielding an SROI of 9.10 under the cash-input perspective and 4.06 under the total-resources perspective, both maintaining positive social returns even under the most conservative scenario. The study's core contributions span three levels. At the conceptual level, it represents the first systematic application of the ESG framework to medical governance of large-scale mobile religious events, addressing a gap in the literature. At the methodological level, it replaces the conventional "projected outcomes" discourse with 162 empirically documented cases, establishing the first structured historical medical dataset in the history of the Baishatun pilgrimage. At the practical level, it provides a replicable institutional innovation template integrating diversified funding mobilization (government subsidies leveraging corporate ESG investment), technology integration, and data governance architecture. The study also identifies areas for improvement — including limited maneuverability of electric tricycles in dense crowds, unstable mobile network coverage in rural segments, and incomplete system integration — and offers four policy recommendations: establishing institutional medical escort standards for large religious events, expanding government subsidy mechanisms to catalyze corporate ESG partnerships, creating cross-county medical data integration mechanisms, and implementing procurement subsidies for electric medical vehicles. The goal is to extend this model to other large-scale mobile cultural and religious events in Taiwan, forming an integrated solution that balances cultural preservation, medical safety, and sustainable governance.