運用模擬技術於大型醫院災難疏散--以某醫學中心為例

Abstract

在天然或人為的災難中，醫療機構是我們生命安全的最後一道防線，在災難應變中，若因緊急災難使醫院受到嚴重的損害，導致病患必須部分或全部疏散，稱之為災難計畫。而『門診』是醫院內部活動最為頻繁的地方，但隨醫療機構漸趨大型化、複雜化，如何避免因內部通道設置不當、或對人員緊急疏散特性考量不全，致使疏散不及而發生嚴重傷亡變成了一個重要的課題，然而，要進行實地災難演練卻非易事，因其相對耗用資源龐大，電腦模擬技術恰提供了此一優勢： 本研究假設醫學中心面對炸彈威脅時，必須疏散建築內所有人群情況下，建立一般情形下人群流動模型，以瞭解現行疏散路線規劃良窳，進而找出在疏散過程中主要疏散結點，並設計替代方案與現狀模型相比。 本研究共設計四個替代方案 方案一：內科與婦產科人群均由後方逃生出口疏散 方案二：內科人群與婦產科之人群均勻由前後疏散 方案三：內科人群由前方出口疏散，婦產科人群由後方出口疏散 方案四：內科人群由後方出口疏散，婦產科人群由前方出口疏散 本研究獲得幾項結果 1.實際就診區域與區域內就診人數之陪病比為1.47。 2.疏散人數瓶頸約於上午十一點及下午三點，並在十點及兩點後，疏散時間增加幅度會大幅上升。 3.經比較疏散時間、人群滯留時間、於疏散過程中等待時間等變項比較，發現方案二最能有效降低疏散時間，且較不會造成後方出口過大的疏散壓力，惟在採取此方案時應注意老年人之情形，避免其滯留於系統或過程時間的等待。

In a natural or man made disaster, a medical institute is our last line of defense. In preparation for dealing with a disaster, a hospital may be severely damaged due to a disastrous emergency, causing partial or all patients to evacuate; we would call this a “Disaster Plan”. Even though the “Outpatient Department” is the most condensed place in the hospital and as medical institutes are becoming super-sized and more complex, the lack of consideration to the prevention of pathway blockage or evacuation of personnel’s has become a severe problem. It is a critical problem because of the severity of casualties that can be caused by inadequate evacuation. Even though it is a serious problem, carrying out disaster drills is not an easy task; the amount of resources needed for drills are enormous and therefore computer simulation technologies provide us with an advantage: This study hypothesizes that facing a bomb threat, a medical institute must under the circumstances of being able to evacuate all people inside the building(s), create a model of “people moving”. In understanding the pros and cons of evacuation routes, we must further understand and find the evacuation node in the evacuation process and design a substitute proposal to compare with the existing simulation. This study provides four substitute proposals： Proposal 1：Department of Internal Medicine and Obstetrics evacuate from the rear exit. Proposal 2：The Department of Internal Medicine and Obstetrics evacuate from the front and the rear exit. Proposal 3：The Department of Internal Medicine evacuate from the front exit, and the Department of Obstetrics evacuate from the rear exit. Proposal 4：Department of Internal Medicine evacuate from the rear exit, and the Department of Obstetrics evacuate from the front exit. Conclusion 1.The percentage of the patient in area of all people is 1.47. 2.Choke point of evacuation is at 10:00 and 15:00 ,after 10:00 and 14:00 the need for evacuation time begins to rise steadily. 3.In comparing variations in evacuation time, population hold up time and evacuation waiting time, proposal 2 seems to be the method which reduces evacuation time to the lowest without creating a hold up in the rear emergency exit. It is important that in using proposal two, elderly patients must be taken into consideration in keeping hold up time and waiting time to a minimum.